Number Of Primary Care Physicians Research Articles

US Primary Care WorkforceGrowth: A Decade of Limited Progress, and Projected Needs Through 2040.

Despite efforts to mitigate a projected primary care physician (PCP) shortage required to meet an aging, growing, and increasingly insured population, shortages remain, compounded by the COVID-19 pandemic, growing inequity, and persistent underinvestment. We examined primary care workforce trends over the past decade and revisited projected primary care clinician workforce needs through the year 2040. Using data from the AMA Masterfile and Medical Expenditure Panel Survey (MEPS), we analyzed trends in the number of primary care physicians (PCPs) and in outpatient PCP visits by age and gender over the past decade. We then used the Medicare PECOS and Physician & Other Practitioners datasets to identify nurse practitioners (NPs) and physician assistants (PAs) in primary care. Using these baseline clinician enumerations and projected population growth estimates from the US Census Bureau for the years 2020-2040, we calculated estimated primary care workforce needs by 2040. The effects of aging and population growth and baseline shortages in the primary care workforce call for significant increases in the primary care workforce to accommodate rising demands. Office visits to primary care clinicians are projected to increase from 773,606 in 2020 to 893,098 in 2040. We project a need for an additional 57,559primary care clinicians by 2040. Workforce shortages in primary care continue to expand due to populationaging, growth, and heightened rates of clinicianburnout& egress.

Primary care physician density and mortality in the United States

BackgroundGeographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established. MethodsThe study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI). ResultsA total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824-832) in the first quartile, 798 (95% CI, 796-801) in the second quartile, 737 (95% CI, 735-739) in the third quartile, and 679 (95% CI, 678-680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443-449),439(95% CI, 437-441), 403 (95% CI, 402-404), and 365 (95% CI, 364-366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783-812) and 430 (95%CI, 419-440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of -4.11 (95% CI, -18.31, 10.08), -35.37 (95% CI, -49.57, -21.17) and -85.79 (95% CI, -100.10, -71.48). Similar results were observed for CVD-related AAMR. ConclusionHigher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.

Continuing professional development for primary care physicians: a pre-post study on lung point-of-care ultrasound curriculum

BackgroundPoint-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings.MethodsWe developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians’ proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire.ResultsFifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p < 0.001), and in identifying normal versus abnormal views, improving from 54 to 74% accuracy (p < 0.001). Ten weeks after training, primary care physicians reported greater comfort using lung ultrasound, rising from 10 to 54% (p < 0.001), and improved grasp of its potential and limits, increasing from 27.5% to 84% (p < 0.001). Weekly usage increased from none to 50%, and the number of primary care physicians not using at all decreased from 72 to 26% (p < 0.001).ConclusionsA two-day focused in-person and remote self-learning lung-POCUS training significantly improved primary care physicians' lung ultrasound skills, comfort, and implementation.

More doctors, better health? A generalised synthetic control approach to estimating impacts of increasing doctors under Brazil's Mais Medicos programme

Worldwide, there are an insufficient number of primary care physicians to provide accessible, high-quality primary care services. Better knowledge on the health impacts of policies aimed at improving access to primary care physicians is important for informing future policies.Using a generalised synthetic control estimator (GSC), we estimate the effect of the increase in primary care physicians from the Programa Mais Médicos in Brazil. The GSC allows us to estimates a continuous treatment effects which are heterogenous by region. We exploit the variation in physicians allocated to each Brazilian microregion to identify the impact of an increasing Mais Médicos primary care physicians. We explore hospitalisations and mortality rates (both total and from ambulatory care sensitive conditions) as outcomes. Our analysis differs from previous work by estimating the impact of the increase in physician numbers, as opposed to the overall impact of programme participation. We examine the impact on hospitalisations and mortality rates and employ a panel dataset with monthly observations of all Brazilian microregion over the period 2008–2017.We find limited effects of an increase in primary care physicians impacting health outcomes - with no significant impact of the Programa Mais Médicos on hospitalisations or mortality rates. Potential explanations include substitution of other health professionals, impacts materialising over the longer-term, and poor within-region allocation of Mais Médicos physicians.

