Studies
Studies Conducted by the WWAMI Rural Health Research Center
RHRC studies in progress are listed below. Search all studies by using the “Advanced Search” button or “Studies by Topic” menu at the right. 
Current Studies: 22
The Aging of the Rural Generalist Physician Workforce: Will Some Locations Be More Affected than Others?
This study will identify rural locations with high proportions of generalist physicians nearing retirement age. As fewer young physicians choose generalist careers, the retirement of older physicians may place additional strain on rural generalist supply. This study is quantifying the extent to which rural generalist physician shortages may be exacerbated by physician retirement, focusing on known shortage locations. The study uses data from the American Medical Association and American Osteopathic Association 2005 Masterfiles. This study is funded by HRSA's Office of Rural Health Policy.
Doescher MP, Fordyce MA, Skillman SM. The aging of the U.S. generalist physician workforce: are rural locations at higher risk? Poster presented at 2010 International Medical Workforce Collaborative Conference, New York, New York, 5/2/10. |
Doescher MP, Fordyce MA, Skillman SM. The aging of the rural primary care physician workforce: are some locations more vulnerable than others? Poster presented at AcademyHealth Annual Research Meeting, Chicago, Illinois, 6/28-30/09. |
Doescher MP, Fordyce MA, Skillman SM. Policy brief: the aging of the primary care physician workforce: are rural locations vulnerable? Seattle, WA: WWAMI Rural Health Research Center, University of Washington; Jun 2009.  Policy brief. |
Doescher MP, Fordyce MA, Skillman SM. The aging of the rural generalist physician workforce: are some areas affected more than others? Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/19/09. |
Community Colleges' Contributions to the Education of Allied Health Professionals in Rural Areas of the United States
This study will identify rural-serving community colleges across the United States and their five-year graduation trends for specific allied health professions, examine the spectrum of how rural allied health professions education currently is being allocated and delivered, and explore how community economic status and estimated regional allied health workforce demand is associated with the availability of rural community college allied health education programs. Funded by HRSA's ORHP.
Institute of Medicine. Community colleges and the education of allied health professionals in rural areas (summary of presentation by SM Skillman). In: Institute of Medicine. Allied health workforce and services: workshop summary. Washington, DC: The National Academies Press; 2011:42-44. |
Skillman SM, Keppel GA, Patterson DG, Doescher MP. The contributions of community colleges to the education of allied health professionals in rural areas. Poster presented at AcademyHealth Annual Research Meeting, Seattle, Washington, 6/12/11. |
Skillman SM, Keppel G, Patterson D, Doescher MP. The contributions of community colleges to the education of allied health professionals in rural areas. Presented at Institute of Medicine Workshop on Allied Health Workforce and Services, Washington, DC, 5/9/11. |
Skillman SM, Keppel GA, Patterson DG, Doescher MP. The contributions of community colleges to the education of allied health professionals in rural areas. Poster presented at National Rural Health Association 34th Annual Rural Health Conference, Austin, Texas, 5/5/11. |
Skillman SM, Keppel G, Patterson D, Doescher MP. The contributions of community colleges to the education of allied health professionals in rural areas. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/27/11. |
Skillman SM, O'Halloran R, Kuebel H, Fulcher R, Adams E. Community colleges' contributions to health workforce development in rural communities: what are the best practices and how do we know them when we see them? Presented at 2010 National Rural Health Association Annual Meeting, Savannah, Georgia, 5/21/10. |
Have Rural Perinatal Health Outcomes Changed Over the Past Two Decades?
This study will determine whether rural-urban disparities in late prenatal care initiation and post-neonatal mortality found in the mid-1980s have persisted, narrowed, or increased. It will also determine whether, given the decreasing number of family physicians practicing in rural areas, maternal and infant outcomes have been deteriorating among rural populations. Funded by HRSA's Office of Rural Health Policy.
