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The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians

Parlier, Anna Beth; Galvin, Shelley L. MA; Thach, Sarah MPH; Kruidenier, David MLS; Fagan, Ernest Blake MD

doi: 10.1097/ACM.0000000000001839
Reviews

Purpose To examine the literature documenting successes in recruiting and retaining rural primary care physicians.

Method The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention.

Results The authors’ proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work–life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice.

Conclusions Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

Supplemental Digital Content is available in the text.

A.B. Parlier was research project coordinator, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, at the time of writing. As of August 2017, she will be a graduate student, Psychology Department, Virginia Commonwealth University, Richmond, Virginia.

S.L. Galvin is director of research, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

S. Thach is director of clinical and community outreach, Western North Carolina Rural Health Initiative, Mountain Area Health Education Center, Asheville, North Carolina.

D. Kruidenier is research and clinical librarian, Center for Research, Mountain Area Health Education Center, Asheville, North Carolina.

E.B. Fagan is chief education officer, Mountain Area Health Education Center (MAHEC), assistant program director, Family Medicine Residency Program, MAHEC, and assistant medical director, Department of Family Medicine, MAHEC, Asheville, North Carolina. He is also associate professor, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable. As this was a narrative review of published literature and not human subject research, ethical oversight for research participants was not required.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A468.

Correspondence should be addressed to Shelley L. Galvin, 121 Hendersonville Rd., Asheville, NC 28803; telephone: (828) 771-5501; e-mail: Shelley.Galvin@mahec.net.

© 2018 by the Association of American Medical Colleges