Shortage Of Primary Care Physicians Research Articles

Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration.

The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown. We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies. We used an instrumental variable approach with a 2-stage residual inclusion specification. We included RN filled vacancies in the VA that were posted nationwide between 2020 and 2021. Our independent variable was the facility-year level number of PB-RNR program allocations. The 3 binary outcomes were whether the RN vacancy was filled within 90, 60, or 30 days. An increase of one training allocation was significantly associated with a 5.60 percentage point (PP) (95% CI: 2.74-8.46) higher likelihood of filling a vacancy within 90 days, 7.34 PP (95% CI: 4.66-10.03) higher likelihood of filling a vacancy within 60 days, and 5.32 PP (95% CI: 3.18-7.46) higher likelihood of filling a vacancy within 30 days. The impact was significant in both 2020 and 2021 positions, and in facilities located in areas with lower social deprivation scores, higher-quality public schools, or with either no or partial primary care physician shortages. We found favorable impacts of the size of the PB-RNR program at a VA facility on filling RN vacancies.

Travel-time barriers to specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia.

Prior studies demonstrate that 20%-50% of adolescents and young adults (age 15-39 years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers, yet a survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to specialty cancer center-level care. We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify adolescent and young adult ALL patients diagnosed between 2004 and 2016 across 43 US states. We calculated driving distance and travel time from counties where participants lived to the closest specialty cancer center sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where adolescent and young adult ALL patients resided and the need to travel more than 1 hour to obtain care at a specialty cancer center. Among 11 813 adolescent and young adult ALL patients, 43.4% were aged 25-39 years, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of adolescent and young adult ALL patients from 60.8% of included US counties would be required to travel more than 1 hour one way to access a specialty cancer center. Multivariable models demonstrate that patients living in counties that are nonmetropolitan, with lower levels of educational attainment, with higher income inequality, with lower internet access, located in primary care physician shortage areas, and with fewer hospitals providing chemotherapy services are more likely to travel more than 1 hour to access a specialty cancer center. Substantial travel-related barriers exist to accessing care at specialty cancer centers across the United States, particularly for patients living in areas with greater concentrations of historically marginalized communities.

Operationalizing a 3-year standalone, accelerated medical school curriculum to nurture physicians to become primary care and health system leaders

The United States faces a shortage of primary care physicians. To address this, there have been pioneering efforts to develop accelerated pathways with a primary care focused curriculum for undergraduate medical education. The New York University Grossman Long Island School of Medicine (NYU GLISOM) was conceptualized as the first standalone, accelerated, tuition-free program in the US in over 100 years, with mission-centered curriculum on primary care and health system leadership. The aim of this article is to map the process for the development of a three-year integrated curriculum, describe the pedagogical approach that guided the design of the longitudinal courses, share the student and faculty’s perspective about the curriculum, and describe the early outcomes of the first two graduate classes. A major key driver for curricular design is integrating longitudinal courses of Clinical Ambulatory Practice Experience (CAPE), Health Systems Science (HSS), and Learning Community - Social Sciences, Humanities, Ethics and Professionalism (LC-SHEP) over three years and active learning through Problem Based Learning (PBL). We have successfully operationalized an accelerated, standalone, integrated medical school curriculum mission-centered on primary care and health system leadership. Our outcomes reveal a higher percentage (76% N =45) of NYU GLISOM students entering primary care compared to national benchmarks. The integration of the longitudinal courses of HSS, LC-SHEP, and CAPE is a key pillar to reinforce the tenants of primary care and health system leadership. Focused interview of graduates from the pioneer cohort consistently stated that the longitudinal courses prepared them well for residency in primary care and as a health systems’ change agent. Despite the challenges of an accelerated program, NYU GLISOM successfully integrated the longitudinal courses with optimal performance and achievement of educational program objectives. Our experience can serve as a model for innovation and design of an accelerated three-year primary care curriculum.

Setting the Target: Comparing Family Medicine Among US Allopathic Target Schools.