Baldwin LM, Fordyce MA, Doescher MP. Maternal and infant health in rural America. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/14/12. |
Doescher MP, Fordyce MA, Baldwin LM. Predictors of negative birth outcomes in rural locations. Presented at Health Outcomes Among Children and Families Living in Rural Communities Conference, National Institute of Child Health and Human Development, Bethesda, Maryland, 12/2011. |
The Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
This multi-state study will examine the practices of rural physicians, advanced practice nurses (APNs), and physician assistants (PAs) regarding their primary care visit productivity and scope of practice. Through surveys, this study will examine the contributions of physicians, APNs, and PAs by state, degree of practice rurality, practice characteristics, and primary care HPSA status in order to provide information on a range of rural primary care workforce needs in the coming decades. Funded by HRSA's Office of Rural Health Policy.
General Center Presentations
We periodically present overviews of research findings and policy issues to different audiences. References to these presentations are listed below.
Skillman SM. Policy implications of primary care practice redesign with and without payment reform: summation panel. Presented at The Primary Care Workforce Crisis: Driving Health Policy Change through Innovation, Seattle, Washington, 5/25/11. |
Skillman SM. The rural health workforce: building on what we know. Presented at National Organization of State Offices of Rural Health, National Workforce Summit, Laramie, Wyoming, 8/19/09. |
Skillman SM. The right mix: linking the workforce to patient and health outcomes. Moderator of session at AcademyHealth Annual Research Meeting, Chicago, Illinois, 6/28-30/09. |
Skillman SM. Wyoming Healthcare Commission workforce project: the role of the University of Washington (WWAMI) Center for Health Workforce Studies and Rural Health Research Center. Presented to Wyoming Healthcare Commission, Cheyenne, Wyoming, 10/13/08. |
Skillman SM. Studies of access to care: University of Washington Rural Health Research Center and Center for Health Workforce Studies. Presented at Measuring Healthcare Access--Washington State Interagency Idea Exchange, Olympia, Washington, 8/21/08. |
General Rural Health Research Center Presentations
We periodically present overviews of research findings and policy issues to different audiences. References to these presentations are listed below.
Doescher MP, Cole A. Receipt of colorectal cancer screening among rural and urban minority group members. Presented at Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 1/31/12. |
Patterson DG. Current health workforce research at the WWAMI Rural Health Research Center. Presented at National Organization of State Offices of Rural Health Region E Meeting, Juneau, Alaska, 7/28/11. |
Doescher MP. Tale of two specialties: general surgery and family medicine in rural America. Presented at Grand Rounds, University of Minnesota School of Medicine, Duluth, Minnesota, 4/2011. |
Skillman SM. Update: University of Washington WWAMI Rural Health Research Center. Presented at National Organization of State Offices of Rural Health Region E Meeting, Laramie, Wyoming, 8/20/09. |
Policy Analyses of Rural Issues Related to Health Care Reform
Since 2009, the WWAMI RHRC has carried out several rapid-turnaround analyses of rural issues related to health care reform. The published products of these analyses have been posted to the WWAMI RHRC Web site.
Doescher MP. Informing rural primary care workforce policy: what does the evidence tell us? Presented at Rural Health Research Gateway Webinar, 9/2010. |
Doescher MP. Can health care reform resuscitate rural primary care in our region? Presented at 23rd Northwest Regional Rural Health Conference, Spokane, Washington, 3/24/10. |
International Medical Graduates on J-1 and H-1B Visas: Understanding Trends in their Contributions to Health Care Delivery for Rural Underserved Populations
This study will identify trends and data needs regarding the contributions of international medical graduates (IMGs) on J-1 and H-1B visas to rural health care delivery. A workgroup of IMG research and policy stakeholders will be established to help identify IMG supply data trends, needs, and pressing policy issues; lay the groundwork for potential areas of study, data integration, and data collection; and strengthen the policy relevance of our work. Funded by HRSA's ORHP.
