Graduate medical education and rural health care

Abstract

Currently, residency training is neither detrimental nor helpful to the problems of rural health. Based on four generally accepted "truths" about rural health, medical schools should recruit students from rural areas, have them choose family practice as a career, and train them in rural settings. Given no substantial changes in residency training, the following recommendations are made. Develop a consensus definition of "rural." Educate rural communities to the purpose of residency training. Residency review committees should support rural rotations of at least six months; consider the number of residencies at a site irrelevant for accreditation; judge the quality of the product as the standard of accreditation; and define teaching competency by other than specialty label. All medical school departments should be involved in seeking solutions to the problems of rural health. New opportunities for funding of rural residency training should be sought. If major changes in residency training are possible, internal medicine, family practice, and pediatrics should merge as a single primary care specialty and for residency training. Only this residency should be considered primary care for residency reimbursement purposes, and only its graduates should be reimbursed for primary care services.

Demography of Pediatric Primary Care in Europe: Delivery of Care and Training

“…However, if we consider the American model, a very important issue is the special training of family physicians to work in rural communities. 15 Our data show that there is a very large discrepancy between the amount of training given to European family physicians and to pediatricians in both primary and community care. The care for pediatric patients in rural settings is also very much influenced by the economic burden, work load, and relatively lower income of the physician working in villages or on islands.…”

Residents' Preferences and Preparation for Caring for Underserved Populations

“…Residents growing up in rural communities are more likely to practice there eventually. 39 However, we did measure educational debt, which might be correlated with rural or poor-inner city origins, and therefore perhaps have served as a proxy for this confounder. Indeed, residents with higher debts in our study were more likely to rate rural areas as desirable practice locations.…”

An Empirical Model of the Medical Match

“…Access to medical care is signi…cantly lower in rural communities of the United States: about a …fth of the US resides in rural counties but only a tenth of physicians practice in these areas (Rosenblatt and Hart, 2000). Increasing residency training in rural areas is seen as an important part of solutions to this disparity in access to care because of the empirical association between rural training or background with recruitment and retention of rural physicians (Brooks et al, 2002;Talley, 1990). About 20% of urban born residents graduating from family medicine programs start their initial practice in rural areas, roughly in proportion to the population in rural communities of the US, whereas about 46% of rural born family medicine residents begin their practice in rural communities (Table D.5).…”