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Medical School Programs to Increase the Rural Physician Supply: A Systematic Review and Projected Impact of Widespread Replication

Rabinowitz, Howard K. MD; Diamond, James J. PhD; Markham, Fred W. MD; Wortman, Jeremy R.

Academic Medicine:
doi: 10.1097/ACM.0b013e318163789b
Physician Supply
Abstract

Purpose: To systematically review the outcomes of comprehensive medical school programs designed to increase the rural physician supply, and to develop a model to estimate the impact of their widespread replication.

Method: Relevant databases were searched, from the earliest available date to October 2006, to identify comprehensive programs (with available rural outcomes), that is, those that had (1) a primary goal of increasing the rural physician supply, (2) a defined cohort of students, and (3) either a focused rural admissions process or an extended rural clinical curriculum. Descriptive methodology, definitions, and outcomes were extracted. A model of the impact of replicating this type of program at 125 allopathic medical schools was then developed.

Results: Ten studies met all inclusion criteria. Outcomes were available for more than 1,600 graduates across three decades from six programs. The weighted average of graduates practicing in rural areas ranged from 53% to 64%, depending on the definition of rural. If 125 medical schools developed similar programs for 10 students per class, this would result in approximately 11,390 rural physicians during the next decade, more than double the current estimation of rural doctors produced during that time frame (5,130).

Conclusions: All identified comprehensive medical school rural programs have produced a multifold increase in the rural physician supply, and widespread replication of these models could have a major impact on access to health care in thousands of rural communities. The current recommendation to expand U.S. medical school class size represents a unique and timely opportunity to replicate these programs.

Author Information

Dr. Rabinowitz is Ellen M. and Dale W. Garber Professor, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Dr. Diamond is research professor, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Dr. Markham is professor, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Mr. Wortman was a research assistant, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Correspondence should be addressed to Dr. Rabinowitz, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Suite 401, 1015 Walnut Street, Philadelphia, PA 19107; telephone: (215) 955-7416; fax: (215) 955-0640; e-mail: (Howard.Rabinowitz@jefferson.edu).

© 2008 Association of American Medical Colleges