Current Projects
Learn more about our active projects here:
Year 12 (2024-2025) Projects
Project 1. DocFlows 2.0: Exploring the Interstate Migration of Residents-in-Training and Practicing Physicians
Investigators: Erin Fraher, PhD, MPP, Evan Galloway, MPS, Brianna Lombardi, PhD, MSW
Shifts in the migration patterns of the population, recent increases in immigration, and new state and federal sources of GME funding have likely spurred changes in where physicians train and practice. This study will update DocFlows version 1 (https://docflows.unc.edu) to track the moves that newly trained physicians and actively practicing physicians made between 2015-2023.
Project 2. Visualizing Trends in Foreign-Born and Foreign-Trained Physicians Working in the United States
Investigators: Brianna Lombardi, PhD, MSW, Evan Galloway, MPS, Brooke Lombardi, PhD, MSW, Erin Fraher, PhD, MPP
As the United States faces worsening workforce shortages and a persistent maldistribution of health care workers, foreign-born and foreign-trained health professionals may comprise an increasingly important labor source. We will develop a data visualization that allows users to explore the demographic, practice, and geographic characteristics of this workforce, as well as their origin-countries and their destinations in the United States.
Project 3. Understanding States’ Use of Alternative Pathways for Foreign-Trained Physicians
Investigators: Erin Fraher, PhD, MPP Colleen Tapen, MPH, MBA, Haley Simons, Emily Hawes, PharmD, BCPS, CPP
An increasing number of US states are allowing international medical graduates (IMGs) to pursue alternative pathways to residency, licensure, and practice, in some cases bypassing the requirement to complete a US residency. In this study, we will interview experts from states pursuing alternative pathways for IMGs to understand the types of alternative pathways being developed, states’ motivations in pursuing these pathways, their design and implementation, and the degree to which they are measuring the outcomes of these changes.
Project 4. Understanding Trends in Nurse Practitioner Turnover by Setting
Investigators: Esita Patel, PhD, Erin Fraher, PhD, MPP
It is unclear how the COVID-19 pandemic affected turnover of Nurse Practitioners (NP) and how NP turnover varies by setting. This study will compare NP workforce behaviors (e.g., turnover rates, intention to leave, and reasons for leaving or staying) during the pre-pandemic (2018) and mid-pandemic (2022) periods in hospital and outpatient settings.
Ongoing Projects
Colocation of Primary Care, Dental, and Pharmacy Residencies: An Analysis of Interprofessional Post-Graduate Training
Principal Investigator: Emily M. Hawes, PharmD, BCPS, CPP
An integrated, interprofessional team-based model of practice is an essential element of delivering high- quality primary care. Integrating dentists and primary care physicians enhances access and coordination of care. Despite support for interprofessional education across national health organizations and accrediting bodies, little is known about the prevalence and composition of interprofessional post- graduate training on a national level. This project will produce a much-needed body of evidence on the prevalence, location and factors predicting co-location of dental, pharmacy and primary care residencies in the United States.
The aims of this study are:
- Identify the proportion of pharmacy and primary care physician post-graduate training programs that are collocated.
- Identify the proportion of pharmacy, dental, and primary care physician post-graduate training programs that are collocated.
- Examine predictors of pharmacy and primary care post-graduate training program colocation as well as pharmacy, dental, and primary care post-graduate training program colocation [such as program sponsor, residency specialty/size, training setting (e.g., FQHC, hospital.), state, and measures of underservice (e.g., Area Deprivation Indices, metro/non-metro)].
Intersecting Identities: The Influence of Race/Ethnicity, Sex and Undergraduate Historically Black College and University (HBCU) Education on Black Student’s Application, Acceptance and Graduation from Medical School
Principal Investigator: Jasmine Weiss, MD, MHS
As a follow-up to a Year 10 study that highlighted the contributions of HBCU undergraduate institutions on the acceptance, matriculation, and graduation of Black physicians from 1980-2020, this project will explore differences in these trends by sex to characterize how intersectionality between race and gender may contribute to the production of Black physicians who complete their undergraduate studies at HBCUs. Findings from this study could serve as evidence of the changing dynamics of gender and race of those applying and matriculating into medicine from HBCUs vs. non-HBCUs. Understanding these dynamics is important to educational accrediting bodies, hospital systems, medical schools, and for federal and state policy makers to shape investments in undergraduate institutions that increase representation in the physician workforce.
Using Latent Transition Analysis as A Tool to Understand How Physician Careers Evolve over the Life Course
Principal Investigator: Erin P. Fraher, PhD, MPP
In a Year 10 study, we used latent class analysis (LCA) to describe the career typologies of primary care physicians (PCPs) in North Carolina which found that PCPs were sorted into four types of careers in 2009 and 2019 with high class separation and classification certainty in both years (entropy = 0.98, mean posterior probabilities > 0.9). Key attributes that predicted career type were whether the PCP practiced in a rural vs urban area, hospital vs. ambulatory care settings, and whether they provided prenatal and obstetric care. We found statistically significant differences in PCPs’ demographic characteristics (gender, age, race/ethnicity), medical school location (IMG vs not) and years in practice between classes. Findings from our Year 10 study suggest that primary care physician career typologies were stable over the decade as a whole, but we could not observe whether individual physicians transitioned to different career typologies during the decade.
In this project, we will leverage the unique panel nature of the North Carolina licensure data to conduct a latent transition analysis (LTA) of the 4,617 PCPs who were present in the data in both 2009 and 2019. LTA will allow us to examine if PCPs display career transitions between different typologies during the 10-year period and identify the factors associated with these transitions. Such an understanding could help policy makers identify if there are specific points in time, and physician characteristics, that are associated with an increased probability of transitioning from one career typology to another.
Understanding the Contributions of Undergraduate Historically Black Colleges and Universities to Increasing the Diversity of the Physician Workforce: Supplement Funded
Principal Investigator: Jasmine Weiss, MD, MHS
Increasing the diversity of the physician workforce is critical to addressing health disparities in the United States, particularly for Black Americans. This study will examine the role of undergraduate Historically Black Colleges and Universities (HBCUs) in increasing the representation of Black physicians in medical schools and ultimately the physician workforce.
This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Cooperative Agreement for a Regional Center for Health Workforce Studies #U81HP26495. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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