Of course, participation in a rural medicine program is no guarantee that students will go to a small town and remain there. Research that looked at six medical schools with a combined 1,600 rural program graduates over three decades found that 53 to 64 percent of grads practiced in rural areas, according to a review published in March 2008 in the journal Academic Medicine. Doctors who choose to leave rural areas generally cite the workload, income, and a preference for living in a larger city with access to cultural or educational options that may not be available in a smaller town.
Medical schools typically track grads to determine how successful their programs are in encouraging students to go into rural medicine and stick with it. Jefferson's data show that 11 to 16 years after starting practice, 68 percent of the Physician Shortage Area Program's graduates were still practicing family medicine in the same rural area in which they began; an additional 11 percent were practicing family medicine in another rural area. About 75 percent of the graduates of the National Center for Rural Health Professions at the University of Illinois–Rockford College of Medicine are practicing medicine in towns of fewer than 20,000 people, says Matthew Hunsaker, director of the college's Rural Medical Education Program. The University of Minnesota says that nearly half of the more than 1,200 graduates of its program work in rural communities.
Rural medicine programs seem to be making a difference in small communities, Rabinowitz says. But retention is key. On average, rural doctors stay about seven years in one rural community, so it takes five doctors to equal the work of one who would spend a whole career there.
Physician retention starts with early recruitment, as students consider which medical programs to apply to. For schools, that means having a presence online and identifying and working with feeder colleges and universities that can refer good candidates. Jefferson works with various Pennsylvania and Delaware colleges to help identify potential applicants, and the Upper Peninsula Health Education Corp. uses its website and social media to reach out to students. The University of Minnesota Medical School's rural program looks for students who have a passion for practicing rural family medicine and primary care, are service oriented, and are from small towns themselves. The hope is that by targeting recruitment to students already interested in rural medicine, the rates of students who start practicing in rural areas—and stay there—will continue to increase.
For Proy, now doing a residency at Ventura County Medical Center in California, a small-town practice is a sure thing. "I'm going to work side by side with my dad at his clinic in Corry," he says. He is excited about practicing rural family medicine because he will have to dip his hand into various specialties—pediatrics, geriatrics, and cardiology, for example—to care for his patients. "I can't think of any other specialty or field of medicine where it offers such comprehensive medical care," Proy says. "It's really quite varied, and that's what I love about it."