Community-Based Training and Impact on Care of Socially Disadvantaged Populations

Community-based training is crucial for the equitable development of the physician workforce and influences the practice location of new physicians. However, little is known about the distribution of the physicians trained in community-based settings across areas of varying social risks.

To examine the association between community-based training of family physicians and subsequent practice comprising socially disadvantaged populations.

Using the 2017-2022 American Board of Family Medicine Initial Certification Questionnaires and the 2024 American Medical Association Physician Masterfile, we performed a multivariate logistic regression analysis to assess the association between community-based training-applying a broad definition (training outside of large academic centers) and a narrow definition (training specifically in Teaching Health Centers [THCs] or rural/Rural Training Tracks [RTTs])-and subsequent practice location in communities with high health-related social needs.

Among the 15 851 family physicians, 5717 (36.1%) trained outside a hospital or large academic center (broad), whereas only 1419 (9%) trained in THCs or rural/RTTs (narrow). Family physicians from a narrowly defined community-based training had higher odds of practicing in socially disadvantaged communities (Social Deprivation Index≥median) compared to their counterparts (OR, 1.224; 95% CI, 1.097-1.366; P<.001). No significant association was found in the model using the broad definition of community-based training. Male, non-White, Hispanic, and international medical graduates were statistically positively associated with practicing in areas with high health-related social needs.

This study shows that family physicians who trained in THCs or rural/RTTs are significantly more likely to be practicing in areas with high social needs than those who did not.