Trends in Subspecialization: A Comparative Analysis of Rural and Urban Clinical Education

Abstract

Background and Objectives: Medical students who train in rural communities are often exposed to physicians practicing a broad scope of care, regardless of discipline. We examined how rural education is associated with practice specialization rates for students who match in primary care or general core specialties. Methods: We linked practice and specialty data (2016 AMA Masterfile dataset), demographics (American Medical College Application Service data), and internal college data for 1974-2011 Michigan State University College of Human Medicine graduates who received clinical education on either the Upper Peninsula (rural) or Grand Rapids (urban) campuses. Current practice was verified using internet searches. We compared specialty and practice data by rural or urban campus, controlling for multiple variables. Results: More rurally-trained graduates entered primary care (PC) residencies (128/208, 61.5%) than urban-trained graduates (457/891, 51.3%; P<.01), with rurally-trained graduates being twice as likely to enter family medicine (FM) residencies. Most FM residents remained PC physicians (205/219, 93.6%). Internal medicine residents were least likely to remain in primary care (91/189, 48.1%). Of the general core disciplines, general surgeons were least likely to remain in general surgical practice (45/134, 33.6%). Within each PC or general core discipline, the proportion of graduates who specialized did not differ by type of campus. Conclusions: Rurally-trained graduates are more likely to practice primary care, chiefly due to increased likelihood of choosing a FM residency. Graduates entering PC or general core residencies subspecialize at similar rates regardless of rural or urban education. FM residency match rate may be the best predictor of long-lasting impact on the primary care workforce.

Impact of the Rural Physician Associate Program on Workforce Outcomes

“…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 UMMS supports a rural mission in multiple ways.…”

Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis

“…The impact of training location can be difficult to isolate because students are generally given a choice about where they want to train, and this regional education is often in the context of an educational pathway program. 10,20,21,[42][43][44][45][46][47] However, Practicing physicians Survey Among graduates in the classes of 1983-1984, underrepresented minority graduates were more likely than white graduates to report that financial aid had influenced their specialty choice. Xu 1996 60…”

“…Between 2003 and 2013, BS-MD students, who received scholarships that covered full tuition and fees, did not enter primary care specialties at a higher rate than other students. Nguyen 2019 61 most studies of career choice of students training on regional campuses have demonstrated that distributed models lead to higher numbers of primary care physicians, 10,41,[48][49][50] with one exception. 51 In some studies, this association was present even in the absence of a distinct curricular pathway.…”

“…9 To positively impact the production of primary care physicians, it is important to identify institutional characteristics that are associated with increased percentages of medical students choosing to enter a career in primary care generally, and family medicine specifically, as students matching into family medicine are those most likely to enter the primary care workforce. 10 These characteristics may be modifiable or fixed, and may include things like geographic location, funding source, governance structures, or institutional missions. Our goal was to review, synthesize, and summarize the existing literature pertaining to those medical schools' attributes.…”

Characteristics of Medical School Applicants: A Single-Institution Study

“…7 Several urban medical schools have also described success with increasing the number of graduates entering rural practice by opening satellite campuses in rural areas. [8][9][10][11] For campuses or schools located in rural areas, there is a need to identify applicants who will be actively engaged in the communities in which they live, embarking to make positive change. Considering the nation-wide decline in medical student applicants who have a rural upbringing, 12 there BACKGROUND AND OBJECTIVES: Medical schools aim to admit talented learners who are honest, patient centered, and caring, in addition to possessing the required cognitive skills.…”