US: Decline in rural medical students likely to hurt rural physician workforce

USA: The rural U.S. is already in dire need of more doctors, and with decreasing numbers of medical students coming from rural towns, the problem is likely to grow, a study suggests.

Doctors who grew up in a rural area are more likely to practice in one, researchers note in a special issue of Health Affairs focused on rural health issues. But the proportion of students from rural areas entering medical school has been declining for 15 years, and by 2017 was less than 5%, the study team reports.

“Having a rural background can provide a distinct and valuable insight into the distinct cultures, joys, challenges, and lives of people in rural communities,” said Dr. Scott Shipman of the Association of American Medical Colleges in Washington, D.C., who led the study.

“Having a physician workforce that (reflects) the breadth of experiences and cultures of the population it serves is an important goal in efforts to achieve greater health equity,” he told Reuters Health by email.

Shipman’s team analyzed data from 2002-2018 on U.S. medical school applicants and first-year students. Students were considered to have a rural background if their county had fewer than 20,000 people and was not adjacent to a metropolitan area.

Over the study period, the number of rural applicants declined by 18%, while the number of urban applicants increased by 59%, the study found. The number of rural applicants who ultimately enrolled in medical school also declined by about 28%, while the number of urban enrollees increased by 35%.

Overall, rural applicants were more likely to be men and were slightly older. Rural applicants also tended to have higher grade-point averages but lower scores on medical school exams. About 11% came from minorities considered to be underrepresented in medicine.

By 2017, less than 0.5% of new medical students were minority members from rural backgrounds, the authors note.

When researchers looked at applicants’ likelihood of acceptance into medical school based on grades and other factors, both rural and urban applicants from underrepresented groups had higher odds than non-minority counterparts. Even rural applicants from non-underrepresented groups had a 13% edge over their urban counterparts.

“Medical schools hold rural background as a favorable characteristic ... yet the number of entering medical students from rural backgrounds has still fallen consistently over the past 15 years,” Shipman said. “This speaks to a profound problem in the pipeline of future physicians from rural America.”

Medical groups and policymakers should work to encourage doctors to practice in underserved areas, the study authors write.

“Rural healthcare today is not the same as it was 50 or even 15 years ago,” said Susanne Hempel of the RAND Corporation in Santa Monica, California, who wasn’t involved in the study.

“Telehealth approaches provide new possibilities for patients as well as physicians through increased options for virtual collaboration and distant support,” she told Reuters Health by email.

New medical education models, including pipeline programs in high schools, could help as well, the study authors say.

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However, said Dr. John Wheat of the University of Alabama in Tuscaloosa, who wasn’t involved in the study, “One shoe of rural medical education does not fit all.”

Wheat directs the Rural Scholars Program, which helps rural students become primary care doctors in Alabama. He has researched how a new rural medical education model, tested in the Northeast and Midwest, might work in Alabama.

“The large population of poor southern blacks that concentrate in 13 confluent Alabama counties does not benefit nearly as much from this model,” he said by email. “We are seeking to learn from the experiences of students from this population, including those who have succeeded through various pathways of medical education.”

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