How To Graduate More Rural Doctors - Birth to Death Issues

Rural Education 

Bigger is not always better, smaller school districts educate students better and give them a sense of community and connectedness and other small town values that can be broken up by increased transportation and consolidation.. 

Centralization 

State educational policies may force rural students to bypass small colleges (and potential small town spouses) thus preventing their ultimate return to small towns as professionals and leaders.

Selections, the College Story - College Health Advisors, under the influence of admissions committees, facilitate the more intellectual students and may tend to discourage students who have less educational preparation and a more broad background. Students with the right stuff to become doctors may be less likely to get in than those with the right numbers. Advisors have pressures to encourage those likely to be admitted to apply, and less obvious pressures to discourage others, to keep professional school admit ratios high. Some health advisors deny this influence (from discussions with health advisors - RCB). 

Admissions  

Admit more from small towns who have true interest in rural practice and family medicine, especially if married to the right spouse and from a small college. More about the Tasks of Medical Schools at the bottom of the page. Includes info and links on Rabinowitz Physician Shortage Area Program.  See Best Models, admissions

Geographic and Organizational Factors

Rural Missions Contribute to Rural Graduation - WAMI Report,    Bowman and Penrod FP residency program research   Also newer and osteopathic schools. 

The organization, location, and mission of medical schools is closely related to the propensity of their graduates to select rural practice. – Rosenblatt in Medical Schools and Rural Physicians, Jama Sept 23/30 268:12 p 1559 WAMI Report. There is a strong interrelationship among several medical school characteristics: public ownership (+), rural location (+), family physician training (+), and research intensity (negative). p1563. Schools with dispersed education and decentralized campuses graduate more rural doctors.

Socialization Factors

    Rural Student Interest  

Educational Factors - see best models

Rural Experiences  and   Why Involvement with Preceptors Is Important for Great Faculty Development

Bridging and Bypassing Techniques

Rural Graduate Programs to influence location and training

The importance of procedures, especially for Docs for the Smallest Towns

Community Leadership Issues

Recruitment is a Community and State Effort

Retention For Your Community

Tasks for Medical Schools

Recruitment of students into rural careers

1. Special affiliations with colleges that have large numbers of rural students (that still have the ability to graduate premeds)
2. Health career clubs in middle schools/high schools
3. Special admissions tracks
4. Recruit rural minority/disadvantaged
5. More primary care and rural practice scholarships and loans

Retention begins early, prevent socialization of medical students out of rural careers

1. Decentralized campuses
2. Sensitize faculty and staff to rural values and needs - John Wheat M.D.
3. Appoint the best pc teachers to lead freshman courses in introductory medicine
4. Orient the students to the schools rural goals
5. Develop early rural preceptorship experiences
6. Set up a pc adoption, mentoring, or buddy system
7. Environmental reminders such as recruitment fairs, rural practice exhibits, invited rural speakers, weekend rural bus trips
8. Student pc societies, especially rural student interest groups and international service or Christian mission groups
9. Encourage students to volunteer
10. Include the spouse or significant other in the above

Curricular Reform to involve students in rural life and practice AAMC Data on Rural-Interested Seniors from 1995 GQ Survey

1. Rural clinical problems and experiences used as examples (good ones)
2. Physical diagnosis to include health risk appraisal
3. PC clinical track
4. Emphasize ambulatory setting for learning
5. Train for community or population-based problem solving with meaningful experiences
6. Rural research options
7. Rural elective programs
8. Rural graduate programs
9. Interdisciplinary joint programs

Strengthen Rural Communities so that they can afford good rural graduates   Working with Rural Communities

1. More relevant facilities with better trained leaders
2. Academic assistance with recruitment and retention problems
3. Trainees to help with community assessment
4. Alternative health plans for serious problem areas
5. More relevant CME
6. Mobilize support from other public and private agencies

Bruce and Norton wrote many of these and more in Improving Rural Health, Initiatives of an Academic Medical Center, Little Rock, Arkansas, Rose Publishing, 1984