Evaluation of the Effect of Nutrition Education on Osteopathic Medical Students' Personal Nutrition Choices and Incorporation Into Future Medical Practice.

Our current research project evaluates the impact of nutrition education on the medical student's personal nutrition goals and the likelihood of incorporating nutrition needs into patient evaluation and treatment plans in future practice. The growing popularity of lifestyle medicine has further emphasized the importance of nutrition in the treatment of all patients, especially those suffering from chronic diseases. The paucity of formal medical nutrition education in medical school curricula leaves a significant gap in the knowledge base of physicians in practice. In an attempt to close the gap, we increased nutrition education in first-year osteopathic medical students by establishing a nutrition course emphasizing modern competencies and their importance in clinical practice. Methods: The course evaluation utilized a two-group quasi-experimental pre-test/post-test study design. The intervention group consisted of medical students participating in the newly established course, and the control group consisted of second-year medical students who had not taken the course as part of their curriculum. Information was collected about students' knowledge, attitudes, behaviors around nutrition, their plans to pursue a residency with a focus on culinary medicine and incorporate medical nutrition into their medical practice in the future, and their intention to incorporate culinary medicine into future treatment plans. Participation rates within a voluntary culinary medicine interest group were also tracked. Students in the intervention group were 26% more likely to report that proper nutrition for patient care had been addressed in coursework. This suggests that medical students exposed to the medical nutrition course have received more training that is critical in proper patient care than students in the control group. Students in the intervention group were 93% more likely to believe that proper nutrition can be used to prevent disease. Lastly, significantly more students in the intervention group (33% more) intend to explore residency programs with a focus on culinary medicine than those students in the control group. These results demonstrate that nutritional education promotes an awareness of the effectiveness of nutritional counseling in disease prevention and management. Furthermore, it will hopefully prompt future physicians to consider nutritional counseling during their clinical rotations, through residency, and into their independent practice. The presentation of nutrition in the first year of medical school is critical to develop increasing numbers of primary care physicians that promote the importance of nutrition and a healthy lifestyle for patients.

Identifying innovations produced by primary health care centers and evaluating their scalability: the SPRINT Occitanie cross-sectional study in France

BackgroundPractice-based research is one of the levers identified by the World Health Organization (WHO) to strengthen primary health care. The scaling of health and social care innovations has the potential to reduce inequities in health and to expand the benefits of effective innovations. It is now rapidly gaining the attention of decision-makers in health and social care, particularly in high-income countries.To meet the challenge of declining numbers of primary care physicians in France, Multi-professional Healthcare Centers (MHC) were created to bring together medical and paramedical professionals. They are a source of innovation in meeting the health challenges facing our populations.Specific methodology exists to identify health innovations and assess their scalability. A working group, including end-users and specialists, has adapted this methodology to the French context and the University department of general practice of Montpellier-Nîmes (France) launched a pilot study in Occitanie, a French region.ObjectiveTo identify and evaluate the scalability of innovations produced in pluri-professional healthcare centers in the Occitanie region.MethodsA pilot, observational, cross-sectional study was carried out. The SPRINT Occitanie study was based on a questionnaire with two sections: MHC information and the modified Innovation Scalability Self-Administered Questionnaire (ISSaQ), version 2020. The study population was all 279 MHC in the Occitanie region.Results19.3% (54) of MHC in the Occitanie region, responded fully or incompletely to the questionnaire. Four out of 5 U-MHCs were represented. Five MHC presented multiple innovations. The average per MHC was 1.94 (± 2.4) innovations. 26% of them (n = 9) had high scalability, 34% (n = 12) medium scalability and 40% (n = 14) low scalability. The main innovation represented (86%) were healthcare program, service, and tool.ConclusionsIn our cross-sectional study, a quarter of the innovations were highly scalable. We were able to demonstrate the importance of MHC teams in working on primary care research through the prism of innovations. Primary-care innovations must be detected, evaluated, and extracted to improve their impact on their healthcare system.

Investigation of geographic disparities of diabetes-related hospitalizations in Florida using flexible spatial scan statistics: An ecological study.

