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Purpose: Physicians of all specialties are more likely to live and work in urban areas than in rural areas. Physician availability affects the health and economy of rural communities. This study aimed to measure and update the availability of physician specialties in rural counties. Methods: This analysis included all counties with a Rural‐Urban Continuum Code (RUCC) between 4 and 9. Geographically identified physician data from the 2019 American Medical Association Masterfile was merged with 2019 County Health Rankings, the Census Bureau's 2010 county‐level population data, and 2010 Topologically Integrated Geographic Encoding and Referencing shapefiles. Multivariate logistic regression was performed to assess the availability of physicians by specialty in rural counties. Findings: Of the 1,947 rural counties in our sample, 1,825 had at least 1 physician. Specialties including emergency medicine, cardiology, psychiatry, diagnostic radiology, general surgery, anesthesiology, and OB/GYN were less available than primary care physicians (PCPs) in all rural counties. The probability of a rural county having a PCP was the highest in RUCC 4 (1.0) and lowest in RUCC 8 (0.93). Of all primary care specialties, family medicine was the most evenly distributed across the rural continuum, with a probability of 1.0 in RUCC 4 and 0.88 in RUCC 9. Conclusions: Family medicine is the physician specialty most likely to be present in rural counties. Policy efforts should focus on maintaining the training and scope of practice of family physicians to serve the health care needs of rural communities where other specialties are less likely to practice. [ABSTRACT FROM AUTHOR]

Background and Objectives: Maternity care training is a standard requirement for all family medicine residents, and family physicians play a critical role in the US maternity care workforce. In 2014, the Accreditation Council for Graduate Medical Education (ACGME) updated the required obstetrical experience during family medicine residency training from a volume-based to a competency-based requirement of 200 hours (2 months rotation). This study aimed to determine if family medicine resident maternity care training experience differed after this change in requirements.Methods: A nationwide survey of family medicine program directors was conducted as part of the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey, replicating a 2013 CERA survey to determine if there was a change in family medicine resident maternity care experience after the ACGME requirements update.Results: The priority programs place on residents' continuity deliveries and family medicine faculty attending deliveries decreased between 2013 and 2019. The reported number of continuity deliveries and vaginal deliveries performed by residents also decreased significantly between 2013 and 2019, yet the program directors' estimate of the number of graduates going on to provide obstetric deliveries or pursue a maternity care fellowship did not change significantly. Programs reporting more than 25% of graduates continuing to conduct vaginal deliveries have reported similar numbers of vaginal deliveries per resident as in 2013.Conclusions: The majority of family medicine residents are graduating with less delivery experience, and residency programs are placing less priority on continuity deliveries and modeling by family physician faculty following the 2014 ACGME Family Medicine Requirements update. This trend may have major implications on the comprehensive nature of our specialty and further widen gaps in the maternity care workforce. Further studies are needed to determine the impact on the competency of graduating family medicine residents in providing maternity care and for the long-term effects on the maternity care workforce. [ABSTRACT FROM AUTHOR]

Background and Objectives: Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency.Methods: We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics.Results: Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center.Conclusions: FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide. [ABSTRACT FROM AUTHOR]

Background and Objectives: Little is known about how family medicine clerkship directors (FMCDs) handle reports of student mistreatment. We investigated FMCDs' involvement in handling and resolving these reports.Methods: We collected data as part of the 2019 CERA survey of FMCDs. FMCDs provided responses on how they handled student mistreatment reports and their comfort level in resolving these reports.Results: Ninety-nine out of 142 FMCDs (69.7%) responded to the survey. Regarding mistreatment reports, 24.2% of FMCDs had received at least one report of student mistreatment about full-time faculty in the past 3 years, compared to 64.6% of FMCDs receiving at least one report about community preceptors (P<.001). Regarding who determined the response to the mistreatment, 13.1% of FMCDs were the highest level of leadership responsible for stopping use of a full-time faculty member for mistreatment concerns, while 42.4% of FMCDs were the highest level of leadership responsible for stopping use of a community preceptor. Regarding their comfort level in resolving mistreatment reports, 59.1% of FMCDs were either somewhat or very comfortable resolving a mistreatment report about a community preceptor, while only 48.9% reported those comfort levels for full-time faculty. FMCDs who had previously stopped using full-time faculty and/or community preceptors due to mistreatment reports were less likely to feel comfortable with resolving reports about full-time faculty compared to those who had no such experience (P=.03).Conclusions: FMCDs more frequently receive mistreatment reports about community preceptors than full-time faculty and are more likely to be the highest decision maker to stop using a community preceptor for mistreatment concerns. Further study is needed to elucidate factors that affect FMCDs' comfort in handling student mistreatment reports. [ABSTRACT FROM AUTHOR]