Despite the persistent primary care physician shortage over 2 decades of allopathic medical school expansion, some medical schools are absent a department of family medicine; these schools are designated as "target" schools. These absences are important because evidence has demonstrated the association between structured exposure to family medicine during medical school and the proportion of students who ultimately select a career in family medicine. In this study, we aimed to address part of this gap by defining and characterizing the current landscape of US allopathic target schools. We identified allopathic target schools by reviewing all Liaison Committee of Medical Education (LCME) accredited institutions for the presence of a family medicine department. To compare these schools in terms of family medicine representation and outcomes, we curated descriptive data from publicly available websites, previously published family medicine match results, and school rankings for primary care. We identified 12 target schools (8.7% of all US allopathic accredited medical schools) with considerable heterogeneity in opportunities for family medicine engagement, leadership, and training. Target schools with greater family medicine representation had increased outcomes for family medicine workforce and primary care opportunities. With growing primary care workforce gaps, target schools have a responsibility to enhance family medicine presence and representation at their institutions. We provide recommendations at the institutional, specialty, and national level to increase family medicine representation at target schools, with the goal that all schools eventually establish a department of family medicine.

Internal Medicine Residents' Perceptions of Their Continuity Clinic Training.

Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training. This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs. The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, P < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, P < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC. This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.

Advancing primary care: Doctoral program for physician associates and nurse practitioners

The United States faces an impending crisis in primary care physician shortages, while Physician Associates (PAs) and Nurse Practitioners (NPs) are poised to help bridge the gap. This manuscript explores a groundbreaking solution: introducing a clinical doctorate program tailored to PAs and NPs, designed to equip them with the knowledge and skills to assume leadership roles in primary care. Unlike traditional medical education, this innovative approach allows these professionals to continue their clinical practice while advancing their education, addressing the workforce shortage and the need for advanced leadership within the primary care landscape. This comprehensive curriculum includes intensive didactic coursework, residency-like training, credentialing examinations, and research opportunities, positioning PAs and NPs as critical contributors to the future of primary care. By recognizing their untapped potential and investing in their advanced education, we can elevate the quality and accessibility of primary care, ensuring that healthcare delivery reaches new heights.

Nurses can be key "REACH" accountable care organization partners to mitigate Medicare inequity.

We propose that Advanced Practice Registered Nurses (APRNs) can be key Accountable Care Organization (ACO) partners in mitigating Medicare inequity due to a shortage of primary care physicians. This shortage particularly impacts minority Medicare beneficiaries residing in urban and rural Health Professional Shortage Areas. In order to expand the primary care workforce to open the gateway to our health care system for these beneficiaries, we propose that APRNs provide primary care in a Medicare Neighborhood Clinic, as key partners of a modified "REACH" (Realizing Equity, Access, and Community Health) ACO model. We review the long history of ineffective efforts to alleviate the physician primary care shortage. After highlighting a report emphasizing the importance of nurses in achieving health equity, we describe the APRN role in a Medicare Neighborhood Clinic, and its potential for alleviating the primary care shortage. This clinic, as part of the modified "REACH" strategy, provides nurses with a key role in achieving Medicare equity. We contend that this strategy, as a means of APRNs providing value-based care to all Medicare beneficiaries while restraining the Medicare budget, contributes to transforming primary care for Medicare equity.

An Analysis of Primary Care Physician Accessibility and Medical Resource Distribution in Eastern Quebec: Utilizing an Enhanced Two-Step Floating Catchment Area (E2SFCA) Methodology