Hospitalizations due to diabetes complications are potentially preventable with effective management of the condition in the outpatient setting. Diabetes-related hospitalization (DRH) rates can provide valuable information about access, utilization, and efficacy of healthcare services. However, little is known about the local geographic distribution of DRH rates in Florida. Therefore, the objectives of this study were to investigate the geographic distribution of DRH rates at the ZIP code tabulation area (ZCTA) level in Florida, identify significant local clusters of high hospitalization rates, and describe characteristics of ZCTAs within the observed spatial clusters. Hospital discharge data from 2016 to 2019 were obtained from the Florida Agency for Health Care Administration through a Data Use Agreement with the Florida Department of Health. Raw and spatial empirical Bayes smoothed DRH rates were computed at the ZCTA level. High-rate DRH clusters were identified using Tango's flexible spatial scan statistic. Choropleth maps were used to display smoothed DRH rates and significant high-rate spatial clusters. Demographic, socioeconomic, and healthcare-related characteristics of cluster and non-cluster ZCTAs were compared using the Wilcoxon rank sum test for continuous variables and Chi-square test for categorical variables. There was a total of 554,133 diabetes-related hospitalizations during the study period. The statewide DRH rate was 8.5 per 1,000 person-years, but smoothed rates at the ZCTA level ranged from 0 to 101.9. A total of 24 significant high-rate spatial clusters were identified. High-rate clusters had a higher percentage of rural ZCTAs (60.9%) than non-cluster ZCTAs (41.8%). The median percent of non-Hispanic Black residents was significantly (p < 0.0001) higher in cluster ZCTAs than in non-cluster ZCTAs. Populations of cluster ZCTAs also had significantly (p < 0.0001) lower median income and educational attainment, and higher levels of unemployment and poverty compared to the rest of the state. In addition, median percent of the population with health insurance coverage and number of primary care physicians per capita were significantly (p < 0.0001) lower in cluster ZCTAs than in non-cluster ZCTAs. This study identified geographic disparities of DRH rates at the ZCTA level in Florida. The identification of high-rate DRH clusters provides useful information to guide resource allocation such that communities with the highest burdens are prioritized to reduce the observed disparities. Future research will investigate determinants of hospitalization rates to inform public health planning, resource allocation and interventions.

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis.

Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated. This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data. Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983-0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents. This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

Effects of work-family conflict, social support and burnout on job satisfaction among primary care physicians in Huaihai economic zone.

Primary care physicians (PCPs) are doctors in primary health care institutions, namely village clinics, township health centers and community health service centers (stations) who are the main providers of primary health care services in primary health care settings. Improving the overall health status of the population requires the support of a large number of primary care physicians; however, the job satisfaction of this group has not been sufficiently emphasized and recognized. The purpose of this study was to examine the effects of primary care physicians' work-family conflict on their job satisfaction, as well as the mediating role of burnout and the moderating role of social support. This cross-sectional study was conducted from February 2023 to March 2023. Participants were 749 primary care physicians from four cities of Xuzhou, Linyi, Huaibei, and Shangqiu in the Huaihai Economic Zone of China. SPSS statistical analysis was used to evaluate the relationship between work-family conflict, social support, burnout and job satisfaction among medical workers. Work-family conflict had a significant negative effect on job satisfaction (β = -0.36, p< 0.001), after adding burnout in the model, work-family conflict also negatively predicted job satisfaction (β = -0.32, p< 0.001). Social support had a moderating effect on the direct effect of burnout on job satisfaction (β = 0.00, t = 2.66, p< 0.01, 95%CI [0.001, 0.007]), the predictive effect of burnout on job satisfaction at high level of social support (β = -0.45, p< 0.001) was higher than a low level of social support (β = -0.33, p< 0.001). This study demonstrated the negative impact of work-family conflict on primary care physicians' job satisfaction, as well as the mediating role of burnout and the moderating role of social support on burnout and job satisfaction, which are important for improving primary care physicians' job satisfaction and enhancing the quality of primary care in the future.

