Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce

Abstract

Purpose: Despite the efforts of numerous medical schools to produce rural physicians, many rural communities in the United States still experience physician shortages. This study describes the current landscape of rural efforts in US undergraduate medical education and catalogs medical school characteristics and activities that evidence has suggested, and that many experts in rural medical education believe, may result in more graduates choosing rural practice.Methods: This is a descriptive study of publicly available and rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016, with rural program information for these schools updated in 2019. The authors constructed a "rural program" definition in order to systematically catalog coordinated and strategic medical school efforts to produce a rural physician workforce.Findings: Few (8.2%) medical schools expressed an explicit commitment to producing rural physicians in public mission statements. However, most (64.8%) provided rural clinical experiences and many demonstrated their commitment in other ways. Only 39 (21.4%) did so through a formal rural program. Conclusions:In establishing an explicit rural program definition and documenting other markers of rural commitment, this paper provides a baseline for future studies of rural workforce production and medical school investment in these programs, activities, and personnel. Demonstrating the effectiveness of schools' rural physician education efforts will require collaboration across institutions and more intensive evaluations of programs involving students who, though relatively few in number, have great potential for contributing to the health of rural communities across the nation.

Impact of the Rural Physician Associate Program on Workforce Outcomes

“…6,9 Rural programs, as recently defined and listed by Longenecker et al, are offered at about 20% of US medical schools. 17 Recent reports of established programs align with our findings that rurally-trained medical students are more likely to join and sustain the rural, primary care, and family medicine workforce. [17][18][19][20] Compared to UMMS matched peers, RPAP graduates have contributed significantly to the Minnesota rural primary care workforce, primarily as family physicians, supporting the findings of Wendling et al, that choosing family medicine may be the best predictor of enduring impact on the primary care workforce.…”

“…[17][18][19][20] Compared to UMMS matched peers, RPAP graduates have contributed significantly to the Minnesota rural primary care workforce, primarily as family physicians, supporting the findings of Wendling et al, that choosing family medicine may be the best predictor of enduring impact on the primary care workforce. 17 UMMS supports a rural mission in multiple ways. The UMMS Duluth medical school campus (UMN-Duluth) is a program that educates firstand second-year students, and has an admissions process and mission to develop rural physicians.…”

“…24 Our study links multiple data sets including the AMA Masterfile, NPPES, and UMMS student databases to efficiently compare student education pathways and practice outcomes and responds to the recent call to use practice data rather than residency match data to determine primary care contribution. 17 Expanding rural medical school programs as a strategy to meet rural workforce needs, and identifying other factors which predict eventual primary care and rural practice, is an area of ongoing research. [25][26][27] Parlier and colleagues examined factors in successfully recruiting and retaining rural primary care physicians.…”

The Role of Rural Graduate Medical Education in Improving Rural Health and Health Care

“…Correcting the existing workforce shortages in rural America with intentional family medicine GME will save lives while contributing to the economic basis of local health care, keeping both patients and health care economic investment close to home. Literature exists addressing the rural placement rates as related to admission of students, 4 undergraduate medical education, 5 recruitment, and retention strategies employed. 6 As we take up our role in GME for rural practice, 7 the core concept of situational adaptation applies.…”

Longitudinal assessment of a Dental and Medical Student Service program in Appalachia: Successes and lessons learned

“…The placement and retention of healthcare providers in rural and underserved communities has been a constant struggle and lack of access to healthcare in these communities is related to reduced care utilization and worse outcomes. 1,2 Interventions at federal, state, and local levels by government and non-governmental organizations within and outside of the United States have had mixed success. In the United States, the National Health Service Corps (NHSC) is a Federal program, which places healthcare providers in underserved communities.…”