Objective: The aim of this study is to evaluate the accessibility of primary care physicians (PCPs) in Eastern Quebec by employing an enhanced two-step floating catchment area (E2SFCA) methodology. This approach will facilitate the identification of patterns in primary care accessibility that may not be readily apparent through the use of regional availability measures. Methods: To evaluate the accessibility of primary care physicians (PCPs), an enhanced two-step floating catchment area methodology was utilized. This approach considers both the population supply of PCPs at the dissemination area level and the travel time between PCPs and dissemination areas. Additionally, a continuous distance decay function (β) was employed. Results: The enhanced two-step floating catchment area (E2SFCA) methodology is effective in identifying possibly underserved areas that could have otherwise appeared to have sufficient access when evaluated using traditional provider-to-population ratios. The availability of primary care services is contingent upon the presence of adequate road infrastructure. Populations residing in areas with limited access to main road networks may experience compromised access to primary care. This issue disproportionately affects vulnerable individuals who lack private transportation options. Conclusions: The application of the enhanced two-step floating catchment area methodology can facilitate the identification of areas experiencing a shortage of primary care physicians. This information can be used to inform the development of regional medical workforce programs, such as "plans régionaux d’effectifs médicaux", and to support the establishment of rural residency initiatives.

Stroke awareness among community health workers from rural health blocks of Thiruvananthapuram, India.

Secondary prevention of stroke largely depends on risk factor control and lifestyle modification. Optimal secondary prevention strategies are limited in rural settings due to the shortage of primary care physicians and neurologists. Awareness of community health workers (CHWs) regarding stroke and its management remains largely unexplored. The current cross-sectional study aimed at assessing the knowledge, attitude, and practice (KAP) of CHWs regarding stroke care. A structured KAP questionnaire was administered among 510 CHWs from randomly selected rural health blocks of Thiruvananthapuram, Kerala, India. Knowledge assessment showed that the CHWs possessed an average knowledge of stroke care. The mean attitude and practice scores were higher, indicating a favorable attitude and good practice. The overall mean (standard deviation) KAP scores of CHWs were 13.54 (4.43) against a total score of 23. The KAP scores were highest among palliative care nurses. The stroke awareness of the accredited social health activists was comparatively lower than other CHWs. Factors such as age and years of work experience were not correlated to the KAP scores. Recurrent strokes remain a major challenge in primary care. Overall, the health workers demonstrated average knowledge, favorable attitudes, and positive practices. The study highlights the importance of training accredited social health activists (ASHAs) and other CHWs in stroke to improve secondary prevention strategies.

Physician Assistants als Zukunftsmodell in der hausärztlichen Versorgung – Erfahrungen, Bedarfe, Potenziale und Hürden

IntroductionIn the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years. Research questions1) What are the potentials for delegation/possibilities for PAs working in primary care practices in contrast to medical assistants? 2) What structural requirements are necessary to regularly integrate PAs in primary care practices? MethodsAfter preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring. ResultsThe participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs. DiscussionThe legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future. ConclusionParticipation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions.

The Effectiveness of Common Interventions in the Management of Sickle Cell Disease in Primary Care Settings: A Review.

Sickle cell disease (SCD), a chronic condition that affects men and women equally, continues to present a public health burden in the United States due to its associated morbidity and complications. Despite advances in medical knowledge and the design of novel therapies for managing the disease, its burden remains compounded because of increasing rates of immigration arising from global displacements and economic unrest in many countries.We thus conducted a comprehensive literature review of publications from 2000 to 2022 to gather guidelines on managing SCD, with a search through four databases, PubMed, Embase, Google Scholar, and Cochrane; 42 articles met the final inclusion criteria after the full-text article screening process. In the United States healthcare system, primary care physicians (PCPs) are generally providers who cater to the lifelong management of chronic medical conditions, SCD not being an exception. While more SCD patients now present to primary care clinics, many PCPs still lack the confidence and adequate experience necessary to manage the condition effectively. The gap created by the shortage of PCPs extensively equipped to provide comprehensive SCD care leads to poor health outcomes for patients. It is imperative now more than ever to continue to raise awareness about this condition at the provider level, to ensure that patients receive well-rounded care to improve their quality of life and clinical outcomes. Providing up-to-date knowledge about existing and novel therapies and/or modalities of SCD treatment would undoubtedly equip the PCPs with self-assurance to manage the condition adeptly. Thus, we explore various public health interventions such as hydroxyurea therapy, pneumococcal vaccination, penicillin therapy, iron chelation therapy, and clinical decision support tools that have been implemented in primary healthcare settings and shown to be effective in improving SCD care. We also discuss recent advancements that can lead to improved outcomes for SCD patients in the future.

Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage

The shortage of primary care physicians is a growing crisis that threatens the stability and effectiveness of healthcare systems. This paper explores a multi-pronged approach to addressing this issue by focusing on the modernization of medical curricula, the establishment of new medical schools, fostering collaboration between institutions, and implementing policy innovations. The cases of South Tyrol, Italy, and Tyrol, Austria, are examined to highlight the challenges faced in establishing new medical schools. This paper proposes that a comprehensive strategy, including the incorporation of general practice content and experience in medical education, is crucial for preparing future physicians for careers in primary care. Furthermore, intensifying efforts to establish new medical schools, particularly in regions such as South Tyrol, which lack native-language medical university education, can provide additional benefits in addressing regional needs and augmenting the number of graduates. Collaboration between existing and new medical schools, regional partnerships, and policy innovations are essential to support the establishment of institutions with a particular focus on general practice and the modernization of curricula at existing universities. By embracing this approach, stakeholders can collectively shape the medical education landscape and address the growing crisis of physician shortages in primary care.

Associations of the Informal Curriculum and Student Perceptions of Research With Family Medicine Career Choice.

The United States is facing a primary care physician shortage that is predicted to continue through the next decade. Determining why graduating medical students pursue a career in family medicine may inform efforts to help address this shortage. Medical student responses to the Family Medicine Attitudes Questionnaire (FMAQ), a 14-item validated questionnaire developed to assess student attitudes toward family medicine, were collected at 16 US medical schools and compared to each institution's proportion of graduates entering family medicine. We also analyzed subscales of the FMAQ, including attitudes toward family medicine lifestyle, research, importance, and shortages, with respect to student choice of family medicine. We used Pearson coefficients to calculate correlations. Student attitudes toward family medicine careers were strongly correlated with an institution's proportion of graduates entering family medicine. Positive perceptions of family medicine research by students was the factor most strongly correlated with matching into a family medicine residency. Strengthening students' exposures and perceptions of family medicine and family medicine research may create viable opportunities for intervention by departments of family medicine and medical schools seeking to increase the number of graduates entering family medicine.

The role of telemedicine in emergency situations with the provision of medical care in hard-to-reach areas of the North Caucasus

This article presents the scientific merits of telemedicine interventions in primary health care in hard-to-reach areas of the North Caucasus. Although there is no single and consistent definition of primary health care, most sources agree that it is central to the healthcare system as it is the first contact for patients seeking medical care. Growing concerns about sustainability and an expected shortage of primary care physicians have sparked interest in exploring the potential of telemedicine to address many of the challenges facing primary health care in the Nor th Caucasus.

The Nurse Licensure Compact's Effect on Telemedicine Usage.

As a result of a shortage of primary care physicians, considerable portion of patients in the US have difficulty accessing primary care. Telemedicine allows healthcare professionals to reach patients in shortage areas, but state-based occupational licensing laws make interstate practice difficult. The Nurse Licensure Compact (NLC) was designed to improve interstate practice for Registered Nurses (RNs), including telemedicine. Our preliminary analysis does not find evidence that the NLC is able to significantly increase telemedicine usage from out-of-state providers. Policymakers cannot rely on just the NLC to encourage the adoption of telemedicine; other regulations currently limit its adoption.