Hybrid health regimes: Access to primary care physicians and COVID-19 vaccine uptake across municipalities in Romania

This study analyses COVID-19 vaccine uptake at the municipal level in Romania using the global health regimes and vaccine hesitancy perspectives. Our spatial regression (SARAR-het Durbin) shows that the number of primary care physicians is a significant predictor of vaccine uptake, and municipalities with higher access to the labour market have higher vaccination rates. We provide a historical perspective to demonstrate that the current health regime in Romania is a hybrid of internationalist and global health regimes, with socialist investments affecting labour participation, education, poverty, and vaccination rates. Our findings highlight the impact of regional disparities and partial privatization of the health system.

The Role of Problem-Based Learning in Preparing Medical Students to Work As Community Service-Oriented Primary Care Physicians: A Systematic Literature Review.

The number of primary care physicians in the United States is dwindling rapidly, and osteopathic medical schools are embracing the challenge of leading students toward a career in primary care to meet this need. In recent years, the Problem-Based Learning (PBL) curriculum in medical education has emerged as a patient-centered, social-justice-focused methodology. The unique format of PBL centered around patient cases allows learning through community-based medicine, promoting medical graduates' entry into primary care. Through exploring the literature on this topic, the research question posed for this review is as follows: How have the skills gained in PBL been effectively preparing medical students to become community service-oriented primary care physicians, and how can we qualitatively and quantitatively assess a learner's preparedness to engage in primary care work? The variables studied were board licensing examination scores, clinical competence, and interpersonal skills, all of which emerged as common ways to assess learners' preparedness to work in primary care. The methodology of this literature review was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart to describe how articles were selected and synthesized to evaluate the variables. The results revealed the variables to be consistent strengths of PBL students, particularly clinical competence, and interpersonal skills, both of which are key in working in primary care and any clinical specialty. Since early in its implementation, literature has demonstrated the tendencies of PBL students to be interested in and later work in primary care, though little follow-up has been done recently. The question of why this phenomenon exists was largely answered by our literature review. In conclusion, through our analysis of the existing literature, the authors demonstrated that the PBL curriculum helps foster students' desire to serve patients. Limitations of the literature included small sample sizes, heterogeneous analysis methods, limited inclusion of qualitative assessment of student progress, and limited existing data on the prevalence of PBL in medical schools, as well as the entrance of PBL graduates into primary care careers.

Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study

ObjectiveTo evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls. Patients and MethodsUsing 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level. ResultsPeople with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls. ConclusionPeople with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.

Factors Related to Drug Overdose Deaths in Ohio

Background: Drug overdoses have had a devastating impact on public health in Ohio. Improving our understand-ing of the relationships between factors that are associated with drug overdose deaths can enhance the quality of public policy and health care reach in Ohio. Methods: Utilizing data from the Centers for Disease Control and Prevention (CDC) and University of Wisconsin Population Health Institute, this research seeks to quantify the associations between the drug overdose rate for counties in Ohio with various factors via statistical regressions. Results: The overwhelming majority of drug/alcohol overdose deaths during the years 2017-2019 were uninten-tional. Drug overdose deaths and life expectancy are strongly associated. Communities with higher overdose rates have lower life expectancies. Socioeconomic status and health care factors, such as mental distress and physical inactivity, are significantly correlated with increased drug overdose deaths. Household income is significantly correlated with increased access to health care, implying that communities of lower socioeconomic status may lack adequate access to quality care and suffer from increased overdose deaths. Conclusion: The data indicate the importance of access to health care and health care providers in response to drug overdoses in Ohio. Health care access is currently proportional to income; higher income households have a greater proportion of insured, as well as a greater number of primary care physicians. Thus, implementing policies that support health care infrastructure should be prioritized to increase the capacity of treatment in under-resourced (low-income and low socioeconomic status) communities.

