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Health Serv Res. 1994 April; 29(1): 39–58.
PMCID: PMC1069987

Medical education and the retention of rural physicians.


OBJECTIVE. This study inquires whether retention in rural practice settings is longer for graduates of public medical schools and community hospital-based residencies, and for those who participated in rural rotations as medical students and residents. These questions are addressed separately for "mainstream" rural physicians and physicians serving in the National Health Service Corps (NHSC). DESIGN. Design is a prospective cohort study. PARTICIPANTS. Study subjects were 202 primary care physicians who graduated from U.S. allopathic medical schools from 1970-1980, and who in 1981 were working in a nationally representative sample of externally subsidized rural practices. Nearly half were serving in the NHSC. Physicians were first identified in 1981 as part of an earlier study. INTERVENTION. In 1990, study subjects were re-located and sent a follow-up mail survey inquiring about their medical training backgrounds and their careers from the time of graduation until 1990. We examined associations between four features of physicians' medical training and their subsequent retention in rural practice settings. RESULTS. Among those not in the NHSC, rural retention duration did not differ for those from public versus private medical schools, those who trained in community hospitals versus university hospital-based residencies, or for those who completed versus did not complete rural rotations as students or residents. Among NHSC physicians, no retention duration differences were noted for those with rural experiences as students or residents, or for those trained in community hospital residencies. Contrary to common wisdom, public school graduates in the NHSC remained in rural areas for shorter periods than private school graduates. CONCLUSIONS. These findings call into question whether current rural-focused medical education initiatives prepare rural physicians in ways able to influence their retention in rural settings. For purposes of enhancing the rural practice retention of its alumni, the NHSC should not selectively award scholarships to students from public medical schools.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Brazeau NK, Potts MJ, Hickner JM. The Upper Peninsula Program: a successful model for increasing primary care physicians in rural areas. Fam Med. 1990 Sep-Oct;22(5):350–355. [PubMed]
  • Chaulk CP, Bass RL, Paulman PM. Physicians' assessments of a rural preceptorship and its influence on career choice and practice site. J Med Educ. 1987 Apr;62(4):349–351. [PubMed]
  • Geyman JP, Ciriacy EW, Mayo F, Wood M, Cherkin DC. Geographic distribution of family practice residency graduates: the experience of three statewide networks. J Fam Pract. 1980 Nov;11(5):761–766. [PubMed]
  • Kairys S, Newell P. A rural primary care pediatric residency program. J Med Educ. 1985 Oct;60(10):786–792. [PubMed]
  • Madison DL, Shenkin BN. Preparing to serve-NHSC scholarships and medical education. Public Health Rep. 1980 Jan-Feb;95(1):3–8. [PMC free article] [PubMed]
  • Pathman DE, Konrad TR, Ricketts TC., 3rd The comparative retention of National Health Service Corps and other rural physicians. Results of a 9-year follow-up study. JAMA. 1992 Sep 23;268(12):1552–1558. [PubMed]
  • Pathman DE, Agnew CR. Querying physicians' beliefs in career choice studies: the limitations of introspective causal reports. Fam Med. 1993 Mar;25(3):203–207. [PubMed]
  • Rosenblatt RA, Alpert JJ. The effect of a course in family medicine on future career choice: a long-range follow-up of a controlled experiment in medical education. J Fam Pract. 1979 Jan;8(1):87–91. [PubMed]
  • Rosenblatt RA, Moscovice I. The National Health Service Corps: rapid growth and uncertain future. Milbank Mem Fund Q Health Soc. 1980 Spring;58(2):283–309. [PubMed]
  • Rosenblatt RA, Whitcomb ME, Cullen TJ, Lishner DM, Hart LG. Which medical schools produce rural physicians? JAMA. 1992 Sep 23;268(12):1559–1565. [PubMed]
  • Scutchfield FD, Barbakow P. The mutual missions of the National Health Service Corps and state-supported medical schools-the Alabama story. Public Health Rep. 1980 Jan-Feb;95(1):16–18. [PMC free article] [PubMed]
  • Sheps CG, Wagner EH, Schonfeld WH, DeFriese GH, Bachar M, Brooks EF, Gillings DB, Guild PA, Konrad TR, McLaughlin CP, et al. An evaluation of subsidized rural primary care programs: I. A typology of practice organizations. Am J Public Health. 1983 Jan;73(1):38–49. [PubMed]
  • Smith BW, Landick R, Dodge R. A curricular model for a rural family practice clerkship. Public Health Rep. 1982 Jul-Aug;97(4):373–379. [PMC free article] [PubMed]
  • Talley RC. Graduate medical education and rural health care. Acad Med. 1990 Dec;65(12 Suppl):S22–S25. [PubMed]
  • Weaver DL. The National Health Service Corps: a partner in rural medical education. Acad Med. 1990 Dec;65(12 Suppl):S43–S44. [PubMed]
  • Whitcomb ME, Myers WW. Physician manpower for rural America: summary of a WAMI region conference. Acad Med. 1990 Dec;65(12):729–732. [PubMed]

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