Context: Over a decade ago, leaders in rural medical education established the Rural Medical Educators (RME) Group, an interest group within the National Rural Health Association, to support faculty in rural medical education programs. This group has convened an annual RME conclave since 2006. In 2008, this conclave convened 15 national leaders in rural medical education at The University of Alabama. Methods: In preparation for the conclave, potential participants were e-mailed a set of questions regarding their respective medical education program's initiating motivation, support, resistance, resources, accomplishments, and continuation plans. Analysis of participants' responses resulted in a question guide that was used at a focus group conducted at the conclave. Purpose: The purpose of the focus group was to explore the experiences of established rural medical educators related to program development and maintenance. The focus group was recorded and transcribed, and then analyzed using the constant comparative method. Findings: Five essential elements for rural medical education programs emerged from the analysis. The elements were: admit the right student, include curricular elements that occur and are required in rural training sites, establish a cadre of rural physicians who are dedicated to education of their successors, secure financial and relational support for the program, and evaluate program progress. Discussion and Conclusions: Discussion about these 5 elements can provide program guidance to neophyte rural medical education programs. Five recommendations are presented in an effort to continue discussion about the essential elements and identify actions that rural medical educators can take to further assist developing programs.

Background: With healthcare costs increasing faster than inflation in the United States. it is expected that fewer people will be able to afford health care in the future without changes to the healthcare system. It has been argued that much of the healthcare utilization presently observed is unnecessary and that a large portion of this wasteful spending can be attributed to the characteristics of local area physician supply and specialty mix. These arguments are based on observed positive correlations between local area health utilization and the local area supply of physicians and physician specialists. Commentators suggest that greater physician supply leads to the use of more physicians by patients resulting in diffuse, uncoordinated, and wasteful care. There have been calls for modifying the physician training system in the United States based on these correlations. However, we have found no studies demonstrating direct relationships between local area physician supply and the use of physicians by individual patients. Studies in physician-induced demand theory have examined the relationships between physician supply and healthcare utilization, whereas studies of physician referrals have only investigated the effects of local supply on referral rates not the number of physicians used by patients. Method: We isolated a set of patients with a consistent diagnosis and course of treatment (stage III colorectal cancer Medicare patients receiving surgery and chemotherapy but not radiation therapy) and investigated whether local area physician supply leads to the use of more physicians by these patients and more diffuse care across physicians during their first treatment course. Result: Our results show that not only the specialists' characteristics but also the market level variable as local physician supply affect the care dispersion in terms of numbers and specialty mix of physicians treating colorectal cancer patients with the same condition. Discussion: According to these findings, it is suggested that local physician supply has the causal relationship between the patterns of care dispersion. Supply of primary care physicians and oncology specialists tend to spur the physician utilization across four specialty groups which are more likely to have discretionary utilization.

Social life, and particularly health care delivery, in a small isolated community is more complex and nuanced than has been reflected in much of the literature on physician retention, which has never extended the notion of the “workload” past the physician’s formal role in the health care setting. Despite having been acknowledged by provincial and national government policies, few of what Anderson and Rosenberg (1990) describe as “unidimensional solutions” have resolved the “multidimensional issues” of physician retention in northern Canada. This thesis employs a qualitative framework to investigate the practice and lifestyle experiences of general practitioners on the Queen Charlotte Islands (Haida Gwaii) to provide a local analysis of physician retention problems experienced by isolated communities. By including both physicians and community members as key informants, the project attempts to determine whether a difference exists between physicians’ perceptions of place and their roles and the voiced expectations of the communities they serve. The research uses a combination of in-depth interviews and questionnaires with physicians (n=6) and community members (n=12) to determine the various roles played by a physician in a small community. It queries whether the community in question expects physician to take up roles outside of the medical space, whether physicians are influenced by these expectations and whether these may contribute to the cessation of practice in remote communities. This thesis examines not only health care-related factors involved in medical practice, but also the informal settings of the community at large, including the general interactions that are incorporated into a physician’s character in a close-knit and isolated place. The findings of the thesis demonstrate that there are significant gaps between what community members and physicians believe is reasonable behaviour and the reality of physicians’ experiences in their respective island communities. The lack of boundaries perceived by physicians in their communities often leads to social isolation, which has the opposite intended effect of respite, instead leading to further disengagement from the local community, finally resulting in a decision to locate elsewhere. / Thesis (Master, Geography) -- Queen's University, 2009-09-26 18:55:16.51