Abstract 6497: Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States

Abstract Background: Survival outcome in Non-Hodgkin lymphoma (NHL) is significantly better in earlier stages, compared to advanced stages. Early identification of signs and symptoms, and prompt specialist availability and referral, are crucial for diagnosis and treatment at earlier stages. Mounting physician shortages are a growing concern, and we sought to analyze their effect on NHL mortality rates. Methods: We extracted data on the age-adjusted mortality rate (AAMR) and crude incidence rate (CIR) of NHL for all U.S. states and the District of Columbia from the Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database (2017-2019). Nevada was excluded due to missing information. Data on the state-wise number of primary care physicians (PCPs) was obtained from the Association of American Medical Colleges (AAMC) state physician workforce data report (2020), and of Hematology/Oncology specialists (HOs) was gathered from the National Provider Identifier (NPI) registry (2020). The number of PCPs and HOs per each NHL incidence (PCP/CIR, HO/CIR respectively) was then calculated. Correlations were analyzed using Pearson’s coefficient. Statistical analysis was performed using VassarStats. Results: Median AAMR for NHL in the US was 5.15 (IQR 4.35, 5.95) per 100, 000 population. The median number of PCP and HO per each case of NHL incidence was 4.32 (IQR 3.43, 5.21), and 0.28 (IQR 0.1, 0.37) respectively. States with fewer PCPs per each NHL incidence had higher AAMR (r=-0.37, p=0.007). States with a lower number of HOs per each NHL incidence had higher AAMR (r=-0.41, p=0.003) Conclusions: Based on the analysis, the availability of a lower number of PCPs and HOs per each NHL incidence is associated with increased AAMR of the disease. This data may strengthen the need for intensification of focus on decreasing the soaring physician shortages in the states, in order to help decrease the overall mortality associated with NHL. Citation Format: Shiva Jashwanth Gaddam, Udhayvir Singh Grewal, Zara Hassan, Poornima Ramadas. Availability of healthcare providers and its association with survival outcomes in non-Hodgkin lymphoma in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6497.

Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes.

It is unknown whether the annual number of primary care physician (PCP) unique outpatient assessments, which we refer to as clinical volume, translates into better cardiovascular preventive care. We examined the relationship between PCP outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline-recommended eligible patients. This was a retrospective cohort study conducted as part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a population-based cohort of almost all adult residents of Ontario, Canada, followed from 2008 to 2012. For each clinical volume quintile, we compared cholesterol testing and major adverse cardiovascular events, defined as time to first event of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The 10,037 PCPs evaluated had an annualized median volume of 2303 clinical encounters (IQR 1292-3680). Among 4,740,380 patients, 84% underwent guideline-concordant cholesterol testing at least once over 5 years, ranging from 73% with the lowest clinical volume quintile physicians to 86% with the highest. After multivariable adjustment, there was a 10.5% relative increase in the probability of cholesterol testing for every doubling of clinical volumes (95% CI 9.7-11.4; P < 0.001). Patients treated by the lowest volume quintile physicians had the highest rate of major adverse cardiovascular outcomes (compared with the highest volume quintile physicians: adjusted HR 1.15, 95% CI 1.10-1.21; P < 0.001). Patients of physicians with the lowest clinical volumes received less frequent cholesterol testing and had the highest rate of incident cardiovascular events. Further research investigating the drivers of this relationship is warranted.

Abigail Geisinger Primary Care Scholars: An Innovative Educational Program Addressing Critical Workforce Needs.

The number of primary care physicians in the United States is inadequate to meet current or projected needs. This is likely exacerbated by continuing increases in the cost of medical education and student debt. The Geisinger Commonwealth School of Medicine is part of an integrated care delivery system in which primary care is central to managing health, improving access, and advancing value-based care. The need for primary care providers and psychiatrists is difficult to meet despite generous recruiting incentives. To address this, the Abigail Geisinger Scholars Program (AGSP) represents a novel curricular approach linked with the provision of full tuition and fees and a living stipend to students who commit to work at Geisinger in primary care or psychiatry following residency. The support is provided as a forgivable loan. The program features preferential clinical placements, curricular enhancements, and celebration of the dedicated cohort. Fair and nonpunitive provisions allow students to opt-out. The AGSP supports 45 students in each class of 115. Outcomes monitored include withdrawals from the AGSP; academic performance of participants and their satisfaction with the program; the number who choose to repay the loan rather than fulfill the service obligation; the percentage who remain at Geisinger and in primary care following the period of obligation; and other measures. This model offers an attractive opportunity for students to experience a curriculum enhanced in primary care while receiving generous financing for their medical education. It bolsters the primary care physician workforce and aligns care delivery with new financing models.

