CONTEXT: Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed.
PURPOSE: To examine RPAP outcomes in recruiting and retaining rural primary care physicians.
METHODS: The RPAP database, including moves and current practice settings, was examined using descriptive statistics. Findings: On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice.
CONCLUSION: RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.
INTRODUCTION: Jichi Medical University (JMU) is an experimental medical school established in 1972 by the Japanese Ministry of Home Affairs and all 47 prefectures in Japan (equivalent to the states of Australia) with a special mission to produce rural doctors and distribute them nationwide. The JMU has adopted a contract-based 'home prefecture recruiting scheme' in which students recruited evenly from all the 47 prefectures of Japan are required to work in their home prefectures for 9 years (including 6 years of rural service) after graduation in exchange for having their 6 years of undergraduate medical education tuition fees waived. Although the JMU system is now being partially adopted by an increasing number of other medical schools in Japan, the effectiveness of this equal distribution scheme is largely unknown. METHODS: A retrospective cohort study of 1255 graduates who had completed their contract by 2000 was conducted. Baseline data were collected at matriculation and graduation between 1972 and 1991. Workplace addresses were followed up in 2000, 2004, and 2006. Follow-up rates were 98.7% in 2000, 98.2% in 2004, and 98.0% in 2006. Data excerpted from the 2004 National Population Census including various demographic indicators (eg population, population density, and physicians/population ratio) for each of the 47 prefectures were merged, through prefectural identification codes, with the baseline and follow-up addresses of the subjects. RESULTS: Of all JMU graduates after contract, 69.8% settled in their home prefectures. The rates varied from 45.5% to 93.3% among the prefectures (p<0.001). The settlement rate tended to be higher in prefectures with a lower population density or physician : population ratio. Among prefectural demographics, the physician : population ratio and medical institution : population ratio were negatively correlated with settlement rate in the prefecture (correlation coefficient -0.34 [p=0.020]; and -0.35 [p=0.017], respectively). In short, prefectures with a relative shortage of physicians had higher settlement rates. In multivariable analysis of personal factors, female sex and physician : population ratio of home prefecture were negatively associated with settlement (OR 0.25 [95%CI 0.10-0.58] and OR for 1 SD increase 0.82 [0.71-0.94], respectively). Primary care specialty was positively associated with settlement (1.80 [1.35-2.39]). Mother's higher academic background was negatively associated with settlement (OR for university vs junior high school graduate 0.54 [95%CI 0.34-0.88]). CONCLUSIONS: The home prefecture recruiting scheme has attained its goal, particularly in medically underserved prefectures. The high retention rates indicate that the scheme would be beneficial for other medical schools in Japan, which are now beginning to implement programs similar to JMU, and also medical educators and policy makers in countries searching for effective political interventions to maldistribution of physicians.
INTRODUCTION: Access to appropriate continuing medical education (CME) opportunities has been identified by many researchers as a key factor in retaining medical practitioners in rural and remote communities. There has, however, been very little research that has measured the actual effectiveness of CME programs on retention. The purpose of this article is to provide some evidence as to the efficacy of rurally relevant CME programs in retaining medical practitioners in rural and remote communities.
METHODS: Evaluation data provided by 426 to 429 CME workshop attendees over a 3 year period has been aggregated to explore participants' perceptions as to whether access to CME has been effective in increasing their confidence in practising in rural and remote communities, reducing professional isolation and increasing commitment to remain in rural practice.
RESULTS: Data from 429 respondents suggest that 94% agree or strongly agree that access to CME contributes to confidence in practising in rural and/or remote locations. Similarly, data suggest that 93% of respondents (n = 427) agree or strongly agree that access to CME alleviates professional isolation. When asked whether they were less likely to remain in rural practice without access to CME, 80% of respondents (n = 426) agreed or strongly agreed that they were less likely to remain without access.
CONCLUSION: The provision of CME based on the expressed needs of rural and remote medical practitioners tends to be well received and highly valued by workshop respondents. We suggest that professional support through the provision of rurally relevant workshop-delivered CME is an effective strategy in retaining doctors in rural and remote communities.