Patterson DP. The contributions of international medical graduates to healthcare for rural and underserved populations: a reference list, 2000-2010. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; Jun 2010. Reference list. |
Rural-Urban Nurse Practitioner Distribution and the Influence of Physician and Physician Assistant Supply
While nurse-practitioners (NPs) may play an important role in alleviating persistent workforce shortages in rural areas, little is known about their rural-urban distribution and even less is known about how rural NP distribution is affected by physician and physician assistant (PA) supply in these locations. This study will explore rural-urban differences in NP supply as well as physician and PA supply using licensure data from 13 geographically-dispersed states. Study questions include: (1) What is the per capita supply of NPs in rural and urban locations? (2) What are the associations between this NP supply and the per capita supply of physicians and PAs in these rural and urban settings? The study population will be assembled from state licensure board data containing the practice location of NPs, physicians, and PAs in AZ, GA, ID, IA, KY, ME, MN, OH, OK, OR, TX, VT, and VA. Having estimates of rural NP supply will help clarify workforce solutions and guide training efforts and recruitment and retention activities for future rural NPs. Funded by HRSA's Office of Rural Health Policy.
The Pre-hospital Emergency Medical Services Workforce in Rural and Urban Areas
Rural populations frequently reside great distances from hospital emergency departments or urgent care facilities, underscoring the need for timely and effective pre-hospital emergency medical services (EMS). Numerous reports and anecdotal evidence indicate that rural EMS agencies face significant resource challenges in terms of sustainable funding, staff recruitment and retention, and staff skill maintenance. Reliable data to quantify the extent of these problems have been lacking. This project aims to quantify systematically workforce supply and demand disparities between rural and urban EMS systems in a sample of states distributed across the U.S. Study results will inform policy options to ensure an adequate supply of EMS personnel in rural areas. This study will analyze secondary data collected via a 2008 telephone survey of all ground-based pre-hospital EMS providers in nine states. Analyses of EMS agency service area coverage, patient volume, funding basis, organizational type, staffing, vacancies, and medical direction will yield statistical comparisons between urban and three subcategories of rural areas. Findings on rural-urban EMS resource distribution will also be displayed in maps for each state. Funded by HRSA's Office of Rural Health Policy.
Patterson DG, Fordyce MA, Skillman SM, Doescher MP, Bolton PA, Williams I. The pre-hospital emergency medical services workforce in rural areas: results from a survey in nine states. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/14/12. |
Problem Drinking: Trends Among Rural Veterans--A National Study
This study will use national data to measure recent trends in problem drinking among VA-eligible adults in rural and urban locations and couple these data with the locations of VA services and substance abuse treatment facilities to identify rural locations where alcohol treatment services are limited. This project is funded by the Veterans Administration Office of Rural Health, through a contract with the northwest Portland, Oregon, Veterans Affairs Medical Center.
Doescher MP, Jackson JE, Patterson DG, Skillman SM. Association between problem drinking and access to Veterans Administration health care services among rural veterans, 2003-2004. Poster presented at 2010 AcademyHealth Annual Research Meeting, Boston, Massachusetts, 6/27/10. |
Doescher MP, Jackson JE. Where do veterans with problem drinking receive health care? A national study. Poster presented at AcademyHealth Annual Research Meeting, Chicago, Illinois, 6/28-30/09. |
Do Rural Patients with Early Stage Prostate Cancer Gain Access to All Treatment Choices?
This research will use cancer registry data from 10 states to examine the degree to which rural residents diagnosed with early-stage prostate cancer access the full range of surveillance, surgical, and radiation treatment options. Study findings will inform cancer centers, advocacy groups, rural program planners, and policymakers about services and programs needed to ensure that rural prostate cancer patients can choose from among all treatment options.
Baldwin LM, Andrilla CHA, Porter MP, Rosenblatt RA, Patel S, Doescher MP. Use of different treatment options by rural early stage prostate cancer patients. Poster presented at 2010 AcademyHealth Annual Research Meeting, Boston, Massachusetts, 6/27/10. |
Baldwin LM. Are rural cancer patients with early stage prostate cancer accessing all treatment choices? Presented at 23rd Northwest Regional Rural Health Conference, Spokane, Washington, 3/24/10. |
Use of Recommended Radiation Therapy in the Rural U.S.
This study will use cancer registry data from 10 U.S. states to examine which rural cancer patients are receiving recommended radiation therapy and what factors influence receipt of recommended treatment. Identifying gaps in radiation therapy will inform cancer centers, rural program planners, and policy makers in rural cancer service location and cancer support program development. Funded by HRSA's ORHP.
