The Relationship Between Entering Medical Studentsʼ Backgrounds and Career Plans and Their Rural Practice Outcomes Three Decades Later

Abstract

Three factors known at the time of medical school matriculation have a powerful relationship with rural practice three decades later. Relatively few students without predictors practice in rural areas, which is particularly significant given subsequent factors known to be related to rural practice--for instance, rural curriculum, residency location, or spouse. These results have major implications for the role of the medical school admissions process in producing rural physicians.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review

“…36 Seven studies showed that growing up in a rural hometown or attending a rural high school was associated with practice in a rural area. 39,41,44,45,63,64,71 …”

Fatores influenciadores na escolha pela medicina de família segundo estudantes numa região neotropical do Brasil

“…7,10 Alguns países têm reagido às iniquidades em saúde com uma seleção de estudantes de medicina com perfil socioeconômico mais variado, pois verificam que profissionais com raízes pobres ou etnias diversificadas estão mais abertos para a MFC. 19 Concluiu-se que a única intervenção eficaz, em escolas médicas, para atrair profissionais para a APS é a exposição que seja uma imersão de boa qualidade. Os estudantes que foram expostos à ESF durante todo o curso queixaram da má qualidade do contato com os médicos, que não eram especialistas em MFC e não tinham comprometimento com a comunidade.…”

Retention of Rural Family Physicians After 20-25 Years: Outcomes of a Comprehensive Medical School Rural Program

“…However, we have previously shown that 3 factors known at matriculation (growing up in a rural area, planning to practice family medicine, and planning to practice in a rural area)-well before most other personal or practice factors are known-are powerful predictors of rural practice 3 decades later and are similar in magnitude to those of well-established cardiac risk factors and future coronary heart disease. 20 In addition, although the scope of practice for rural physicians represents an important policy question, this study did not address whether those physicians remaining in rural family medicine provided the same medical services as they did when they began practicing.…”

“…13 Although this study did not address the reason why PSAP graduates were more likely to remain in family practice in the same rural area than their peers, previous studies have suggested that the major reason for the successful outcomes of the PSAP and other RPs is the admissions process, that is, selecting medical school applicants most likely to practice in a rural area (including those who grew up in a rural area and plan to practice family medicine at the time of matriculation). 7,20 Because this study was a program evaluation extending the long-term retention outcomes of PSAP graduates, it did not directly address the impact of other potential variables related to rural retention. Our prior research, however, has shown that participation in the PSAP, as well as attending college in a rural area, were the only factors independently predictive of rural primary care, whereas other variables including sex, medical school curriculum, National Health Service Corps scholarship participation, and expected peak practice income were not.…”