Community dimensions and HPSA practice location: 30 years of family medicine training

In 1996, the Institute of Medicine revised the definition of primary care to include “the community context of medical practice.” Shortly after, as a way to move beyond the general sentiment that community should factor into a physician’s work, Pathman et al1 identified and defined four distinct categories of activities (sociocultural aspects of patient care, use of community health resources, community-oriented primary care, and community participation and assimilation) through which physicians engage with communities. This framed much of the last decade’s discussion about and exploration into physicians’ community involvement.2-6 Recently, the concept of community has been raised by the Future of Family Medicine Project.7 With the specialty’s founders feeling strongly that family physicians should be the doctors for their communities,8 the specialty of family medicine has committed to instruction in numerous community-related skills meant to complement clinical training. Clinical training and practice, however, have changed over time. There have been notable declines in the proportion of family physicians engaged in delivering babies, providing intensive care and general hospital medicine, and performing certain procedures.9 Unknown is whether these changes have been accompanied by changes in family physicians’ level and type of community involvement. To our knowledge, no studies have explored family physicians’ community-related activities longitudinally. Thus, we surveyed 30 years of graduates from one family medicine residency to assess confidence in and participation in a range of community-related activities. Additionally, we explored strength of relationships between reported medical school and residency training in community-related activities and current community involvement, as well as whether they were practicing in an underserved location. Community Dimensions and HPSA Practice Location: 30 Years of Family Medicine Training