More details on Accelerated Family Medicine Training Programs
Robert C. Bowman, M.D.
Accelerated family medicine training programs involve 3 years of medical school and 3 years of family medicine training. At least 15 medical schools had accelerated programs at one time, although only a few departments developed mature programs (Tolleson).1 Students were selected based on maturity and mid to upper academic standing (Bratton).2 Not surprisingly, accelerated graduates did very well academically and have contributed in teaching and leadership areas during and after residency (Petrany and Crespo)3. (Galazka, Zweig, Young)4.
Accelerated programs were not designed to address specific workforce needs, but they have done so. Graduates have taken a number of teaching positions. 3 Graduates have chosen rural practice at a much higher rate. In studies involving 142 recent graduates of the past 7 years, 48% of accelerated graduates chose rural locations. Nebraska had 28 graduates with 20 (71%) in rural locations. Nebraska's rural results were understandable, since this program selected at trained specifically for rural practice. Over 80 % opted for an extra year of a rural/procedural fellowship (Stageman, Bowman, Harrison)5 However the rural choices of other programs were remarkable. Creighton’s 6 graduates had a 50% rural graduation rate, Kentucky 9 with 78%, Case Western 8 with 38%, Medical College of Ohio 9 with 67 %, East Tennessee 18 with 50%, University of Tennessee 14 with 64%, East Carolina 6 with 56%, University of South Alabama 10 with 60%, and Marshall 13 with 15%. The percentage of 120 graduates choosing any size of rural practice according to birth location (by RUCA coding):
|
Birth Location |
Rural % by Accelerated FP |
Rural % by Usual FP |
|
Urban |
48.8% |
15.7% |
|
Large Rural |
42.1% |
35.5% |
|
Medium Rural |
63.6% |
33.7% |
|
Isolated Rural |
87.5% |
33.6% |
| Urban Under-served | Rural Under-served | All Rural | Rural Not MMC | Major Medical Center | Teaching | ||
| Not Accelerated | 20815 | 5.1% | 6.3% | 20.5% | 17.3% | 50.6% | 3.2% |
| Accelerated | 136 | 0.7% | 14.0% | 44.1% | 42.6% | 35.3% | 5.9% |
| Control in Same Residency | 587 | 3.1% | 10.4% | 27.9% | 25.4% | 46.8% | 4.4% |
| Control in Same Med Sch and Residency | 249 | 7.2% | 8.8% | 32.1% | 26.5% | 45.0% | 3.2% |
| Same Med School Diff Residency | 1026 | 4.2% | 8.5% | 28.1% | 23.1% | 46.9% | 2.5% |
| 22813 | 5.0% | 6.6% | 21.3% | 18.1% | 50.1% | 3.2% |
see Distribution: Index Concentrations of Physician Distribution
Significant Findings
Accelerated family medicine residency programs are able to enhance rural distribution of urban born, female, and possibly foreign born family physicians. These are major directions of medical school admissions trends.
Accelerated graduates had greater concentrations in rural underserved areas
Accelerated graduates were 56% older than 29 years at medical school graduation, one of the oldest groups and twice the 28% level of family physicians and 3 times the level of elite medical school graduates with 18% older.
Accelerated graduates supplied distributional locations at the highest levels for all types of physicians and also supplied higher levels of teaching positions
Graduates chose practice locations in the state of their residency 79% of the time.
Accelerated training greatly improves rural location rates in rural born students.
Female graduates were no different than males in percentage choosing rural and the size of small town practice both by location and by birth origin. This contrasts with previous graduate literature and has been replicated only by special admissions programs based on rural background and interest in FP and rural practice. 6,7
Accelerated programs involve more active "hands-on" patient care responsibilities earlier. The success of the program brings larger questions about what happens to those who would choose accelerated programs at other medical schools. Do they opt for other specialties? Do they suffer retardation of their development and training such that they are less able to choose underserved locations? What would happen with 6 years of training, including admissions? There is also potential to extend the model to inner city (COPC/public health), international (overseas family medicine development or missions preparation), or additional faculty development (teaching, research).
State legislatures may be more than willing to assist graduate programs that retain state educational investments and improve economics and access in underserved areas. States with significant rural populations are typically “donor” states, losing significant numbers of graduates to high growth or high recruitment states. Widespread application of the accelerated model would add workforce flexibility that the nation has yet to experience, addressing the needs of rural and academic communities.
It is indeed ironic that many medical leaders blame poor rural economics on the lack of rural physicians, when clearly the selection of the right students 6,7 and the development of the right medical education programs can address rural economics. Eliminating an accelerated model with superior outcomes, one that is perhaps the "most family medicine" of all curricula, one that has achieved much of what family medicine was designed and funded to do, has been a bad decision for the country.
It is a critical time for family medicine nationwide, and for rural communities. Each year means fewer students admitted who are more likely to choose family medicine and rural practice. Rural born medical students are down 55% over the past 25 years.8 The urban students who are now increasing in numbers in US medical schools are half as likely to choose family medicine and far less likely to choose rural practice. Any training model that facilitates rural practice choice in urban origin students is a model that should be replicated, not terminated. The Nebraska model has adapted to a senior year track. It is not known whether other accelerated programs will survive.
The work to develop such a program is not easy, involving special efforts in a variety of facilities and dimensions involving licensing, billing, curricular modifications, added responsibilities for faculty and residents, and scheduling modifications. However the outcomes in graduates, workforce, and program impacts are significant.
More details on Accelerated Family Medicine Training Programs
Accreditation and Demands of Rural Practice
References