What actually keeps physicians in rural practice

Where a physician completed residency was more closely associated with rural practice than where that physician grew up, according to a research letter published Aug. 5 in JAMA Network Open.

Researchers at the Association of American Medical Colleges (AAMC), the University of Washington and George Washington University analyzed the AAMC's 2022 National Sample Survey of Physicians, a weighted sample of 5,778 active U.S. physicians.

Earlier work tested rural background and rural training separately, but this study built one model accounting for how three inputs feed into each other: where a physician grew up, where that physician spent medical school clinical rotations, and where residency and fellowship training happened.

Completing all graduate medical education in rural areas was associated with 42.0 percentage points more rural patient care time. Rural upbringing was associated with 23.5 points. Rural medical school rotations, on their own, showed no significant direct association.

The eight possible combinations of those three inputs fall into four tiers, set by rural origin and rural residency. Within each tier the only variable that changes is medical school, and the estimate moves about two points every time.

Practices recruiting into rural and semi-rural markets often screen for rural roots. Training background is the stronger of the two signals in this model, and unlike a hometown it is not in fixed supply.

Each tier assumes a physician spent an entire training stage in a rural setting. Physicians in the survey reported an average of 8.3% of medical school and 6.2% of residency in rural areas, so these figures sit at the outer edge of what the model can produce.

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