Abstract 15756: The Beneficial Impact of Primary Care Providers’ Supply on the Cardiovascular Mortality Rates in the United States: A Nationwide Population Analysis 2011-2019

Introduction: United States is facing an increasing shortage of primary care physicians (PCP) and health care demands. However, data on the relationship between PCP availability and burden of cardiovascular mortality (CVM) and related disparities, is limited. Hypothesis: Herein, we evaluate the nationwide impact of county PCP levels on CVM in overall and within disparate populations stratified by age, sex, and race/ethnic subgroups. Methods: PCP is calculated as the ratio of PCPs to the population, using data from National Center for Health statistics. Age-adjusted CVM rates (ACVM) between 2011 to 2019, were obtained using CDC database. Behavioral Risk Factor Surveillance was utilized to acquire county characteristics and confounders. Poisson linear mixed model was employed. Results: Of 3143 U.S. counties, 2900 counties (62% white; 51% female; 14% aged ≥65) had data available on ACVM and PCP.In a multivariate model adjusted for demographics, CV risk, socioeconomic, and environmental factors, higher PCP levels significantly associated with lower ACVM (Standardized IRR: 0.979; 95% CI: 0.972 to 0.986), which translates to 4.8 fewer CV deaths each year (AYD). This effect was relatively higher in middle-aged [45-64] (IRR: 0.967) versus elderly [≥65] (IRR: 0.980), males (IRR: 0.981) versus females (IRR: 0.972), and within Whites (IRR: 0.976). Notably, the relative impact of PCP was greatest in [45-64] Whites (IRR: 0.963), while the absolute impact was highest amongst ≥65 males with 36 fewer CV deaths each year. ( Figure ). Conclusions: Higher PCP supply is robustly associated with lower ACVM, and that beneficial effect is most evident amongst both age and sex subgroups as well as non-Hispanic whites. Moreover, this association is significantly independent of potential confounders that have a plausible association with CVM. Therefore, population-level strategies to promote primary care access, are imperative for reducing the burden of CVM and promoting health equity.

The impact of volunteering with a student-run free clinic on medical student specialty selection

BackgroundThe shortage of primary care physicians in the United States is expected to grow to 17,800–48,000 physicians by 2034. Student Run Free Clinics are an increasingly popular component of medical schools and may provide an avenue for increasing medical student interest in primary care specialties. However, there is limited research on the impact of Student Run Free Clinics on medical student specialty choice. This investigation sought to determine whether volunteering with the Interprofessional Community Clinic (ICC), the Student Run Free Clinic associated with Chicago Medical School, was associated with an increased likelihood of matching into primary care specialties. Secondarily, the authors investigated associations between volunteering and matching into family practice. Finally, the authors explored associations between volunteering and the competitiveness of specialty choice.MethodsThis retrospective review utilized data on medical school graduates from 2015 – 2021 including their matched specialties, the number of ICC shifts they volunteered for, and whether they held an ICC leadership position (executive officers). Primary care specialties were defined as internal medicine, family practice, pediatrics, or combined internal medicine/pediatrics. Residency fill rate was used as a proxy for competitiveness.ResultsThis analysis included 506 medical students (254 ICC volunteers and 252 non-volunteers). Among ICC volunteers, 47.2% matched into a primary care specialty compared to 36.5% of non-volunteers (RR 1.29, 95% CI 1.05–1.59). Each additional shift worked at the ICC was correlated with increased odds of matching into family practice by a factor of 1.042 (95% CI 1.005–1.079).ConclusionsMedical students who volunteered with the ICC were more likely to match into primary care residencies. Students who volunteered more frequently were more likely to match into family practice. Further investigation is warranted to determine whether these associations are causative and could thus be leveraged to encourage medical students to pursue primary care careers.

Association of UV Radiation Exposure, Diagnostic Scrutiny, and Melanoma Incidence in US Counties

