Among respondents who desired technical assistance, women were nearly twice as likely as men to report lack of technical assistance as a barrier (61% versus 34%) but desired technical assistance only slightly more often than men. Men reported desiring help in forming relationships with community members more often than women did; the difference approached, but did not achieve, significance. The findings are intriguing, but speculation about their implications would be based on stereotypes. Certainly further investigation is desirable.
Controlling for age, the longer the respondents had been members of their departments, the more often they participated on community health boards, committees, and organizations. Respondents who have been in their departments longer may be better established in their careers and in the community, resulting in more frequent invitations to these activities. Other explanations could include changes accompanying life stages, such as concern for assisting younger generations.
Length of employment in a particular department correlated with less reported need for faculty development around community-based activities. Since we did not attempt to ascertain respondents’ levels of expertise, we cannot interpret this finding. However, it cannot be assumed that long experience and lack of reported need necessarily reflect a high skill level.
Older respondents were less likely to desire release or supported time for their community activities. The perceived need for more time diminished by 28% with each decade of life. It may be that they have already garnered sufficient support and protected time in their institutions.
That MDs were significantly more likely than non-MDs to have precepted students and residents at community sites reflects the requirements of medical education accrediting bodies. The reason for the prevalence of research by respondents with master’s degrees and not those with terminal degrees is not known, although we surmise that at least some may have been hired specifically to conduct research. More study of the role of this small subset of respondents is warranted.
We did not examine differences in practice environments and their effect on community-based activities. University-, military-, and community-based practices have different goals, incentives, and disincentives, as do managed care and fee-for-service organizations. Furthermore, the traditional patterns of these organizations may be changing in response to interest in performance measures.19 This is another important area for investigation.
Limitations
This is a descriptive, not a definitive, study. The 58% response rate to the survey may limit the generalizability of our findings. Individuals who are involved or interested in community projects may have been more likely to return the survey, resulting in an overestimation of involvement in community-based activities. Although we do not have demographic or community involvement information about nonrespondents, our sample is demographically similar to active STFM membership and national family medicine department faculty. We provided examples of community-based activities; however, individual interpretations of what constitutes such an activity may differ. Using exploratory analyses increased the likelihood that a significant result would occur by chance. Thus, marginally significant results require further study, and those with P values between .01 and .05 should be considered hypothesis generating.
Conclusions
This descriptive study helps establish a baseline for better understanding academic physicians’ current participation in community-based activities. Although the scope of this study is narrow, it suggests that most academic faculty are providing community service and education and are deriving satisfaction from doing so.
Our results also raise a number of questions for further study. Is there enough appropriate research being done within communities to address its health needs? Should women and younger faculty receive additional support in establishing community-based activities, and if so, what kind? If women perceive technical barriers more often, why do they not report a desire for technical assistance more often? Is the difference between men and women in ease of forming community partnerships meaningful? The answers to these questions will provide a richer understanding of the ability of an academic health center to respond to the health care needs of their surrounding communities.