title: Medical school rural programs:  a comparison with international medical graduates in addressing state-level rural family physician and primary care supply.
abstract: OBJECTIVE
  Comprehensive medical school rural programs (RPs) have made demonstrable contributions to the rural physician workforce, but their relative impact is uncertain. This study compares rural primary care practice outcomes for RP graduates within relevant states with those of international medical graduates (IMGs), also seen as ameliorating rural physician shortages.
  
  
  METHODS
  Using data from the 2010 American Medical Association Physician Masterfile, the authors identified all 1,757 graduates from three RPs (Jefferson Medical College's Physician Shortage Area Program; University of Minnesota Medical School Duluth; University of Illinois College of Medicine at Rockford's Rural Medical Education Program) practicing in their respective states, and all 6,474 IMGs practicing in the same states and graduating the same years. The relative likelihoods of RP graduates versus IMGs practicing rural family medicine and rural primary care were compared.
  
  
  RESULTS
  RP graduates were 10 times more likely to practice rural family medicine than IMGs (relative risk [RR] = 10.0, confidence interval [CI] 8.7-11.6, P < .001) and almost 4 times as likely to practice any rural primary care specialty (RR 3.8, CI 3.5-4.2, P < .001). Overall, RPs produced more rural family physicians than the IMG cohort (376 versus 254).
  
  
  CONCLUSIONS
  Despite their relatively small size, RPs had a significant impact on rural family physician and primary care supply compared with the much larger cohort of IMGs. Wider adoption of the RP model would substantially increase access to care in rural areas compared with increasing reliance on IMGs or unfocused expansion of traditional medical schools.
authors.affiliation: Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. Howard.Rabinowitz@jefferson.edu
authors.forename: Howard K
authors.initials: HK
authors.lastname: Rabinowitz
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.forename: James G
authors.initials: JG
authors.lastname: Boulger
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hunsaker
authors.forename: James J
authors.initials: JJ
authors.lastname: Diamond
authors.forename: Fred W
authors.initials: FW
authors.lastname: Markham
authors.forename: Andrew
authors.initials: A
authors.lastname: Bazemore
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
mesh_terms: D004504:Education, Medical, Undergraduate; D005194:Family Practice / Q000193:education; D005550:Foreign Medical Graduates; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D011320:Primary Health Care; D015397:Program Evaluation; D019035:Rural Health Services / Q000600:supply & distribution; D014481:United States; D000078329:Workforce