Increasing the Supply of Rural Family Physicians: Recent Outcomes From Jefferson Medical College's Physician Shortage Area Program (PSAP)

Rabinowitz, Howard K. MD; Diamond, James J. PhD; Markham, Fred W. MD; Santana, Abbie J. MSPH

Academic Medicine:
doi: 10.1097/ACM.0b013e31820469d6
Impact of Rural Care Education
Abstract

Purpose: The shortage of primary care physicians in rural areas is an enduring problem with serious implications for access to care. Although studies have previously shown that medical school rural programs—such as Jefferson Medical College's Physician Shortage Area Program (PSAP)—significantly increase the rural workforce, determining whether these programs continue to be successful is important.

Method: The authors obtained, from the Jefferson Longitudinal Study, the 2007 practice location and specialty for the 2,394 PSAP and non-PSAP graduates of 11 previously unreported Jefferson graduating classes (1992–2002). They determined the relative likelihood both of PSAP versus non-PSAP graduates practicing rural family medicine and of all PSAP versus non-PSAP graduates practicing in Pennsylvania's rural counties.

Results: PSAP graduates were much more likely both to practice rural family medicine than their non-PSAP peers (32.0% [31/97] versus 3.2% [65/2,004]; relative risk [RR] = 9.9, confidence interval [CI] 6.8–14.4, P < .001) and to practice any specialty in rural Pennsylvania (PSAP 24.7% [24/97] versus non-PSAP 2.0% [40/2,004]; RR = 12.4, CI 7.8–19.7, P < .001).

Conclusions: Despite major changes in health care in recent decades, Jefferson's PSAP continues to represent a successful model for substantially increasing the supply and distribution of rural family physicians. Especially with the forthcoming expansion in health insurance, access to care for rural residents will require an increased supply of providers. These results may also be important for medical schools planning to develop similar rural programs, given the new Rural Physician Training Grants program.

Author Information

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

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

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

Ms. Santana is clinical research specialist, Department of Family and Community Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.

Correspondence should be addressed to Dr. Rabinowitz, Jefferson Medical College of 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.

First published online December 16, 2010

© 2011 Association of American Medical Colleges