A Decade of Rural Physician Workforce Outcomes for the Rockford Rural Medical Education (RMED) Program, University of Illinois (original) (raw)

United States is facing a continuing shortage of primary care physicians. 1,2 Responses to the Graduation Questionnaire of the Association of American Medical Colleges by physicians from 1997 to 2006 show there was an overall decrease in those who chose general internal medicine from 15.7% to 6.7%, from 10.2% to 6.6% in general pediatrics, and from 17.6% to 6.9% in family practice. 3 On the other hand, there was an overall increase in the proportion of physicians who chose internal medicine subspecialties (6.8% to 11.4%) and pediatrics subspecialties (2.2% to 4.4%). 3 Recent trends reveal a major drop in graduating medical students specializing in general internal medicine over the past 15 years. In 1998, approximately 55% of residents specialized in general internal medicine, whereas in 2005, this proportion dropped to 20%. 4,5 This ever-growing shortage of primary care physicians is magnified in rural communities. In 2005, there were 55 primary care physicians for every 100,000 people in rural areas compared with an estimated need for 95 per 100,000. 6,7 Whereas approximately 19% of the U.S. population lives in rural America, only about 11% of physicians practice in rural locations. 8 The shortage of rural family practitioners can be attributed to various factors, some of which include an aging rural population, a retiring medical workforce, and fewer medical students interested in practicing in rural areas. 9 Research conducted by the Health Resources and Services Administration Rural Health Research Centers found that effective recruitment strategies for primary care include focusing on students with rural backgrounds, exposing students to rural areas and issues during medical school, and offering financial incentives to practice and remain in rural areas. It also concluded that older and nontraditional medical students are more likely to practice in rural areas. 10 Obstacles that discourage practicing as a rural primary care provider include lower salaries than in urban areas, cultural isolation in rural areas, lower-quality schools and housing options than more metropolitan areas, and a lack of spousal job opportunities. 5,11 Rabinowitz and colleagues 12 have systematically reviewed the outcomes of comprehensive medical school programs designed to increase the rural physician supply, and developed a model to estimate the impact of their widespread replication. The investigators found six studies that summarized the rural outcomes of medical school programs addressing rural physician supply: the Rural Physician Associate Program (RPAP) of the University of Minnesota; the University of Minnesota Medical