Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, MI.
Departments of Internal Medicine and Pediatrics, University of North Carolina, Chapel Hill.
Fam Med. 2020 May;52(5):332-338. doi: 10.22454/FamMed.2020.182557. Epub 2020 Mar 17.
Medical students who train in rural communities are often exposed to physicians practicing a broad scope of care, regardless of discipline. We examined how rural education is associated with practice specialization rates for students who match in primary care or general core specialties.
We linked practice and specialty data (2016 AMA Masterfile dataset), demographics (American Medical College Application Service data), and internal college data for 1974-2011 Michigan State University College of Human Medicine graduates who received clinical education on either the Upper Peninsula (rural) or Grand Rapids (urban) campuses. Current practice was verified using internet searches. We compared specialty and practice data by rural or urban campus, controlling for multiple variables.
More rurally-trained graduates entered primary care (PC) residencies (128/208, 61.5%) than urban-trained graduates (457/891, 51.3%; P<.01), with rurally-trained graduates being twice as likely to enter family medicine (FM) residencies. Most FM residents remained PC physicians (205/219, 93.6%). Internal medicine residents were least likely to remain in primary care (91/189, 48.1%). Of the general core disciplines, general surgeons were least likely to remain in general surgical practice (45/134, 33.6%). Within each PC or general core discipline, the proportion of graduates who specialized did not differ by type of campus.
Rurally-trained graduates are more likely to practice primary care, chiefly due to increased likelihood of choosing a FM residency. Graduates entering PC or general core residencies subspecialize at similar rates regardless of rural or urban education. FM residency match rate may be the best predictor of long-lasting impact on the primary care workforce.
在农村社区接受培训的医学生通常会接触到广泛的医疗服务，而不受专业限制。我们研究了农村教育与在基层医疗或一般核心专业中匹配的学生的专业实践率之间的关系。
我们将实践和专业数据（2016 年 AMA 主文件数据集）、人口统计学数据（美国医学学院申请服务数据）以及密歇根州立大学人类医学学院 1974 年至 2011 年毕业生的内部学院数据进行了关联，这些毕业生在半岛上（农村）或大急流城（城市）校区接受临床教育。使用互联网搜索来验证当前的实践情况。我们通过农村或城市校区比较了专业和实践数据，同时控制了多个变量。
更多接受农村培训的毕业生进入基层医疗（PC）住院医师培训（128/208，61.5%），而接受城市培训的毕业生为 457/891，51.3%（P<.01），农村培训的毕业生更有可能进入家庭医学（FM）住院医师培训。大多数 FM 住院医师仍然是 PC 医生（205/219，93.6%）。内科住院医师最不可能留在基层医疗（91/189，48.1%）。在一般核心学科中，普通外科医生最不可能留在普通外科实践（45/134，33.6%）。在每个 PC 或一般核心学科中，选择专业的毕业生比例与校区类型无关。
农村培训的毕业生更有可能从事基层医疗工作，主要是因为他们更有可能选择 FM 住院医师培训。进入 PC 或一般核心住院医师培训的毕业生无论接受农村还是城市教育，都会以相似的比例进行专业培训。FM 住院医师匹配率可能是对基层医疗劳动力产生持久影响的最佳预测指标。
