{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:42:51Z","timestamp":1792669371279,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":51,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats: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\u2010metropolitan counties than other hospitals in metropolitan counties in terms of hospital and community characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross\u2010sectional, 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\u2010rural metropolitan hospitals and each comparison group: metropolitan non\u2010FORHP\u2010rural hospitals and non\u2010metropolitan hospitals. Our main similarity analysis estimated pairwise logistic regression models predicting FORHP\u2010rural metropolitan classification using community characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We classified 459 hospitals as FORHP\u2010rural metropolitan hospitals. Our pairwise comparisons showed that hospital and community characteristics are similar to non\u2010metropolitan hospital characteristics but significantly differ from metropolitan non\u2010rural hospital characteristics. Predicted probability distributions for FORHP\u2010rural metropolitan and non\u2010metropolitan hospitals showed substantially greater overlap than distributions for FORHP\u2010rural metropolitan and metropolitan non\u2010FORHP\u2010rural hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FORHP's tract\u2010level 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70238","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:22:03Z","timestamp":1792668123000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Rurality in Graduate Medical Education"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1091-328X","authenticated-orcid":false,"given":"Mukesh","family":"Adhikari","sequence":"first","affiliation":[{"name":"Cecil G. Sheps Center For Health Services Research University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Health Policy and Management University of North Carolina Gillings School of Global Public Health Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9340-6740","authenticated-orcid":false,"given":"Raquel","family":"Davis","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center For Health Services Research University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Health Policy and Management University of North Carolina Gillings School of Global Public Health Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6169-7847","authenticated-orcid":false,"given":"George M.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center For Health Services Research University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Health Policy and Management University of North Carolina Gillings School of Global Public Health Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8954-5055","authenticated-orcid":false,"given":"Lori","family":"Rodefeld","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center For Health Services Research University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Wisconsin Collaborative for Rural Graduate Medical Education  Sauk City Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7717-4066","authenticated-orcid":false,"given":"Emily M.","family":"Hawes","sequence":"additional","affiliation":[{"name":"Cecil G. Sheps Center For Health Services Research University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Department of Family Medicine University of North Carolina at Chapel Hill School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Economic Research Service \u201cAvailability of Healthcare Providers in Rural Areas Lags That of Urban Areas \u201d accessed June 20 2026 https:\/\/www.ers.usda.gov\/data\u2010products\/charts\u2010of\u2010note\/106208."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.33994"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00722"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2015.04.001"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748\u20100361.2006.00022.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14168"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME\u2010D\u201021\u201001143.1"},{"key":"e_1_2_11_9_1","unstructured":"M.Adhikari \u201cThe Effects of Rural Training During Residency on Physicians' Rural Practice and Rural Physician Supply \u201d (Diss. 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