Educating generalist physicians for rural practice: How are we doing?

Although about 20 percent of Americans live in rural areas, only 9 percent of physicians practice there. Physicians consistently and preferentially se ttle in metropolitan, suburban and other nonrural areas. The last 20 years have seen a variety of strategies by medical education programs and by fede ral and state governments to promote the choice of rural practice among phy sicians. This comprehensive literature review uns based on MEDLINE and Heal th STAR searches, content review of more than 125 relevant articles and rev iew of other materials provided by members of the Society of Teachers of Fa mily Medicine Working Group on Rural Health. To the extent possible, a part icular focus was directed to "small rural" communities of less than 10,000 people. Significant progress has been made in arresting the downward trend in the number of physicians in these communities but 22 million people stil l live in health professions shortage areas. This report summarizes the suc cesses and failures of medical education and government programs and initia tives that are intended to prepare and place more generalist physicians in rural practice. It remains clear that the educational pipeline to rural med ical practice is long and complex, with many places for attrition along the way Much is now known about how to select, train and place physicians in r ural practice but effective strategies must be as multifaceted as the barri ers themselves.