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Rural doctors often born and raised, not recruited

A new JAMA study indicates that the best way to increase the number of rural physicians is to support rural students and mentor them through medical school.

By Jay Greene, amednews staff. Oct. 1, 2001.

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Larry Lloyd Rapp, DO, has practiced in rural Minnesota for 28 years. After his residency in Cleveland, Dr. Rapp wanted to return home.

"I grew up in southern rural Minnesota," said Dr. Rapp, a primary care osteopathic physician in Elbow Lake, Minn. "I was anxious to get back even though I almost stayed in Cleveland to pay off my debt. I am glad I am here."

Indeed, place of birth appears to be the best predictor of whether a medical student chooses to practice in a rural area or small town, according to a new study. But a consistent mentoring program during medical school and family practice preceptorships are also key, according to the Sept. 5 issue of JAMA.

With declining income, high medical student debt and lack of support services to physicians and their families in rural and small towns, recruiting and retaining physicians for rural service is becoming more difficult, said Howard Rabinowitz, MD, professor of family medicine at Jefferson Medical College in Philadelphia.

"We know physicians in rural areas work longer hours and are reimbursed less. It is critically important to help support physicians out there. They are dealing with substantial challenges," said Dr. Rabinowitz, the study's lead author.

The federal government has not put forth the necessary funding that provides incentives for physicians to practice in rural areas, Dr. Rabinowitz said. While 20% of the nation's 285 million people reside in rural areas, only 9% of physicians practice there.

"The background of the students and career plans at time of medical school are by far the most predictive factors of who ends up practicing in rural primary care and staying there," Dr. Rabinowitz said. [...]