|
FP Grads 1997 - 2003 |
Urban |
Large Rural |
Rural |
Isolated Rural |
|
US population 1998 est |
77.6% |
9.3% |
6.9% |
6.1% |
|
FP Grads 1997 - 2003 |
78.9% |
9.8% |
9.5% |
4.8% |
|
Duluth med school grads doing any FP % |
54.2% |
13.6% |
18.1% |
14.1% |
|
U of MN grads doing any FP program % |
76.4% |
7.3% |
12.1% |
4.2% |
|
UNMC ARTP (part rural admit + training) |
31.3% |
18.8% |
28.5% |
28.1% |
|
UNMC RTT (full rural admit + training) |
11.1% |
33.3% |
25.9% |
29.6% |
|
South Dakota FP (full rural admit) |
53.4% |
11.6% |
14.6% |
20.4% |
|
South Dakota RTT n=5 (full rural admit + training) |
0% |
20% |
20% |
60% |
Traditional Medical Education vs Enhanced Medical Education Using RME
Duluth is a 2 year medical school that selects medical students primarily for their potential to become rural family physicians. Rural background is a key characteristic (Boulger – Duluth studies). Duluth students join other University of Minnesota students in Minneapolis for their final two years. Studies show that both groups have graduated about 80 rural family physicians from 1997 - 2003, although the class size of the parent is much larger than that of Duluth (Bowman FP Grads 2004). Here is the distribution of each regarding the type of rural location. Large rural is RUCA 4 – 6, rural is RUCA 7 – 9, and Isolated rural is RUCA 10. The urban focused codes are 1 – 3, 4.1, 7.1, and 10.1.
The Duluth graduates that chose family medicine are much more likely to choose family medicine all three rural categories, particularly the most isolated rural locations by over 3 to 1. Comparisons with the table below reveal the difference in outcomes. US pop distribution is in the final column with 6.1% in isolated rural locations
How Important is Graduation to the Isolated Rural Category?
Consider the distribution of family physicians in the nation who graduated from residency during 1997 to 2003 in the table above.
More widespread implementation of the Duluth model across the nation would be more likely
1. To improve the numbers of rural background students and
2. To distribute family physicians to the most rural areas of the nation.
It is important not to discount the role of the Rural Physician Associate Program (RPAP) in preparing such physicians for rural practice. RPAP students spend 9 months with a rural family physician in the third medical school year. Equivalent numbers of Duluth and U of MN students have taken RPAP during this time period. The combination of Duluth selections and environment, coupled with intensive and specific rural medical education, is a powerful weapon to combat one of the most persistent and troubling areas of medical education – maldistribution. In addition some 60 RPAP students have returned to the rural sites of their 9 month experience. The value of such graduates is difficult to calculate in terms of recruitment cost, orientation cost , and acceptance by patients, a key factor in rural practice. Towns that get involved with training may aso be more willing to embrace the final product.
Rural background and admissions may be the foundation of rural medical education, but specific rural training may be the icing on the cake. Again review the impact of specific rural training such as Rural Training Tracks and Accelerated Rural Training Programs as noted above in the table.
Side Effects of Selecting for Family Medicine
Medicine, Education, and Social Status