Study: Med schools can boost rural physician supply

Only 9% of doctors practice in rural areas, while 20% of the population lives there.

By Myrle Croasdale — Posted May 26, 2008

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Medical schools would more than double the number of new graduates going into rural practice if each adds a rural training program, according to a study in the journal Academic Medicine.

The small investment would have a sizable impact on rural access to health care, said Howard Rabinowitz, MD, lead study author and director of Jefferson Medical College's Physician Shortage Area Program. "Rural areas are very fragile, because you only have one or two doctors," he said. "One doctor in a small town has a disproportionately big impact."

Dr. Rabinowitz and his co-authors reviewed outcomes of programs designed to increase the rural physician supply and developed a model to estimate the impact of widespread replication. The study defined rural programs as those that focused admissions on candidates with a rural background or had an extended rural clinical curriculum of six months or longer.

The study, published in the journal's March issue, estimated that if each of the 125 allopathic medical schools committed 10 seats per class to a rural training track, the schools would produce 1,139 new rural doctors a year, or 11,390 physicians over 10 years. If schools expand enrollment 30%, as recommended by the Assn. of American Medical Colleges, rural programs would produce 1,292 physicians a year, or 12,920 rural doctors over 10 years, the study said.

Currently, 3% of the roughly 17,100 allopathic medical students who graduate each year plan to practice in a rural or small-town setting, the AAMC said. That's about 513 graduates a year, or 5,130 over 10 years.

Practicing rural medicine

Nine percent of physicians practice in rural areas, experts said. But 20% of the population lives in those communities, and many rural residents tend to be older and sicker.

The study found that the impact of existing rural programs was significant, with 53% to 64% of graduates going into rural practice. Such programs could be duplicated by schools regardless of location.

"If this program works for Jefferson in Philadelphia, it can work anywhere," Dr. Rabinowitz said of the urban school's rural track.

Rural work-force experts supported the study's recommendation that all schools adopt rural training tracks. The American Medical Association supports education to develop rural physicians and encourages the training of more rural physicians.

"It's a golden time to be thinking about this because of the increase in medical school enrollment that is occurring," said Mark Doescher, MD, MSPH, director of the WWAMI Rural Health Research Center at the University of Washington Center for Health Workforce Studies in Seattle. "You have to think about where the need for physicians is greatest in this country, and rural areas have a long-standing, persistent need for physicians, particularly generalists."

But Rick Kellerman, MD, board chair of the American Academy of Family Physicians, said the current education system does not generally support students with rural interests.

"We get medical students from rural areas who want to return, who end up training in urban settings that are very subspecialty focused," he said.

AAFP President-elect Ted Epperly, MD, said it would be ideal if each medical school developed a rural training track, but he doesn't expect that to happen. "These programs do work," said Dr. Epperly, who heads the Boise-based Family Medicine Residency of Idaho, a community program affiliated with the University of Washington. "We just need to muster the effort to develop and support them."

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Training rural doctors

Number of rural physicians produced over 10 years:

Given 2004-05 enrollment Given 30% increase
No rural programs in medical schools 5,130 6,670
Rural programs in each medical school 11,390 12,920

Source: "Medical School Programs to Increase the Rural Physician Supply: A Systematic Review and Projected Impact of Widespread Replication," Academic Medicine, March

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