To keep up with the growing gap in primary healthcare in rural areas, medical schools have begun to emphasize rural training programs for their students. Learn more here.
As medicine has grown more stressful, some doctors are seeing the advantages of rural practices. More than 40 medical schools have created programs that give their students a chance to experience rural medicine and decide for themselves.
Rural residents need them. In part because they need to travel for care, they are more likely to die from heart and lung disease and tend to be diagnosed with cancer when the disease is further along. There are 40 physicians per 100,000 people in rural America, compared with 53 per 100,000 in large cities, and rural areas have a growing elderly population.
Medical students who grew up in small towns are most likely to choose to practice there, research shows. But even as doctors everywhere are heading for retirement, the number of medical school students from rural areas has fallen. In 2017, students from rural backgrounds made up just 4.3 percent of the incoming classes. So, attracting people who grew up elsewhere has become essential.
How medical schools are encouraging rural medicine
One step is to attract more students from rural areas. Oregon Health & Science University (OHSU), for example, sends representatives to community colleges and high schools to find potential medical students and help them apply. The University of Kansas School of Medicine invites college sophomores from rural areas of Kansas to apply and guarantees them admission if they finish college.
Another is to give medical students a taste of rural medicine. The University of New Mexico School of Medicine’s Rural and Underserved Populations program selects students to experience working with the Indian Health Service on reservations, among other opportunities, and attend special seminars on underserved populations.
Other schools, including Ohio University and the University of Colorado, offer a rural track for medical students that can begin even before the first day of medical school.
After coursework, doctors complete three to seven years of training called a residency. Traditionally, more than half of residents choose to practice in the state of their residency, and a rural track steers students toward residency slots in rural areas. Rural training can be especially rewarding. As part of the University of South Dakota Frontier and Rural Medicine program, medical student Kristin Inman, who grew up in Pierre (population 13,980), trained in Winner (population 2,852). “Because the community is so small, I was able to work closely with the same attending physician all year, which was the best learning experience really anyone could have,” she told the Association of American Medical Colleges. “Everyone on the team got to know me, to identify my strengths and weaknesses and encourage me.”
Why it’s hard for young doctors to practice in rural areas
Medical schools tend to emphasize the challenge and prestige of working as a specialist at big-name hospital.
For people who grew up in the suburbs or cities, rural life is a major change. You may worry about the schools, for example.
Also, rural doctors tend to work more hours than they would in cities.
In the past, spouses tended to have fewer opportunities, but the growth of remote work may be changing that scenario.
The poverty rate in rural regions is higher, and rural family health doctors say that treating the poor can be heartbreaking. Mental healthcare is scarce. Poor children are more likely to have serious mental health issues and land in foster care. There may be few social services to help a parent with a drug addiction, for example, or an abusive spouse. Rural primary care doctors can end up providing addiction and psychiatric treatment. Their patients may not have insurance or be able to afford copayment (co-pay).
The advantages of practice in a rural area
Rural doctors have easier access to open space, less exposure to noise and traffic, and the chance to be a well-known and appreciated person in their community.
Doctors actually earn a bit more in rural areas — by 5 to 10 percent — and may enjoy much lower living costs. They can also get significant signing bonuses, relocation packages, and a write-off on a medical school loan.
If telemedicine continues to take off, it may be possible for doctors to see local patients and increase their income with patients they see virtually. At the same time, they may be able to take care of entire families and build strong relationships.
A rural practice is also a way to expand skills. Doctors are likely to be busy but have a varied day. Researchers who conducted a small 2019 study in South Dakota were surprised to find that only 25 percent of physicians in towns with fewer than 10,000 people reported feeling burned out, compared to 37.5 percent in medium sized towns (10,000 - 50,000 people) and more than 51 percent in areas with more than 50,000 people. It can be deeply rewarding to practice in a rural area because doctors will know their services are truly needed and they can save lives.
January 20, 2022
Janet O’Dell, RN