Medical School Rural Programs: A Comparison With International Medical Graduates in Addressing State-Level Rural Family Physician and Primary Care Supply

Rabinowitz, Howard K. MD; Petterson, Stephen PhD; Boulger, James G. PhD; Hunsaker, Matthew L. MD; Diamond, James J. PhD; Markham, Fred W. MD; Bazemore, Andrew MD, MPH; Phillips, Robert L. MD, MSPH

doi: 10.1097/ACM.0b013e3182488b19
Physician Supply in Rural Areas

Purpose: Comprehensive medical school rural programs (RPs) have made demonstrable contributions to the rural physician workforce, but their relative impact is uncertain. This study compares rural primary care practice outcomes for RP graduates within relevant states with those of international medical graduates (IMGs), also seen as ameliorating rural physician shortages.

Method: Using data from the 2010 American Medical Association Physician Masterfile, the authors identified all 1,757 graduates from three RPs (Jefferson Medical College's Physician Shortage Area Program; University of Minnesota Medical School Duluth; University of Illinois College of Medicine at Rockford's Rural Medical Education Program) practicing in their respective states, and all 6,474 IMGs practicing in the same states and graduating the same years. The relative likelihoods of RP graduates versus IMGs practicing rural family medicine and rural primary care were compared.

Results: RP graduates were 10 times more likely to practice rural family medicine than IMGs (relative risk [RR] = 10.0, confidence interval [CI] 8.7–11.6, P < .001) and almost 4 times as likely to practice any rural primary care specialty (RR 3.8, CI 3.5–4.2, P < .001). Overall, RPs produced more rural family physicians than the IMG cohort (376 versus 254).

Conclusions: Despite their relatively small size, RPs had a significant impact on rural family physician and primary care supply compared with the much larger cohort of IMGs. Wider adoption of the RP model would substantially increase access to care in rural areas compared with increasing reliance on IMGs or unfocused expansion of traditional medical schools.

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. Petterson is research director, Robert Graham Center, Washington, DC.

Dr. Boulger is professor, Department of Behavioral Sciences, College of Medicine, University of Minnesota Medical School–Duluth, Duluth, Minnesota.

Dr. Hunsaker is associate professor, Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois.

Dr. Diamond is honorary 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.

Dr. Bazemore is assistant director, Robert Graham Center, Washington, DC.

Dr. Phillips is director, Robert Graham Center, Washington, DC.

Please see the end of this article for information about the authors.

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

First published online February 22, 2012

© 2012 Association of American Medical Colleges