A Program to Increase the Number of Family Physicians in Rural and Underserved Areas Impact After 22 Years
Howard K. Rabinowitz, MD, James J. Diamond, PhD, Fred W. Markham, MD, Christina E. Hazelwood
Context: The shortage of physicians in rural areas is a longstanding and serious problem, and national and state policymakers and educators continue to face the challenge of finding effective ways to increase the supply of rural physicians.
Objective: To determine the direct and long-term impact of the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) on the rural physician workforce.
Design: Retrospective cohort study.
Participants and Setting: A total of 206 PSAP graduates from the classes of 1978 to 1991.
Main Outcome Measures: The PSAP graduates currently practicing family medicine in rural and underserved areas of Pennsylvania, compared with all allopathic medical school graduates in the state, and with all US and international allopathic graduates. All PSAP graduates were also compared with their non-PSAP peers at JMC regarding their US practice location, medical specialty, and retention for the past 5 to 10 years.
Results: The PSAP graduates account for 21% (32/150) of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% (206/14,710) of graduates from those schools (relative risk [RR], 19.1). Among all US and international medical school graduates, PSAP graduates represent 12% of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in underserved areas. Overall, PSAP graduates were much more likely than their non-PSAP classmates at JMC to practice in a rural area of the United States (34% vs 11%; RR, 3.0), to practice in an underserved area (30% vs 9%; RR, 3.2), to practice family medicine (52% vs 13%; RR, 4.0), and to have combined a career in family practice with practice in a rural area (21% vs 2%; RR, 8.5). Of PSAP graduates, 84% were practicing in either a rural or small metropolitan area, or one of the primary care specialties. Program retention has remained high, with the number of PSAP graduates currently practicing rural family medicine equal to 87% of those practicing between 5 and 10 years ago, and the number practicing in underserved areas, 94%.
Conclusions The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas.
JAMA. 1999;281:255-260
The PSAP program began in 1974. It admits about 15 students a year. According to Howard K. Rabinowitz, MD, Professor of Family Medicine at Jefferson Medical College and Director of the PSAP since 1976, the program recruits students who have grown up in a rural area and who are committed to practicing family medicine in the same or similar area. PSAP students follow a curriculum similar to their non-PSAP classmates, but take some courses that focus on practicing family medicine in a rural community, receive training in rural or small town areas and pair with an academic advisor from Jefferson’s family medicine department.Overall, PSAP graduates were eight times more likely than their non-PSAP classmates at Jefferson to practice family medicine in a rural area of the United States Program retention was also found to be high, with the number of PSAP graduates currently practicing family medicine in rural and underserved areas of the United States equal to approximately 90 percent of the number practicing five to 10 years ago.
“The biggest impact of the PSAP program has been our ability to provide doctors to rural areas that have a limited number of physicians,” explains Dr. Rabinowitz. “With more people living in rural Pennsylvania than in any other state in the nation, the medical needs of this population are great, and this program has let us meet JAMA continued from page one these needs to a large extent.” Dr. Rabinowitz views the PSAP as a public service program, providing family physicians to rural areas where the demand for good medical care is high and the availability is low.
Since 1978, the PSAP has also been supported by the PSAP Cooperative Program, a joint program with six undergraduate institutions in Pennsylvania – Allegheny College, Bucknell University, Franklin and Marshall College, Indiana University of Pennsylvania, the Pennsylvania State University and the University of Scranton. All of these institutions assist in the recruitment and selection of PSAP applicants.