Growing a rural family physician workforce: The contributions of rural background and rural place of residency training

Abstract

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.

Data sources and study setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS).

Study design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency.

Data collection/extraction methods: We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background.

Principal findings: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees.

Conclusions: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.

Keywords: health equity; health policy/politics/law/regulation; health workforce; primary care; rural health.