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Context for this review AcademyHealth undertook this review from the perspective of a regional policymaker or funder considering interventions to improve the recruitment and retention of health professionals who provide primary care services to rural populations. We examined previously synthesized evidence concerning the effectiveness of specific recruitment and retention strategies and factors associated with health professionals' decisions to locate in a given geographic setting. At the direction of the funder, we excluded studies of telehealth as a tool to extend patient access or support professional practice in remote areas as well as efforts to expand non-physicians' scopes of practice. We included evidence from other countries if it examined strategies relevant to the United States. RAPID EVIDENCE REVIEW Answer: Some strategies are effective in recruiting providers to rural areas, but less so in retaining health professionals in these settings. While few approaches have a positive effect on both recruitment and retention, combining individual interventions may be the most effective way to expand and maintain the rural primary care workforce. Among the individual approaches shown to increase recruitment but not necessarily retention are: (1) educational scholarships, (2) loans, (3) postgraduate loan repayment, (4) salary increases and other direct payments, (5) short-term rural placements for students, and (6) curriculum tailored to rural practice. The strategies shown to have some positive effect on both recruitment and retention are: (1) targeted recruitment of specific groups, such as those with existing ties to rural communities, (2) professional development opportunities for rural practitioners, and (3) taking actions to ensure a stable, well-resourced work environment. Services to help health professionals cope with rural life have yielded mixed results.

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ObjectiveTo determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.Data Sources and Study SettingWe used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016–2018) and American Medical College Application Service (AMCAS).Study DesignWe conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post‐residency.Data Collection/Extraction MethodsWe merged NGS data with residency type—rural or urban—and practice location with AMCAS data on rural background.Principal FindingsFamily physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees.ConclusionsIncreasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.

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Purpose. Lack of health care providers’ knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. Method. Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. Results. Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. Conclusions. Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.

Background and Objectives: Little is known about how rural and urban family medicine residencies compare in preparing physicians for practice. This study compared the perceptions of preparation for practice and actual postgraduation scope of practice (SOP) between rural and urban residency program graduates. Methods: We analyzed data on 6,483 early-career, board-certified physicians surveyed 2016-2018, 3 years after residency graduation, and 44,325 later-career board-certified physicians surveyed 2014-2018, every 7 to 10 years after initial certification. Bivariate comparisons and multivariate regressions of rural and urban residency graduates examined perceived preparedness and current practice in 30 areas and overall SOP using a validated scale, with separate models for early-career and later-career physicians. Results: In bivariate analyses, rural program graduates were more likely than urban program graduates to report being prepared for hospital-based care, casting, cardiac stress tests, and other skills, but less likely to be prepared in some gynecologic care and pharmacologic HIV/AIDS management. Both early- and later-career rural program graduates reported broader overall SOPs than their urban-program counterparts in bivariate analyses; in adjusted analyses this difference remained significant only for later-career physicians. Conclusions: Compared with urban program graduates, rural graduates more often rated themselves prepared in several hospital care measures and less often in certain women’s health measures. Controlling for multiple characteristics, only rurally trained, later-career physicians reported a broader SOP than their urban program counterparts. This study demonstrates the value of rural training and provides a baseline for research exploring longitudinal benefits of this training to rural communities and population health.