INTRODUCTION: In 1988, the New South Wales (NSW) Department of Health developed the NSW Rural Resident Medical Officer Cadetship Program (Cadetship Program) to help overcome a junior doctor workforce shortage in rural hospitals. A second aim was to increase recruitment to the rural medical workforce on the basis that positive exposure to rural medicine increases the likelihood of choosing to practice in a rural location. The Cadetship Program offers bonded scholarships which provide financial support for residents of NSW studying medicine during the final 2 years of their medical degree. In return, cadets are contracted to complete 2 of their first 3 postgraduate years in the NSW rural hospital network. NSW Rural Doctors Network has managed the Cadetship Program for the NSW Department of Health since 1993, and carried out an evaluation in 2004. The purpose of this evaluation was to track the career choice and practice location of medical students entering the Cadetship Program before 1999, and to comment on the impact of the Program on the rural medical workforce in NSW to date, and its implications for the future workforce. METHODS: The career choice and practice locations of 107 medical students who received cadetships between 1989 and 1998 were tracked. Students who did not graduate from medical school (n = 3) or who did not complete their rural service (13) were excluded from the analysis. Career choice was not available for a further nine former cadets and they were also excluded from the analysis. The NSW Rural Doctors Network was the major source of data on career choice and practice location due to its role in administering the Cadetship Program on behalf of the NSW Department of Health. Two brief questionnaires targeting specific groups of cadets were used to fill knowledge gaps about where cadets grew up, what vocational training they undertook, and where they were working in 2004. Where this information was not obtained from cadets first hand, it was sourced from the CD-ROM version of the Medical Directory of Australia. RESULTS: Forty-three percent of cadets entering the Program before 1999 were working in rural locations in 2004 (compared with 20.5% of medical practitioners nationally), 46% had attended primary school in a rural location and 44% chose to specialize in general practice. Career choice was the major determinant of practice location. Having a rural background did not appear to influence practice location; whereas, those specialising in general practice made up 70% of this cohort of cadets working in rural areas. All general practice trainees were in rural locations compared with only two of the 25 trainee specialists, which reflects the availability of accredited training places in rural Australia. CONCLUSIONS: The Cadetship Program, which ensures junior doctors work for 2 of their first 3 postgraduate years in a rural allocation centre, is an effective link between medical school and rural practice, particularly rural general practice. Providing vocational training opportunities in rural locations is central to this success, and needs to be considered in efforts to expand the rural specialist workforce, and in ensuring rural health capitalises on the increasing number of medical students moving through the education and training system in the next 4-10 years.
OBJECTIVE: This study aimed to evaluate the impact of the Dr DOC program, a rural doctor workforce support program, which consists of social and psychological support and practical interventions, on the well-being and retention of rural GPs.
DESIGN: Rural GPs were assessed on different aspects of well-being and their intentions to leave rural general practice, and these were compared with similar data collected two years prior.
SETTING: Rural general practices in South Australia.
PARTICIPANTS: Two hundred and twenty-one rural GPs (55% of South Australian rural GP workforce).
MAIN OUTCOME MEASURES: GPs completed a questionnaire assessing their levels of support, intention to leave rural practice, use of the dr doc program, and psychological health.
RESULTS: Improvements were found in the support networks and in the physical and emotional health of rural GPs from time 1 to time 2. There was also a reduction in the number of GPs wanting to leave rural general practice in the short to medium term (from 30% to 25%).
CONCLUSIONS: The initial study in this series suggested that improving psychological well-being might influence rural GPs' intentions to leave rural practice. The current study confirms these suggestions by demonstrating that programs targeted at psychological and physical well-being do indeed impact on rural GPs' intentions to leave. The results of this study highlight the role of psychological well-being in retaining rural GPs and emphasise the value of developing psychologically based programs to not only boost the physical and mental health of GPs, but also to reduce departure from rural areas.
PURPOSE: To determine the long-term retention of rural family physicians graduating from the Physician Shortage Area Program (PSAP) of Jefferson Medical College.
METHOD: Of the 1,937 Jefferson graduates from the classes of 1978-1986, the authors identified those practicing rural family medicine when their practice location was first determined. The number and percent of PSAP and non-PSAP graduates practicing family medicine in the same rural area in 2002 were then identified, and compared to the number of those graduates practicing rural family medicine when they were first located in practice 11-16 years earlier.
RESULTS: After 11-16 years, 68% (26/38) of the PSAP graduates were still practicing family medicine in the same rural area, compared with 46% (25/54) of their non-PSAP peers (p = .03). Survival analysis showed that PSAP graduates practice family medicine in the same rural locality longer than non-PSAP graduates (p = .04).
CONCLUSIONS: These results are the first to show long-term rural primary care retention that is longer than the median duration. This outcome combined with previously published outcomes show that the PSAP represents the only program that has resulted in multifold increases in both recruitment (eight-fold) and long-term retention (at least 11-16 years). In light of recent national recommendations to increase the total enrollment in medical schools, allocating some of this growth to developing and expanding programs similar to the PSAP would make a substantial and long lasting impact on the rural physician workforce.