Association of distance to gynecologic oncologist and survival in a rural midwestern state (414)

Objectives: Rural ovarian cancer patients experience worse survival outcomes compared to urban patients. We hypothesized that those living farther from gynecologic oncology would have greater mortality because they may be more likely to seek care locally from less specialized providers. Our objective was to assess whether distance to gynecologic oncology providers affects mortality among ovarian cancer patients living in a largely rural midwestern state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients residing in Iowa diagnosed with malignant primary ovarian cancer from 1990-2018. County-level data from the 2018-19 Area Health Resource File included a number of primary care physicians, surgeons, OB/GYN’s, and hospital beds per 10,000 population. Rurality was categorized using 2013 Rural-Urban Continuum Codes for the patient’s county of residence at the time of diagnosis. Distance to the nearest gynecologic oncologist was calculated from the centroid of the patient’s county of residence to the centroid of the nearest county in Iowa or surrounding states containing a hospital with at least one gynecologic oncologist (n=7). Survival was assessed via Cox proportional hazards models. Results: There were 1,588 patients included, with a mean distance to gynecologic oncology of 45.8 miles and a mean survival of 31 months. Unadjusted models showed those who lived farther from gynecologic oncology had progressively significantly greater risk of death compared to those who lived 0-9 miles: 10-29 (HR: 1.07, 95% CI:1.03-1.12), 30-49 (HR: 1.15, 95% CI:1.05-1.25), 50-69 (HR: 1.23, 95% CI:1.08-1.40), 70+ (HR:1.32, 95% CI:1.11-1.57). In multivariate models that included age, marital status, stage, county-level poverty, and rate of surgeons per 10,000 population, the distance was no longer associated with a higher risk of mortality. Stage II (HR: 3.10, 95% CI: 2.13-4.50), stage III (HR: 7.09, 95% CI: 5.40-9.31), stage IV (HR: 11.59, 95% CI: 8.73-15.38) versus stage I, age 60-69 (HR: 1.47, 95% CI:1.13- 1.90), age 70-79 (HR: 2.08, 95% CI: 1.59-2.71), age 80+ (HR: 4.96, 95% CI: 3.76-6.53) versus <50, unmarried versus married (HR: 1.35, 95% CI: 1.09-1.67) were the strongest predictors for risk of death. Conclusions: Those living farthest from gynecologic oncology care had an increased risk of mortality, but this increase was diminished after controlling for patient/tumor characteristics. Further studies are needed to elucidate reasons contributing to worsened survival for rural women, which could include referral practices of local providers, rates of surgery performed by general OB/GYN’s, and other unknown factors. Objectives: Rural ovarian cancer patients experience worse survival outcomes compared to urban patients. We hypothesized that those living farther from gynecologic oncology would have greater mortality because they may be more likely to seek care locally from less specialized providers. Our objective was to assess whether distance to gynecologic oncology providers affects mortality among ovarian cancer patients living in a largely rural midwestern state. Methods: Demographic, tumor, and treatment characteristics were extracted from the Iowa Cancer Registry for patients residing in Iowa diagnosed with malignant primary ovarian cancer from 1990-2018. County-level data from the 2018-19 Area Health Resource File included a number of primary care physicians, surgeons, OB/GYN’s, and hospital beds per 10,000 population. Rurality was categorized using 2013 Rural-Urban Continuum Codes for the patient’s county of residence at the time of diagnosis. Distance to the nearest gynecologic oncologist was calculated from the centroid of the patient’s county of residence to the centroid of the nearest county in Iowa or surrounding states containing a hospital with at least one gynecologic oncologist (n=7). Survival was assessed via Cox proportional hazards models. Results: There were 1,588 patients included, with a mean distance to gynecologic oncology of 45.8 miles and a mean survival of 31 months. Unadjusted models showed those who lived farther from gynecologic oncology had progressively significantly greater risk of death compared to those who lived 0-9 miles: 10-29 (HR: 1.07, 95% CI:1.03-1.12), 30-49 (HR: 1.15, 95% CI:1.05-1.25), 50-69 (HR: 1.23, 95% CI:1.08-1.40), 70+ (HR:1.32, 95% CI:1.11-1.57). In multivariate models that included age, marital status, stage, county-level poverty, and rate of surgeons per 10,000 population, the distance was no longer associated with a higher risk of mortality. Stage II (HR: 3.10, 95% CI: 2.13-4.50), stage III (HR: 7.09, 95% CI: 5.40-9.31), stage IV (HR: 11.59, 95% CI: 8.73-15.38) versus stage I, age 60-69 (HR: 1.47, 95% CI:1.13- 1.90), age 70-79 (HR: 2.08, 95% CI: 1.59-2.71), age 80+ (HR: 4.96, 95% CI: 3.76-6.53) versus <50, unmarried versus married (HR: 1.35, 95% CI: 1.09-1.67) were the strongest predictors for risk of death. Conclusions: Those living farthest from gynecologic oncology care had an increased risk of mortality, but this increase was diminished after controlling for patient/tumor characteristics. Further studies are needed to elucidate reasons contributing to worsened survival for rural women, which could include referral practices of local providers, rates of surgery performed by general OB/GYN’s, and other unknown factors.