Although UV radiation exposure is the conventionally reported risk factor for cutaneous melanoma, an alternative exposure is diagnostic scrutiny: the more physicians look for and biopsy moles, the more melanoma they find. To assess the association of proxies for UV radiation exposure and diagnostic scrutiny with geographical patterns of melanoma incidence. This was a cross-sectional ecological analysis of the 727 continental US counties reporting to the Surveillance, Epidemiology, and End Results (SEER) Program (among a total of 3108 counties). Environmental data relevant to UV radiation exposure (from a variety of sources), Health Resources and Services Administration data relevant to diagnostic scrutiny, and SEER data on melanoma incidence among the non-Hispanic White population diagnosed with melanoma from 2012 through 2016 were combined. Data analysis was performed between January 2020 and July 2022. Three UV radiation proxies (UV daily dose, cloud variability, and temperature variability) and 3 diagnostic scrutiny proxies (median household income, dermatologists, and primary care physician supply). Melanoma incidence (in situ and invasive cancers). In total, 235 333 melanomas were diagnosed. Proxies for UV radiation exposure changed gradually across geography, while melanoma incidence and proxies for diagnostic scrutiny changed abruptly across contiguous counties. The UV daily dose, a variable the National Cancer Institute specifically developed for melanoma analyses, was uncorrelated with incidence (r = 0.03; P = .42). For context, smoking prevalence was highly correlated with lung cancer incidence in the same counties (r = 0.81; P < .001). Melanoma incidence was correlated with median household income (r = 0.43; P < .001). Counties with no dermatologists and shortages of primary care physicians had the lowest incidence, while counties amply supplied with both had the highest, despite having lower mean UV daily dose. There was little association between melanoma incidence and melanoma mortality (r = 0.09; P = .05), while the analogous association in lung cancer was strong (r = 0.96; P < .001). In this cross-sectional ecological study, the current geographical pattern of melanoma incidence across US counties was less associated with proxies for UV radiation exposure and more so with proxies for diagnostic scrutiny. Incidence-the fundamental epidemiologic measure of disease frequency-now had little association with the feared outcome of melanoma: death.

We Need You Here! Predictors of Job Placement and Practice among New Mexico Family Medicine Residents.

Primary health care (PHC) is essential for a well-functioning health system. Although PHC has been shown to have adverse effects on health outcomes, many barriers prevent adequate access, including a shortage of primary care physicians. In New Mexico, 32 of 33 counties are designed as primary care health professional shortage areas, and the state has a lower-than-average primary care provider density compared with other states. This study explored the predictors of job placement among New Mexican Family Medicine residents. A retrospective cohort study design was used, which included a subset of data from The University of New Mexico (UNM) Family Medicine Residency Alumni Database and hard copy personnel files. The study's population consisted of the 260 graduates from the UNM Family Medicine Residency Program between 1998 and 2019. Analysis included simple and multiple logistic regression. Results indicated that, consistently, approximately two-thirds of first practices are in New Mexico, whereas the percentage with a current practice in New Mexico decreases over time. Those born in New Mexico or who attended the UNM School of Medicine were more likely to have their first and current practice in New Mexico. The results of this study provide further evidence that the relationship between place of birth and place of medical training are determining factors for both place of first and current practice. These results can inform practice, policy, and future research to address the pressing need for PHC in underserved and rural communities.

Factors Influencing Graduating Medical Students in Puerto Rico to Pursue a Primary Care Residency in the Continental United States.

Primary care physician shortage represents a challenge for many countries and territories, including Puerto Rico (PR), where a significant proportion of the graduating medical students preferred the continental United States (C-US) to complete their training and even as the definitive setting for their practice. We surveyed medical students who graduated from medical schools in PR and have been accepted in a residency program to evaluate the influence of a set of demographics, academic, and personal factors in their decision to pursue a primary care residency program in the C-US. A 19-item questionnaire was distributed by institutional email to those medical students who graduated from one of the four Liaison Committee on Medical Education fully accredited medical schools in PR in 2019. We summarized our data by frequency and percentages. We performed data analysis with statistical significance considered for P values &lt;.05. The questionnaire had a response rate of 51% (138/273), where 49% (67/138) were accepted in a primary care residency. Sixty percent (40/67) matched in a primary care program in the C-US. Among the evaluated factors, a prior degree in C-US (65%) and first-degree relatives living in the C-US (70%) were associated with students who matched in the mainland. First-degree relatives living in PR (96%) were associated with students who remained on the island for training. The results provide insight into the influence that personal factors have on the decision of medical students in PR to pursue primary care training in the C-US.