Preparing and retaining rural physicians through medical education

Purpose. To identify educational approaches that best prepare physicians fo r rural work and small-town living, and that promote longer rural practice retention. Method. In two mail surveys (1991 and 1996-97), the authors collected data from primary care physicians who had moved to rural practices nationwide fr om 1987 through 1990. A total of 456 eligible physicians responded to both surveys (response rate of 69.0%). The authors identified those features of the physicians' training that correlated with their self-reported preparedn ess for rural practice and small-town living, and with how long they stayed in their rural practices. Analyses controlled for six features of the phys icians and their communities. Results. The physicians' sense of preparedness for small-town living predic ted their retention duration (hazard ratio, 0.74, P < .0001), whereas their preparedness for rural medical practice did not predict their retention du ration after controlling for preparedness for small-town living (hazard rat io, 0.92; p = .27). For the physicians who had just finished their training , only a few features of their training predicted either rural preparedness or retention. Residency rural rotations predicted greater preparedness for rural practice (p = .004) and small-town living (p = .03) and longer reten tion (hazard ratio, 0.43, p = .003). Extended medical school rural rotation s predicted only greater preparedness for rural practice (P = .03). For the physicians who had prior practice experience, nothing about their medical training was positively associated with preparedness or retention. Conclusion. Physicians who are prepared to be rural physicians, particularl y those who are prepared for small-town living, stay longer in their rural practices. Residency rotations in rural areas are the best educational expe riences both to prepare physicians for rural practice and to lengthen the t ime they stay there.