Impact of Curricula and Electives on Primary Care Specialty Choice: A Narrative Synthesis.

Educational components and electives that may influence medical student choice of primary care careers have been studied individually, but not reviewed or synthesized. Examining educational components and electives in a comprehensive manner may inform evidence-based approaches to raise the number of primary care physicians in the United States and help optimize use of finite resources. We sought to determine evidence-based educational components and electives associated with increased medical student choice of primary care careers. We searched PubMed, Scopus, and CINAHL for undergraduate medical education articles in English describing an educational component or elective and outcome relevant to primary care specialty choice. We assessed titles, then abstracts, and finally full texts for inclusion in a narrative synthesis. The searches returned 11,211 articles and we found 42 that met the inclusion criteria. The most described components were outpatient clinical rotations, preclinical courses, and preceptorships. The most common electives were international health, summer preceptorships, and rural medicine. While most articles described curricula that appeared to have a positive correlation with primary care specialty choice, six articles found limited benefit. In sum, results were mixed. The current literature is limited, and many contemporary electives have not been studied with respect to primary care choice. Increased attention and funding to studying the impact of electives and other educational components on primary care specialty choice is warranted.

Physicians’ Perception About Primary Care Nurse Practitioners in Saudi Arabia

The purpose of this study was to explore physicians’ perception about the supply and demand of nurse practitioners (NPs) in primary care settings. We used a cross-sectional design and the National Survey of Primary Care Physicians and Nurse Practitioners to recruit physicians working in Saudi Arabia. Most participants agreed that the numbers of primary care physicians and NPs are less than the demand and increasing the NP supply would improve health care access and quality. Statistically significant differences were found between physicians based on demographic characteristics. Physicians support the development of the primary care NP role in Saudi Arabia to optimize health care access and quality.

The Social and Economic Factors Underlying the Incidence of COVID-19 Cases and Deaths in US Counties During the Initial Outbreak Phase

This paper uncovers the socioeconomic and health/lifestyle factors that can explain the differential impact of the coronavirus pandemic on different parts of the United States during the initial outbreak phase of the pandemic. Using a dynamic panel representation of an epidemiological model of disease spread, the paper develops a Vulnerability Index for US counties from the daily reported number of cases over a 20-day period of rapid disease growth. County-level economic, demographic, and health factors are used to explain the differences in the values of this index and thereby the transmission and concentration of the disease across the country. These factors are also used to examine the number of reported deaths. The paper finds that counties with high median income have a high incidence of cases but reported lower deaths. Income inequality, as measured by the Gini coefficient, is found to be associated with more deaths and more cases. The remarkable similarity in the distribution of cases across the country and the distribution of distance-weighted international passengers served by the top international airports is evidence of the spread of the virus by way of international travel. The distributions of age, race and health risk factors such as obesity and diabetes are found to be particularly significant factors in explaining the differences in mortality across counties. Counties with better access to health care, as measured by the number of primary care physicians per capita, have lower deaths, and so do places with more health awareness as measured by flu vaccination prevalence. Environmental health conditions such as the amount of air pollution are found to be associated with counties with higher deaths from the virus. It is hoped that research such as these will help policymakers to develop risk factors for each region of the country to better contain the spread of infectious diseases in the future.