We also analyzed the type of community served to determine its effect on participation in community activities. Institutions serving rural communities were more likely to have designed a community health curriculum (51% vs 36%; P = .023 by Fisher’s exact test) and to have evaluated a community-based project or program (32% vs 18%; P = .010 by Fisher’s exact test). Those serving a small town were also more likely to have evaluated a community-based project or program (30% versus 18%; P = .026 by Fisher’s exact test). Those serving urban communities were more likely to have taught students to work in a community site (58% vs 48%; P = .052 by Fisher’s exact test), to have designed a community health curriculum (43% vs 31%; P = .010 by Fisher’s exact test), and to have educated faculty on community-based education (27% vs 17%; P = .021 by Fisher’s exact test). Neither community served nor community activity, however, is mutually exclusive.
Some of the barriers to community-based activities and desired support for such work were also associated with respondents’ sex, age, and number of years in the current department. Women were 2.41 times more likely than men to report a lack of technical assistance as a barrier to community-based projects (95% CI, 1.41-4.13; P = .001). However, women were only 1.56 times (95% CI, 0.99-2.46; P = .054) more likely than men to desire technical support from their department. Men were 1.57 times (95% CI, 0.99-2.48; P = .054) more likely than women to desire help in forming relationships with the community. Increased age was associated with a decreased desire for sufficient release or protected time for community-based work. For each decade increase in age, there was a 28% reduction in the perceived need for sufficient release or protected time (OR = 0.72; 95% CI, 0.55-0.95; P = .02). Similarly, respondents who had been in their departments longer were less likely to report a need for faculty development regarding community-based activities (OR = 0.95 for each year [a 5% reduction for each additional year]; 95% CI, 0.91-0.99; P = .009).
Discussion
Advocates of community health have challenged academic institutions to more and better involvement in teaching and researching community health and providing service in the community. However, there are almost no data describing the status quo. Our study of 446 health providers who demographically mirror current STFM members and family medicine department faculty establishes a baseline of current activities. The findings support some of our beliefs, call others into question, and raise a number of specific areas for further study.
First, our results indicate that significant numbers of family medicine personnel are participating in a variety of community-based activities. Ninety-five percent of those responding reported having participated in a community education, service, or research project in the past year; 92% performed those activities in the community itself. The activities included precepting medical students and residents, providing clinical services at community-based sites, and making educational presentations in the community. Although this finding does not obviate the need for more and better services, it does suggest that faculty are fulfilling their responsibilities in this area. Less than half of our respondents participated in research, however, a finding that merits further investigation.
Second, this group of physicians and other family and community medicine personnel reported personal interest and satisfaction as the primary motivation (77%)for participating in community projects. This finding supports attempts to motivate community involvement as a personally rewarding experience. Other motivating factors were health of the community and importance to medical student and resident education.
Predictably, the most commonly perceived barrier to community service project participation was a lack of time. More release time was the most desired form of department support for surmounting that barrier. However, we found no data about release time and service. Bland and Schmitz18 have suggested that dedicating 40% of effort to research is necessary for adequate research productivity. If community service is a mission of a medical school, it seems that protecting time for community service projects would also be necessary. Further research is needed to ascertain whether schools offer faculty protected time for community service and, if so, how much is necessary or optimal.
Participation patterns, perceived barriers, and desired resources varied by age, sex, educational background, and academic rank. These factors are often interrelated and individual effects are difficult to segregate. Greater experience and time with an organization may be associated with higher status (rank), which in turn may lead to greater access to monetary and other resources, more protected time, and greater ability to allocate one’s own time. There are still more male family physicians than female, and more men have higher faculty rank. These factors may affect our findings that men were significantly more often involved in teaching other faculty about community-based education and providing care at a community or school clinic.