Bringing Better Health to Rural America

The nation's small towns need more physicians, and med schools aim to fill the gap.

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For Vincent Proy, 28, deciding to become a rural family doctor wasn't a tough call. His father has a family practice in his hometown of Corry, Pa. (population 6,834), and growing up, Proy saw firsthand what the job was like. "I knew I wanted to practice rural family medicine because of all of the interesting challenges that my father faced," says Proy, who graduated in 2007 from the Physician Shortage Area Program at Jefferson Medical College at Thomas Jefferson University in Philadelphia. 

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Facing a continued shortage of primary-care physicians nationwide, and an especially tight supply in rural areas and small towns, medical schools are making an effort to recruit students like Proy to launch long-lasting careers in rural areas. While 1 in 5 U.S. residents lives in a rural area, just 9 percent of doctors practice there, according to a 2002 study. The shortage of primary-care doctors in rural areas isn't new, but it's poised to get worse. Fewer than 4 percent of recent medical school graduates say they intend to start their careers in rural areas or small towns. And the number of practicing physicians will shrink as baby boomers retire.

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Since the early 1970s—after national recognition of physician shortages in the 1950s and 1960s—medical schools have ramped up efforts to recruit, train, and provide support for new doctors in an effort to encourage them to build their lives and their careers in small towns. Many students who choose to go into rural medicine, like Proy, are from small towns themselves and either decide to go back to their hometowns or move to a community of similar size. "Studies show that one of the biggest predictors of [practicing in] a small town is coming from one," says David Luoma, chief executive officer of the Upper Peninsula Health Education Corp., a nonprofit created in partnership with Michigan State University that administers the school's Rural Physician Program. "One of the biggest predictors was the size of your high school graduating class."

It's unusual for students from big cities to choose to practice in a rural area. That's largely because of misconceptions about what making that choice means, experts say. "The culture of most medical schools is that no one in their right mind would want to become a rural family doctor," says Howard Rabinowitz, director of Jefferson's Physician Shortage Area Program. "People tell these students, 'Why would you want to live in a small town? You can't practice good medicine; you can't have a personal life; you can't take care of patients adequately.' " But those are "all myths," Rabinowitz says. Doctors in rural areas "tend to be much happier personally and professionally, [to] have a better life balance," he says. "Really, it comes down to where people want to live."

Rural immersion. To give students an idea of what life as a rural family doctor is really like, rural medical education programs send students to small towns for a portion of their time in school. They get hands-on, usually one-on-one experience working with doctors, and they see and develop relationships with patients. During their third year in school, students in Jefferson's program participate in a six-week course in Latrobe, Pa. (population 8,994). In their fourth year, most students work one-on-one with a doctor in a rural area. At the University of Minnesota Medical School's Rural Physician Associate Program, third-year students spend nine months working with a primary-care doctor in a small Minnesota community. While seeing patients regularly, the students "also live in the community and understand and step into the role of healthcare professional in a way that they haven't before," says Kathleen Brooks, director of Minnesota's program.

That aspect of the program was a highlight for Austin Krohn, 26, a fourth-year med student at the University of Minnesota. "I really enjoy the relationships that you can build," he says. He doubts he would have gotten similar training so early in his career if he'd gone to a larger city. "I was able to be first assistant on a lot of surgeries and also get a lot of freedom to do things on my own," he says.