OBJECTIVE: To establish whether a six-month rural attachment influenced female GP registrars' future plans to work in a rural area. Secondary aims include establishing the adequacy of postgraduate training in preparing the registrars for the attachment, opinions regarding rural practice and suggestions to improve the attachment.
DESIGN: A six-page questionnaire was sent to eligible participants via state branches of General Practice Education Australia.
SUBJECTS: Female GP registrars who undertook a six-month rural attachment during 2002.
MAIN OUTCOME MEASURE: Whether the six-month rural attachment influenced female registrars to practise in the country.
RESULTS: The rural attachment was a positive experience for 82% of participants. One-third were more likely, as a result of the attachment, to practise rurally in the future. In total, 14% were influenced against working rurally as a result of the attachment. Those who had previously resided or studied in a rural area were more likely to plan to work rurally. Level of vocational preparation was adequate for the majority with notable deficits in obstetrics and gynaecological procedural skills. Main negatives associated with the attachment included working long hours and social isolation. Recommendations for change focused on amending these issues along with improved child-care facilities and improved remuneration.
CONCLUSION: The rural attachment is a predominantly positive experience for female registrars with the exception of professional and personal hardships associated with relocating to rural practice. The attachment dissuades only a small proportion of its female counterparts, which is promising considering the increasing role of female practitioners in the workforce.
Difficulty recruiting and retaining doctors in rural and remote Australia is well recognised. Here, we describe the positive impact on recruitment and retention of general practitioners of a network of university-linked rural family practices in South Australia. Between August 1995 and October 1999, 17 doctors were recruited; eight (47%) were female and six (35%) worked part time. Four doctors left the practices after an average of 20 months service (annual turnover of 6%). Of the two general practice registrars placed in the single accredited practice, one has since joined the practice and the other will do so in 2000. Five doctors are overseas-trained (24%) and four are expected to stay permanently. Rural academic family practices have successfully recruited and retained medical staff in this setting over the past few years. This model of practice may be a useful recruitment and retention strategy for other parts of Australia.
BACKGROUND: The National Health Service Corps (NHSC) scholarship program is the most ambitious program in the United States designed to supply physicians to medically underserved areas. In addition to providing medical service to underserved populations, the NHSC promotes long-term retention of physicians in the areas to which they were initially assigned. This study uses existing secondary data to explore some of the issues involved in retention in rural areas. METHODS: The December 1991 American Medical Association (AMA) Masterfile was used to determine the practice location and specialty of the 2903 NHSC scholarship recipients who graduated from US medical schools from 1975 through 1983 and were initially assigned to nonmetropolitan counties. We used the AMA Masterfile to determine what percentage of the original cohort was still practicing in their initial county of assignment and the relation of original practice specialty and assignment period to long-term retention. RESULTS: Twenty percent of the physicians assigned to rural areas were still located in the county of their initial assignment, and an additional 20 percent were in some other rural location in 1991. Retention was highest for family physicians and lowest for scholarship recipients who had not completed residency training when they were first assigned. Retention rates were also higher for those with longer periods of obligated service. Substantial medical care service was provided to rural underserved communities through obligated and postobligation service. Nearly 20 percent of all students graduating from medical schools between 1975 and 1983 who are currently practicing in rural counties with small urbanized populations were initially NHSC assignees. CONCLUSIONS: Although most NHSC physicians did not remain in their initial rural practice locations, a substantial minority are still rural practitioners; those remaining account for a considerable proportion of all physicians in the most rural US counties. This study suggests that rural retention can be enhanced by selecting more assignees who were committed to and then completed family medicine residencies before assignment.
In this article the authors describe and present an evaluation of the Arizona Medical Student Exchange Program of the Western Interstate Commission for Higher Education. The program is designed to help defray the cost that an Arizona student faces in attending an out-of-state medical school by paying, in the student's behalf, the difference between the resident and nonresident tuition at the out-of-state school. Furthermore, the accepting medical school is paid an additional sum as an inducement to accepts more Arizona students in the future. The program's goal is to increase the number of graduating physicians who will return to practice in Arizona, especially in areas of medical need. While the program apparently has been successful in increasing the number of Arizona students studying medicine and the number of physicians returning to the state--both to metropolitan areas and to areas of medical need--these increases have not kept pace with Arizona's growing population.
Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed.
PURPOSE:
To examine RPAP outcomes in recruiting and retaining rural primary care physicians.
METHODS:
The RPAP database, including moves and current practice settings, was examined using descriptive statistics. Findings: On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice.
CONCLUSION:
RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.
