Preparing and retaining rural physicians through medical education.
OBJECTIVE
To identify educational approaches that best prepare physicians for rural work and small-town living, and that promote longer rural practice retention.


METHODS
In two mail surveys (1991 and 1996-97), the authors collected data from primary care physicians who had moved to rural practices nationwide from 1987 through 1990. A total of 456 eligible physicians responded to both surveys (response rate of 69.0%). The authors identified those features of the physicians' training that correlated with their self-reported preparedness for rural practice and small-town living, and with how long they stayed in their rural practices. Analyses controlled for six features of the physicians and their communities.


RESULTS
The physicians' sense of preparedness for small-town living predicted their retention duration (hazard ratio, 0.74, p < .0001), whereas their preparedness for rural medical practice did not predict their retention duration after controlling for preparedness for small-town living (hazard ratio, 0.92; p = .27). For the physicians who had just finished their training, only a few features of their training predicted either rural preparedness or retention. Residency rural rotations predicted greater preparedness for rural practice (p = .004) and small-town living (p = .03) and longer retention (hazard ratio, 0.43, p = .003). Extended medical school rural rotations predicted only greater preparedness for rural practice (p = .03). For the physicians who had prior practice experience, nothing about their medical training was positively associated with preparedness or retention.


CONCLUSIONS
Physicians who are prepared to be rural physicians, particularly those who are prepared for small-town living, stay longer in their rural practices. Residency rotations in rural areas are the best educational experiences both to prepare physicians for rural practice and to lengthen the time they stay there.
Pathman
D E
DE
Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. don_pathman@unc.edu
Steiner
B D
BD
Jones
B D
BD
Konrad
T R
TR
D000328:Adult; D001291:Attitude of Health Personnel; D004501:Education, Medical; D005194:Family Practice / Q000193:education; D005260:Female; D005544:Forecasting; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D016017:Odds Ratio; D010372:Pediatrics / Q000193:education; D010560:Personnel Selection; D010820:Physicians; D011364:Professional Practice; D012424:Rural Population; D012577:Schools, Medical; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States