Baldwin LM, Patel S, Andrilla CHA, Fordyce MA, Doescher MP. Are rural cancer patients receiving recommended radiation therapy? Poster presented at AcademyHealth Annual Research Meeting, Chicago, Illinois, 6/28-30/09. |
Distributed Expertise: Sustaining Rural Training Tracks as a Strategy in Rural Medical Education
This project is building a national partnership between professional groups, academic units, governmental entities, and sustaining organizations to provide ongoing support and technical assistance to community-embedded rural health professions education. The project is (1) establishing a network of organizations and experts by visiting Rural Training Tracks (RTTs), creating RTT-state office of rural health coalitions, and convening stakeholder meetings; (2) building a Web portal with a virtual library of tools, information, and access to technical assistance; (3) developing new models and programs while sharing best practices; (4) initiating a process for identifying and training new leaders; and (5) publishing a final report. Under the NRHA umbrella and anchored by project directors and field offices in Idaho, Ohio, and Washington DC, the program is connecting RTT program directors, faculty, and staff with state offices of rural health, a rural assistance center, and a rural research center to bolster existing RTTs, foster new programs, and utilize community expertise in identifying systemic issues and remedies. While focused on rural medical education, the network will provide a model for community-embedded training and an infrastructure for training other rural health professions. UW WWAMI RHRC researchers are designing and maintaining a research data set and protocol for RTT site visits, including consents and IRB approval. The RHRC is the repository of these data-gathering efforts and will analyze and synthesize data underpinning reports and other dissemination activities. The RHRC is sharing data and coordinating its effort with the Graham Center in Washington DC to promote policy development, and assisting in the preparation of a final evaluation and report of this demonstration program.
Patterson DG, Longenecker R, Schmitz D, Xierali IM, Phillips RL, Skillman SM, Doescher MP. Rural training track characteristics and graduates' early-career outcomes. Presented at National Rural Health Association 35th Annual Rural Health Conference, Denver, Colorado, 4/18/12. |
Patterson DG, Longenecker R, Schmitz D, Xierali IM, Phillips RL, Skillman SM, Doescher MP. Rural training track characteristics and graduates' early-career outcomes. Presented at Second Annual Rural Training Track Conclave, Omaha, Nebraska, 3/1/12. |
Patterson DG, Longenecker R, Schmitz D, Xierali IM, Phillips Jr RL, Skillman SM, Doescher MP. Policy brief: rural residency training for family medicine physicians: graduate early-career outcomes. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; Jan 2012. Policy brief. |
Longenecker R, Schmitz D, Doescher MP, Patterson DG. Training physicians for rural practice: Rural Training Track Technical Assistance Program. Presented at National Organization of State Offices of Rural Health Region E Meeting, Juneau, Alaska, 7/28/11. |
Doescher MP. Training physicians for rural practice: Rural Training Track Technical Assistance Program. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/30/11. |
Doescher MP. Primary care supply: are we up to the challenge? Presented at Ohio Association of Community Health Centers and 3RNet Webinar: Creative Solutions to Meeting the Clinical Workforce Shortfall, Columbus, Ohio, 2/2011. |
Patterson DG, Longenecker R, Schmitz D, Skillman SM, Doescher MP. Policy brief: training physicians for rural practice: capitalizing on local expertise to strengthen rural primary care. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; Jan 2011. Policy brief. |
Health Information Technology (HIT) Workforce Needs in Rural America
The goal of this study is to improve understanding of health information technology (HIT) workforce needs and constraints in rural primary care settings. This study will determine rural primary care practices' current and projected level of electronic health record (EHR) and health information technology (HIT) adoption and estimate demand for workers with HIT skills. This study will survey a stratified sample (large and small rural areas) of approximately 1,600 rural primary care practices across the U.S. The questionnaire will assess EHR and HIT implementation at the facility level; their relative need for different components of the HIT workforce; and whether they train and develop HIT staff from within, hire new staff, employ consultants, and/or join forces with other institutions to fill these workforce needs. We will include questions about the institutions' current HIT workforce, expected future demand, education and training resources available to the institution and its staff, and other workforce-related factors that support or impede the practices' implementation and use of HIT. Our descriptive analyses will produce national rural and sub-rural estimates of findings. The study will also identify relationships between specific practice attributes and HIT workforce variables. Funded by HRSA's Office of Rural Health Policy.
