Rural Health Paradox: Can Nonrural GME Programs Create a Pathway to Expand the Rural Physician Workforce?
by Mario P. DeMarco, M.D., MPH | December 11, 2024
Article Citation: Hawes EM, Rodefeld L, Weinstein DF. Academic Medicine and Rural Health System Partnerships: Enhancing Education While Advancing Physician Workforce Priorities. Acad Med 2024; 99(10):1065-1069. DOI: 10.1097/ACM.0000000000005753
What is this article about?
In this policy-based commentary, the authors describe some of the key determinants that explain the rural physician shortage as well as some of the past and current approaches which have to this date not sufficiently addressed those shortages. They provide justification for a recommendation to routinely engage residents from nonrural GME programs in rural GME rotations as an alternative strategy. Such an approach they argue has lower initial barriers, more immediate impact, and can be a bridge for rural health centers to sponsor independent GME programs in the future.
Why should you read the article?
There are growing shortages of rural physicians which has restricted access to primary and specialty care for those populations in rural areas resulting in widening health disparities. The authors provide a focused policy analysis of previous state and federal efforts that have been designed to address this dilemma but have fallen short to meet the needs of rural America. This legislative landscape analysis would be helpful to medical educators and system leaders who are less versed in these programs, especially those at academic medical centers which are primarily urban. In light of these challenges, readers will understand the potential for health system partnerships to be mutually beneficial for resident education as well as increasing the size of the rural physician workforce.
How can you use this article?
Faculty and education directors at academic medical centers should consider the importance of rural health electives as part of both UME and GME training. Evidence suggests that even brief rural rotations at UME or GME levels can significantly increase the likelihood of practicing in a rural area. Moreover, rural training locations may expand a learners skill sets through practice in a lower subspecialty setting, diversifying the patient populations and clinical challenges encountered and more direct work with experienced physicians. Such experiences may also buffer resident resilience by offering opportunities to explore new areas or communities and proximity to nature and outdoor activities that may be less available at the academic medical center. In the current era of hospital acquisition and health system expansion, greater opportunities may emerge for traditional academic medical centers to partner with rural organizations to foster these mutually beneficial training models. While health professionals from rural backgrounds are far more likely to practice in rural areas, the vast majority of medical residents have nonrural backgrounds – and the right GME structures could facilitate a strong minority of those to serve rural communities.
Review Author: Mario P. DeMarco, M.D., MPH, Associate Professor of Clinical Family Medicine, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Organization: Society of Teachers of Family Medicine