The article discusses the role of the journal in the history of the field of lactation and the professionalization of breastfeeding support. It mentions that the World Health Organization (WHO) and United Nations Children Fund (UNICEF) prioritized the issue of unethical formula marketing and its influence on infant health.

Background and Objectives: Board certification programs have been criticized as not relevant to practice, not improving patient care, and creating additional burdens on already overburdened physicians. Many physicians may feel compelled to participate in board certification programs in order to satisfy employer, hospital, and insurer requirements; however, the influence of forces as motivators for physicians to continue board certification is poorly understood.Methods: We used data from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification Examination practice demographic registration questionnaire for those seeking to continue their certification, removing physicians who indicated they did not provide direct patient care. We utilized a mixed-methods design. For the quantitative analysis, a proportional odds logistic regression was used to examine the association between predictor variables and increasing levels of external motivation. For the qualitative analysis, we used a deductive approach to examine open-text responses.Results: Of the analytical sample of 7,545 family physicians, approximately one-fifth (21.4%) were motivated to continue their board certification solely by intrinsic factors. Less than one-fifth (17.3%) were motivated only by extrinsic factors, and the majority (61.2%) reported mixed motivations for continuing their board certification. Only 38 respondents (0.5%) included a negative opinion about the certification process in their open-text responses.Conclusions: Approximately half of family physicians in this sample noted a requirement to continue their certification, suggesting that there has been no significant increase in the requirements from employers, credentialing bodies, or insurers for physicians to continue board certification noted in previously cited work. Furthermore, only 17.5% of our sample reported solely external motivation to continue certification, indicating that real or perceived requirements are not the primary driver for most physicians to maintain certification. [ABSTRACT FROM AUTHOR]

Background and Objectives: The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in their practices. The objective of this study was to understand barriers to providing obstetrical care faced by recent family medicine residency graduates who intended to provide obstetrical care at graduation.Methods: Email surveys were sent to graduating family medicine residents who indicated intention to include obstetrics in their practice on the American Board of Family Medicine (ABFM) Certification Examination Registration Survey (2014-2016). We used descriptive and bivariate statistics to analyze the data.Results: Of our sample of 2,098 early career family physicians, 1,016 (48.4%) responded. Seven hundred (68.9%) currently include obstetrics in their practices. Those currently including obstetrics were more likely to practice in a small rural or isolated (15.4% vs 5.2% and 4.6% vs 1.7%, P<0.001) community and report credentialing was easy (85.2% and 26.5%, respectively, P<0.001). Physicians not currently including obstetrics in their practice reported "found a job without OB" and "lifestyle concerns" as the most significant barriers. Respondents living in the Middle Atlantic and West South Central regions were least likely to provide obstetric deliveries, with fewer than 50% doing so.Conclusions: Among recent graduates who intended to practice obstetrics, finding a job without obstetrics and lifestyle concerns were the most significant barriers to realizing the scope of practice they intended. [ABSTRACT FROM AUTHOR]

Background: Family Medicine‐Obstetrics fellowships provide family physicians with advanced obstetrics training. No accreditation system exists for these fellowships, which leads to variable training. Variation of fellows' experiences is not well understood. Our objective is to understand the motivations, training, and overall experiences of fellows in Family Medicine‐Obstetrics fellowships, which may inform opportunities for improvement in fellowship design and suggest how Family Medicine‐Obstetrics fellowship‐trained physicians are prepared to practice among other obstetrics providers postgraduation. Methods: We conducted semistructured interviews with current and past Family Medicine‐Obstetrics fellows between Spring 2014 and Winter 2015. We used a snowball sampling approach. Interviews were recorded, transcribed, and coded following an inductive approach to content analysis. Results: We contacted 47 and interviewed 21 current and past Family Medicine‐Obstetrics fellows from 15 programs from across the country. Fellowships varied in cohort size, length, co‐occurring presence of obstetrics and gynecology training programs, and structure and curriculum. Interviewees were motivated to complete a fellowship because of inadequate obstetrics training in residency, or because of an interest in rural or urban underserved practice. Fellowship experiences were shaped by fellowship leadership, program structure and curriculum, and relationships with obstetricians. Some felt prepared to forge collaborative professional relationships with obstetricians. Conclusions: The diversity of fellows' experiences suggests possible avenues of improvement for Family Medicine‐Obstetrics fellowships. These fellowships can prepare physicians to provide obstetric services in a variety of settings, including working in multispecialty integrated maternity care systems. [ABSTRACT FROM AUTHOR]

Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design. [ABSTRACT FROM AUTHOR]

This article shares the problem-solving process and resultant rapid sensemaking methodology created by an interdisciplinary research team faced with qualitative "big data." Confronted with a data set of over half a million free text comments, within an existing data set of 320,500 surveys, our team developed a process to structure the naturally occurring variability within the data, to identify and isolate meaningful analytic units, and to group subsets of our data amenable to automated coding using a templatebased process. This allowed a significant portion of the data to be rapidly assessed while still preserving the ability to explore the more complex free text comments with a grounded theory informed emergent process. In this discussion, we focus on strategies useful to other teams interested in fielding open-ended questions as part of large survey efforts and incorporating those findings as part of an integrated analysis. [ABSTRACT FROM AUTHOR]

Background and Objectives: The breadth of family medicine (FM) generates debate about the length of residency training. One argument used by proponents for lengthening training is that residents feel unprepared for practice. The objectives of our study were to (1) identify the proportion of FM residency graduates intending to pursue fellowship training and those who would have done an additional year of core residency training had it been available, and (2) determine whether an association exists between these two variables.Methods: We used data collected by the American Board of Family Medicine (ABFM) as part of resident certification examination application in 2014 and 2015. Data included fellowship intention, and interest in pursuing another year of residency training if it were available. We used descriptive and bivariate statistics.Results: The questionnaire was completed by 6,235 residents, of which 17.0% (n=1,063) intended to enroll in a fellowship. Overall 54.2% of residents were "not at all likely" to extend residency training, with 19.9% "extremely/moderately likely". Forty-six percent of those intending a fellowship were "not at all likely" to extend training and only 29% of those "extremely/moderately likely" to extend residency training intended to enroll in a fellowship.Conclusions: We found a disconnect between fellowship intention and desire for another year of residency training. Desire for fellowship may be more about obtaining specific skills and expertise or additional certifications, and less about being prepared for general practice in family medicine. [ABSTRACT FROM AUTHOR]

Background and Objectives: Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ).Methods: In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached.Results: Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization.Conclusions: Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations. [ABSTRACT FROM AUTHOR]

Family physicians who report their race as "Other" in a single best option question find the existing categories and forced choice of one category to be problematic. Our analysis of open-text responses in the "Other" race category supports a modification in the way these data are collected to provide more accurate and meaningful ways to understand the workforce and move toward more diverse, equitable, and inclusive policies in family medicine., Competing Interests: Conflicts of interest: Drs. Eden, Taylor, and Wang are employees of the American Board of Family Medicine., (© Copyright by the American Board of Family Medicine.)

Background: While barriers to care for pregnant patients with opioid use disorder (OUD) have been described, the experiences and challenges of the physicians providing care to these patients are poorly understood., Objectives: To describe the experiences of family physicians providing comprehensive care to pregnant people with OUD and the challenges they face in providing such care., Methods: Qualitative thematic analysis of 17 semistructured interviews conducted from July 2019 to September 2020 with family physicians who possess a Drug Enforcement Administration "X" waiver and provide care to pregnant patients., Results: Seventeen family physicians practicing in the United States who care for pregnant people with OUD were interviewed. They described physician-, patient-, and systems-level barriers to providing and accessing care for this patient population. Of the 12 interrelated themes regarding challenges to delivering and accessing this care, 3 were particularly salient: the pervasive effects of social determinants of health, a lack of adequately trained providers, and social stigma associated with pregnant people with OUD., Conclusion: A comprehensive, multilevel, and multidisciplinary approach is necessary to address these barriers and move towards health equity for this vulnerable patient population., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)