Policy Analyses of Rural Issues Related to Health Care Reform
Health care reform provides an array of opportunities to improve health care access and quality for rural Americans. The WWAMI RHRC will support HRSA's efforts to inform this process by summarizing existing evidence characterizing the rural health care workforce and rural health care delivery and will conduct analyses exploring the potential impact on rural populations of proposed and newly-enacted health care reform legislation. Funded by HRSA's ORHP.
The Current Contribution of Physicians, Advanced Practice Nurses, and Physician Assistants to the Rural Primary Care Workforce
This two-year study will survey 10,000 rural primary care physicians, advanced practice nurses (APNs), and physician assistants (PAs) in four states to examine provider demographics, rural location type, practice type and arrangement, whether located in a primary care HPSA, history of rural practice, and practice autonomy. APNs likely to delivery primary care will be identified through state licensure records. A stratified random sample of actively practicing primary care physicians, APNs, and PAs with rural ZIP codes will be drawn from state licensure data to obtain an overall sample that is approximately representative of the rural United States (totaling 4,000-5,000 providers). The study will assess the total contribution to rural outpatient primary care made by each of these professions; how they vary by region of the country, degree of rurality, and practice autonomy; what the roles are of these provider types in offering primary care in rural primary care HPSAs; and what the role is of each provider type in inpatient care and after-hours call coverage. Obtaining accurate estimates of rural primary care productivity and scope of practice will help determine the relative contribution of different provider types, clarify workforce solutions, and guide training and recruitment/retention efforts.
Factors Associated with Rural-Residing Registered Nurses' Choices to work in Urban Locations and Larger Rural Cities
While larger numbers of registered nurses (RNs) are living in rural areas, research from the WWAMI RHRC shows that since 1980, a growing percentage are commuting from rural residences to work within urban and larger rural cities. This study will explore factors that may be associated with RNs' decisions to commute away from their rural areas of residence to work in less rural areas. This project is expected to be completed by August 2008. Funded by HRSA ORHP.
Skillman SM, Palazzo L, Fordyce M, Doescher MP, Butterfield P. Factors associated with rural-residing RNs' choices to work in larger rural and urban areas, presented at AcademyHealth Annual Research Meeting, Washington, DC, 6/9/08. |
The Influence of State Policies and Practices on J-1 Visa Waiver Physicians' Service in Rural Areas
States rely on international medical graduates (IMGs) to fill workforce gaps in rural and urban underserved areas. This study will collect information from all states regarding their efforts to track IMG practice after their Conrad 30 program waiver obligations are satisfied, quantify long-term retention for states with available data, and assess how state policies shape IMG practice and long-term retention. Funded by HRSA's Office of Rural Health Policy.
Patterson DG, Keppel G, Skillman SM, Doescher MP, Berry C, Daniel C. The influence of state policies and practices on J-1 visa waiver physicians' service in rural areas through the Conrad State 30 program. Presented at 8th Annual Association of American Medical Colleges Physician Workforce Research Conference, Washington, DC, 5/3/12. |
Patterson DG, Keppel G, Skillman SM, Doescher MP, Berry C, Daniel C. States' strategies for recruiting physicians through the Conrad State 30 J-1 Visa Waiver Program. Presented at National Rural Health Association 35th Annual Rural Health Conference, Denver, Colorado, 4/18/12. |
Patterson DG, Keppel G, Skillman SM, Doescher MP, Berry C, Daniel C. The influence of state policies and practices on J-1 visa waiver physicians' service in rural areas through the Conrad 30 program. Presented at Department of Family Medicine Grand Rounds, University of Washington, Seattle, Washington, 6/1/11. |
Patterson DG, Keppel G, Skillman SM, Doescher MP, Berry C, Daniel C. The influence of state policies and practices on J-1 visa waiver physicians' service in rural areas. Presented at National Rural Health Association 34th Annual Rural Health Conference, Austin, Texas, 5/5/11. |
Patterson DG, Keppel G, Skillman SM, Doescher MP. The influence of state policies and practices on J-1 visa waiver physicians' service in rural areas. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/30/11. |
General and Specialist Surgeon Supply and Inpatient Procedural Content: A National Rural-Urban Study
This study will examine the degree to which access to inpatient surgical care in rural areas is affected by the diminishing workforce of general surgeons. Using inpatient surgical procedure data, we will examine the availability and content of general surgical procedures in rural and urban hospitals nationally as a function of surgeon supply. We will develop a novel typology of surgical procedures based on their complexity, necessity, and urgency. We posit that inpatient procedures in rural areas with low surgeon supply will have lower complexity, but higher necessity and urgency, than in rural and urban areas with higher surgeon supply.
