Recipe for more rural physicians: more exposure in residency training

Exposure to rural medicine during residency training is associated with a significant increase in the likelihood that a physician will practice in a rural setting upon entering practice, according to a recently published study.

The study-published in the Journal of Higher Medical Education— found that family medicine residents who spent 50% or more of their training time in rural settings were at least five times more likely than residents without rural training to practice in rural settings. The results, collected from a sample of more than 12,000 family physicians who completed residency training between 2008 and 2012, also indicate that even a small amount of rural training time — between 1% and 9% — increases considerably the chances of a trainee eventually opting for rural practice.

One in five Americans lives in a rural community. Yet these regions face shortages of physicians in all medical specialties. Residency training institutions are working to meet the need with programs such as Fully Integrated Preparation for Service Training (FIRST), a project to expand the reach of graduate medical education in the state of North Carolina. North. The program, which received an AMA Reimagining Residency grant, is an extension of the residency preparation program at the University of North Carolina (UNC) School of Medicine.

FIRST offers a dedicated pathway to practice in rural areas that includes three years of medical school, three to five years of residency training, and three years of early-career mentorship once established in practice in a Carolina community North.

Catherine Coe, MD, is an assistant professor at UNC and principal investigator of the FIRST project. “One thing this program facilitates is for residents to build longitudinal relationships with the community,” Dr. Coe said. “Students are exposed to certain chronic conditions that may be less well controlled due to available resources and must think outside the box to provide patients with the care they need. In some ways, it’s the kind of exposure that allows them to understand these communities.

Related coverage

Emergency telemedicine is poised to grow in the new phase of the pandemic

Most of the residents in the study—more than 90 percent—had received no rural training. The study found that 14% of all family medicine residents were pursuing rural practice opportunities in 2018. The vast majority of family physicians practicing in rural settings had little or no training in the unique aspects of providing of care to this patient population, which can create a difficult transition to practice.

“Any doctor is equipped to go rural from a medical training standpoint,” Dr. Coe said. “Some of the challenges that we don’t necessarily train people for are systemic, like patient access to care. You can definitely learn some of it on the job, but that’s the element you get when you do residency training in this area.

Disincentives related to attracting residents to post-training rural opportunities, particularly those in small rural communities, may be related to the practical limitations of these positions.

“For family medicine, many rural communities have closed labor and delivery practices and are moving them to larger academic medical centers,” Dr. Coe said. “This not only impacts patient care, but also our ability to train our residents and the job opportunities available to physicians who wish to practice family medicine at full capacity.”

The FIRST project is in its infancy and its roots go back to medical school. Yet the undergraduates produced three graduates, all of whom went to practice in rural or underserved areas after exposure to them during residency.

“The hope is that it continues,” Dr Coe said. “We want to create a program where graduates will feel connected to the community and stay there or pursue a rural position elsewhere.”

Related coverage

Pragmatic measures address the complex challenges of rural health care

The AMA has developed a policy to address and eradicate rural physician shortages. Many of the interventions called for by the Association begin with medical education.

One of the goals of the policy is to work with medical education stakeholders “to consider adding exposure to rural medicine, where appropriate, to encourage the development of rural curriculum streams in health care curricula.” training and to increase physicians’ awareness of the challenging conditions and lack of resources in rural areas. areas “.