Regarding the importance of Family Practice cited from the "Journal of the American Board of Family Practice" article by Benson page 32S

Reasons why rural medical education best illustrates important points in Family Medicine training (1995, revised 1999)

Experience in Ambulatory Care

Rural Practice is undiluted by patient self-referral

Exposure to Chronic Illness, Rehabilitation and Employability

Specialization and selection often allow urban physicians to avoid or refer these patients

Issues related to Disability, Death and Bereavement

Rural physicians have a closeness to their patients that best illustrates the needs of these patients and their families

Care of the Elderly, New Settings, Functional Assessment

Rural practice has a larger share of elderly, poor, and those in greater need of medical care

Precepts and Practices of Preventive Medicine

Rural patients often delay care, highlighting the need for such care. Screening interventions are sometimes more successful due to more people at risk. There is less problem with overscreening as when patients have too much access to care. Many rural physicians double up and serve in health departments, allowing students exposure to public health that is often missing from medical school curricula.

Consultation with Other Specialists

Consultants are the educators of rural physicians. Consultants want the referrals and realize the continuing need for patients to get local care, thus the need to educate their local physician. Consultants help rural physicians define their limits, try out new treatments, etc. In urban areas there is too much blurring between specialists and primary care and it is hard for students to see the real differences. Consultation is often more than just having the nurse or secretary call the specialist for an appointment

Clinical Decision-Making

The lack of access to all technology, patients with less financial resources, the larger numbers of patients, the greater variety and severity of the pathology, and the closeness with patients conspire to enhance clinical decision-making skills

Access to and Use of Medical information

Rural physicians facing the broadest range of pathology and the more severe and most puzzling patients need the best physicians, ones who can access the best and latest of medical technology.

Economics of Medical Care

Economics have a more direct impact on solo or small group rural physicians. They must know the economics of practice to survive

Systematic Self and Peer Review

A necessity with only a few providers and close scrutiny of rural patients.

Quality Control is a Daily Exercise

Rural patients may take years to check out a physician before they come in for care. This is frustrating for new physicians, unaccustomed to small towns where the way they treat patients, who they are, how much experience they have, is common knowledge.

Why Rural Fits With These Goals

Rural practices thrive or fold based on the physician’s ability to relate to their patients. Rural doctors without reasonable interpersonal skills just don’t do well.

Rural doctors face ethical dilemmas every day about how to use resources, care for those without the ability to pay, deal with tough family situations,

3. What is medicine as a profession? How did it get there?

The story of medicine is a rural to urban shift. This is not just in location. It is also in values. Rural values are personal, practical, caring, interdependent. Urban is impersonal, anonymous, money and thing dependent. Technology over personal. Medical schools especially need rural values so that we can select the right physicians for the future of the nation and the survival of medicine as a profession. All physicians need to invest in their communities to the same degree that rural physicians are expected to do and actually do.

Roman makes a key point: doctors have a social contract with patients, agreeing to serve health care needs of the patients first and foremost. He believes this is vastly under-taught. He points out that medicine is a calling, not a business; and students should not go into medicine unless they are willing to serve. Rural physicians are often role models of this devotion to patients and medicine

Also noted from the Benson article:

   c. Procedural Skills

Trainees in rural environments learn about a wide range of pathology, have less access to bells and whistles, diverse situations, need to meet emergent conditions, rural physicians are constantly learning and student are encouraged and stimulated by such learners

Cannot be avoided in rural areas

Physicians must become competent and develop confidence in their abilities.

6. Medical Care (Laboratory Tests, Etc.)

Physicians have a wider range of responsibilities toward their own clinic, their personnel, the hospital and other health care facilities. Decisions are based on what is needed for care, not for profit.

7. Moral, Ethical Behavior

Physician behavior is constantly observed. Students cannot avoid close relationships, one to one, with rural physicians. Students with less than the best behaviors are often found out, after years of hiding their problems This relationship also unmasks problems in rural physicians, giving a special value to education in rural areas (Verby and RPAP).