Rethinking Rurality in Graduate Medical Education

IF 3.2 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2026-10-22 DOI:10.1111/jrh.70238

Mukesh Adhikari, Raquel Davis, George M. Holmes, Lori Rodefeld, Emily M. Hawes

{"title":"Rethinking Rurality in Graduate Medical Education","authors":"Mukesh Adhikari, Raquel Davis, George M. Holmes, Lori Rodefeld, Emily M. Hawes","doi":"10.1111/jrh.70238","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Graduate medical education policy relies on rural classification to determine eligibility for rural training programs. This study aimed to assess whether hospitals classified by the Federal Office of Rural Health Policy (FORHP) as rural, but located in metropolitan counties, more closely resemble hospitals in non-metropolitan counties than other hospitals in metropolitan counties in terms of hospital and community characteristics.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This was a cross-sectional, observational study. Our study sample consisted of 4686 acute general hospitals in the United States from a 2024 publicly available hospital list. We conducted pairwise comparisons of hospital characteristics from 2024 Medicare cost report data and community characteristics from the Agency for Healthcare Research and Quality 2020 Social Determinants of Health Database and the 2024 American Medical Association Master file between FORHP-rural metropolitan hospitals and each comparison group: metropolitan non-FORHP-rural hospitals and non-metropolitan hospitals. Our main similarity analysis estimated pairwise logistic regression models predicting FORHP-rural metropolitan classification using community characteristics.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>We classified 459 hospitals as FORHP-rural metropolitan hospitals. Our pairwise comparisons showed that hospital and community characteristics are similar to non-metropolitan hospital characteristics but significantly differ from metropolitan non-rural hospital characteristics. Predicted probability distributions for FORHP-rural metropolitan and non-metropolitan hospitals showed substantially greater overlap than distributions for FORHP-rural metropolitan and metropolitan non-FORHP-rural hospitals.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>FORHP's tract-level rural definition identifies a distinct group of hospitals. Expanding the definition of rural could unlock federal funding for physician training for nearly 500 additional US hospitals.</p>\n </section>\n </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"42 4","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Rural Health","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jrh.70238","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Graduate medical education policy relies on rural classification to determine eligibility for rural training programs. This study aimed to assess whether hospitals classified by the Federal Office of Rural Health Policy (FORHP) as rural, but located in metropolitan counties, more closely resemble hospitals in non-metropolitan counties than other hospitals in metropolitan counties in terms of hospital and community characteristics.

Methods

This was a cross-sectional, observational study. Our study sample consisted of 4686 acute general hospitals in the United States from a 2024 publicly available hospital list. We conducted pairwise comparisons of hospital characteristics from 2024 Medicare cost report data and community characteristics from the Agency for Healthcare Research and Quality 2020 Social Determinants of Health Database and the 2024 American Medical Association Master file between FORHP-rural metropolitan hospitals and each comparison group: metropolitan non-FORHP-rural hospitals and non-metropolitan hospitals. Our main similarity analysis estimated pairwise logistic regression models predicting FORHP-rural metropolitan classification using community characteristics.

Findings

We classified 459 hospitals as FORHP-rural metropolitan hospitals. Our pairwise comparisons showed that hospital and community characteristics are similar to non-metropolitan hospital characteristics but significantly differ from metropolitan non-rural hospital characteristics. Predicted probability distributions for FORHP-rural metropolitan and non-metropolitan hospitals showed substantially greater overlap than distributions for FORHP-rural metropolitan and metropolitan non-FORHP-rural hospitals.

Conclusions

FORHP's tract-level rural definition identifies a distinct group of hospitals. Expanding the definition of rural could unlock federal funding for physician training for nearly 500 additional US hospitals.

查看原文本刊更多论文

重新思考研究生医学教育中的乡村性。

目的：研究生医学教育政策依赖于农村分类来确定农村培训计划的资格。本研究旨在评估被联邦农村卫生政策办公室（FORHP）分类为农村但位于大都市县的医院，在医院和社区特征方面是否比大都市县的其他医院更接近非大都市县的医院。方法：这是一项横断面观察性研究。我们的研究样本包括美国2024年公开提供的医院名单中的4686家急性综合医院。我们两两比较了来自2024年医疗保险成本报告数据的医院特征和来自医疗保健研究和质量机构2020年健康社会决定因素数据库和2024年美国医学协会主文件的社区特征，在forhp -农村大都市医院和每个对照组之间：大都市非forhp -农村医院和非大都市医院。我们的主要相似性分析估计了两两逻辑回归模型，预测forhp -农村大都市分类使用社区特征。结果：我们将459家医院分类为forhp -农村城市医院。两两比较表明，医院和社区特征与非大都市医院特征相似，但与大都市非农村医院特征显著不同。与forhp -农村城市医院和非城市医院相比，forhp -农村城市医院和非城市医院的预测概率分布的重叠程度要大得多。结论：FORHP的基层农村定义确定了一组独特的医院。扩大农村的定义可以为近500家额外的美国医院提供医生培训的联邦资金。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.