In order to get doctors to go into the smallest towns, there must be a combined effort by the state, the community, and medical educators. The state must hold medical educators accountable and it must support rural community development and education. The community must make an effort to maintain and expand local jobs and education and support for health care. Medical educators must choose students from the smallest towns and implement programs that have been shown to graduate family practice residents into these towns. Their failure to do so is illustrated by this chart (declining purple bars) noting that the number of FP grads going to the smallest towns has been cut in half in the past 15 years. Currently there are only a few programs that demonstrate this ability. For more about state efforts, see this. For more about local efforts, check this out.
The Rural Physician Associate Program at MN
State legislators held the University accountable back in 1970 and the Rural Physician Associate Program resulted. The program has documented its success in locating physicians in rural communities, including the smallest. Specific admissions programs assist RPAP in this effort. As with other rural preceptorships, RPAP students get lots of hands-on experiences.
The Accelerated Rural Training Program at NE
This program enters its 8th year in 2000. 90% of the graduates of this program have stayed in the state. 70% of the graduates of this program have entered rural practice in towns of less than 5,000. The program graduates 4 residents a year. This is the only such program in the nation. The program accepts medical students at the end of their M-3 year. The 4th year of medical school is combined with the first year of FP residency. The trainees take three years of medical school, three years of FP residency, and a rural/procedural fellowship year.
Procedural Training is a Key Element - The fellowship includes OB, anesthesia, scopes, colposcopy, minor surgical training, neonatology, and critical care. The program costs less than a usual residency year. The key to this program is a superb 4th year of training with dedicated faculty from a variety of disciplines. For more, see Nebraska's Graduate Programs.
The potential is there for various Rural Training Programs that emphasize procedural training, including rural family practice programs and rural fellowships.
The way to create such programs is to find dedicated faculty such as Jack Verby and Jim Stageman and fund them adequately to do what it takes to select and train the right people.
Medical leaders at the national level would have you believe that small town practice is impossible, but rural medical education has proved them wrong again.