SEATTLE — The United States has a growing shortage of rural physicians, but interest in addressing the problem seems to be lagging behind that of some other countries, notably Australia.
At a recent conference on rural health sponsored by WONCA, the World Organization of Family Doctors, some participants were dismayed that there was not a greater U.S. presence at a meeting held in the United States.
“I honestly would have thought there would have been a large presence here from U.S. medical schools,” said Dr. James Rourke, dean of medicine at Memorial University, St. John's, Nfld., one of the meeting organizers. “If it is not an issue for them, it should be.”
Organizers said U.S. medical schools and departments of family medicine were invited. But Australia, which is seen as a world leader in efforts to improve rural physician supply, had the largest contingent of meeting participants. Presentations from Australia outnumbered those from the United States by almost three to one.
The population of Australia is 20 million, of which only about 2 million live in rural areas. The United States has 20 million people living in rural, federally designated primary-care-physician shortage areas.
Patricia Taylor, Ph.D., formerly director of research for the federal Office of Rural Health Policy, said she was disappointed by the U.S. showing but not especially surprised. In 1999, before retiring from the agency, Dr. Taylor organized a meeting of health educators on rural health issues. There has not been another such meeting since then, she said in an interview.
Like Dr. Taylor's meeting, the WONCA meeting focused on the role of medical schools and residency programs in addressing rural shortages. Much of the discussion was about how medical schools often discourage rural practice.
Good rural physicians need somewhat different training from that of urban general physicians, but medical schools and most residency programs are located in urban areas, speakers said. Moreover, they added, most tend to be more interested in burnishing their international reputation and in training specialists and academics.
U.S. medical students who grew up near a medical school are less likely to become rural physicians, and those from a rural background are much more likely to end up practicing in a rural area, said Dr. Robert Bowman, director of rural health education and research in the department of family medicine at the University of Nebraska Medical Center, Omaha.
Currently, about 90% of U.S. medical students have urban roots, but 70% of rural physicians grew up in rural areas, Dr. Bowman said. About 25% of medical students with rural backgrounds return to a rural area to practice, he added.
Although 20% of the U.S. population lives in areas considered rural, only 9% of physicians practice there.
Current trends suggest the situation is getting worse rather than improving, Dr. Bowman said. Medical school students who come from rural areas tend to come from lower income homes. But the average household income of the families of medical students has been rising for about 20 years, so that in recent years, about 40% of medical school students come from families making $100,000 a year or more.
In 1970, 17% of medical students had rural origins; in 2005, only 10% did, he added. Also, the percentage of women in medical school classes is rising, but women tend not to go to rural areas.
This issue has been overshadowed on the national level by concerns that there will likely be a shortage of physicians overall by 2020. Improvements in the supply of rural physicians are likely to come from state and local efforts, Dr. Taylor said.
Improvements in the supply of rural physicians are likely to come from state and local efforts. DR. TAYLOR
Catering to Rural Practice Needs
Schools that produce the highest number of medical graduates who go into rural practice (between 21% and 36% of each graduating class):
University of Minnesota, Duluth
University of Mississippi, Jackson
University of South Dakota, Sioux Falls
Mercer University, Macon, Ga.
University of North Dakota, Grand Forks
East Carolina University, Greenville, N.C.
University of Kentucky, Lexington
University of Nebraska, Omaha
East Tennessee State University, Johnson City
University of Arkansas, Little Rock
Schools that produce the lowest number of medical graduates who go into rural practice (between 0% and 3% of each graduating class):
State University of New York, Brooklyn
Cornell University, New York
University of Chicago
Harvard Medical School, Boston
University of California, Los Angeles
Albert Einstein College of Medicine, New York
Yale University, New Haven, Conn.