Lessons Learned as Thomas Jefferson University’s Rural Physician Shortage Area Program (PSAP) Approaches the Half-Century Mark

Abstract

To help increase the supply and retention of rural family physicians, Thomas Jefferson University initiated the Physician Shortage Area Program (PSAP) in 1974. The program selectively admits medical school applicants who both grew up in a rural area and plan to practice in a rural area. During medical school, PSAP students have ongoing mentoring and rural clinical experiences. As the program now approaches the half-century mark, this commentary summarizes several important lessons learned. First, outcomes research is critical, and program leaders have been able to publish 15 papers and a book about the PSAP and its outcomes. Second, these studies have shown that the program has been highly successful, with PSAP graduates 8.5–9.9 times more likely to enter rural family medicine than their peers, and that the PSAP contributed 12% of all rural family physicians in Pennsylvania. Other similar medical school rural programs have had comparable success, with more than half of all graduates combined (including PSAP graduates) practicing rural. Third, long-term retention has a multiplicative impact. Long-term retention of PSAP graduates in rural family medicine was greater than 70% after 20–25 years. Fourth, research has shown that the admissions component accounted for approximately three-quarters of the PSAP’s success. Three factors available at the time of matriculation (rural background, plans for rural practice, and plans for family medicine) identified almost 80% of all Jefferson graduates in rural practice 3 decades later. Having a peer group with similar backgrounds, mentoring, and the rural curriculum were also very important. Fifth, wanting to live rural appears key to the rural practice decision. Finally, given that medical school programs like the PSAP produce substantial increases in the supply and retention of rural physicians while requiring modest resources, medical schools can have a critical role in addressing the rural physician shortage.

Emphasizing Geographical Ties in Holistic Admission: A Community-Oriented School of Medicine Approach

“…Our community-oriented holistic admissions emphasize geographic ties providing more opportunities for students who may not have been accepted into medical schools that disproportionately emphasize academics; this could have implications for students underrepresented in medicine. 4 Our school's mission is to recruit students who want to serve East Texas; interviewing and admitting those who have ties to the community will likely result in greater retention 5 and ultimately support the region's critical need for physicians.…”

Recognizing Rural Health Resource and Education Needs

“…4 Fortunately, some MD-granting and DO-granting medical schools have been established to help address these needs, and faculty and trainees in some academic programs have identified rural health as a priority. [5][6][7] Nevertheless, curricula of medical schools are often silent on the topic of culturally attuned care for patients who live in rural and frontier areas. 8 The co-location of health resources and larger population areas contributes to health disparities that are substantial and foreseeable.…”

“…Clinicians, educators, and leaders in community-based health systems and academic medicine continue to develop innovative responses to address distinct rural health needs, as reflected in many articles that have appeared in our journal. [4][5][6][7][8]12,[21][22][23][24][25][26][27] We should be inspired by the courage and creativity that exists among rural and frontier people, both in seeking to live their best lives and in working to address the health needs of those around them.…”

Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants

“…1,2 Over the past 50 years, the rural physician shortage prompted innovation in medical education intended to identify medical students with rural interests and to ensure appropriate training for rural careers. [3][4][5][6][7] Provider shortages also helped lead to the creation of the physician assistant (PA) profession. 8,9 In the early years of the profession, PA education was often aimed at training PAs for primary care rural careers.…”