Doescher MP, Jackson JE, Fordyce MA, Lynge DC. Variability in general surgical practice in rural and urban U.S. hospital settings. Presented to International Health Workforce Commission, Brisbane, Australia, 10/2011. |
Doescher MP. The crisis in rural general surgery: can research drive policy change? Presented at Collwill Lecture, University of Missouri Family Medicine Department, Columbia, Missouri, 8/2011. |
Doescher MP, Jackson JE, Fordyce MA, Lynge D. Variability in surgical practice in rural and urban U.S. hospital settings. Presented at AcademyHealth Annual Research Meeting, Seattle, Washington, 6/12/11. |
Doescher MP, Jackson JE, Fordyce MA, Lynge D. Variability in surgical practice in rural and urban U.S. hospital settings. Presented at Association of American Medical Colleges Physician Workforce Research Conference, Washington, DC, 5/6/11. |
Doescher MP, Jackson JE, Fordyce MA, Lynge D. Variability in surgical practice in rural and urban U.S. hospital settings. Presented at National Rural Health Association 34th Annual Rural Health Conference, Austin, Texas, 5/5/11. |
Doescher MP. Variability in surgical practice and patient characteristics in rural and urban U.S. hospital settings. Presented at Northwest Regional Rural Health Conference, Spokane, Washington, 3/30/11. |
Small Town Walkability: Measuring the Effect of the Built Environment
This study is identifying built environmental correlates of walking in rural towns and evaluating the role of low socioeconomic status (SES) and Latino ethnicity on these relationships. By studying 9 rural towns from 3 diverse regions, Washington State, the Northeast, and Texas, with a varying range of socioeconomic and ethnic characteristics, this study is: (1) measuring built environmental correlates of walking among small town residents, using objective and perceived measures of the built environment and self-reported measures of walking; (2) evaluating the degree to which built environmental correlates of walking among rural town residents are influenced by SES and Latino ethnicity; and (3) validating the perceived correlates of walking using accelerometer and global positioning system measures. The study will first involve a survey of 1,800 residents of these towns on physical activity patterns and attributes of their towns that promote or impede walking, and will next recruit a sample of 270 respondents who agree to wear two small devices measuring their physical activity for 7 consecutive days. Objective measures of their physical activity will be compared to self-reported data. This work will lay the foundation for future research on the relationship between various aspects of the rural built environment and health behaviors and, ultimately, intervention trials to help rural towns better structure the built environment to promote walking and healthier life styles among their highest risk residents.
WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) Rural Health Workforce Monograph: Guide for State Legislators Regarding Rural Workforce Information and Issues
This project will compile and present state-level information about the rural health workforce in the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region. Information will be derived from many sources, such as the American Medical Association and American Osteopathic Association, the National Sample Survey of Registered Nurses, the American Academy of Physician Assistants, and the American Dental Association. The monograph will illustrate issues such as the shortage of different types of health care providers in various kinds of rural locations. This information can be used by policymakers, legislators, and others as a basis for making informed workforce decisions that affect rural areas, such as allocating funding, enhancing training at state institutions, and implementing strategies to address provider shortages. The Web site and multicolored monograph that result will provide national data as a comparison for this information and will present some intrastate rural workforce supply data. (In Progress)