Retention of Rural Family Physicians After 20-25 Years
Retention of Rural Family Physicians After 20-25 Years
Background: The Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) is one of a small number of comprehensive medical school rural programs that has been successful in increasing the supply of family physicians practicing in rural areas. Although retention is a critical component of the rural physician supply, published long-term outcomes are limited.
Methods: Of the 1937 JMC graduates from the classes of 1978 to 1986, we identified those who were practicing family medicine in a rural county when they were first located in practice (in 1986 for 1978–1981 graduates and in 1991 for 1982–1986 graduates). Using the Jefferson Longitudinal Study, we then compared the numbers of PSAP and non-PSAP graduates who were still practicing family medicine in the same area in 2011.
Results: Of the 92 JMC graduates initially practicing rural family medicine, 90 were alive in 2011, and specialty and location data were available for 89 (98.9%). Of the 37 PSAP graduates who originally practiced rural family medicine, 26 (70.3%) were still practicing family medicine in the same rural area in 2011 compared with 24 of 52 non-PSAP graduates (46.2%; P = .02).
Conclusion: This study provides additional support for the substantial impact of medical school rural programs, suggesting that graduates of rural programs are not only likely to enter rural family medicine but to remain in rural practice for decades.
The shortage of primary care physicians in rural areas, especially family physicians, has been a serious problem for decades, with major implications in access to health care for a substantial proportion of the US population. It is widely accepted that this rural physician shortage will worsen over the next few years because of the increase in insured patients, as occurred in Massachusetts. Among policies aimed at addressing this problem, comprehensive medical school rural programs (RPs; ie, a defined cohort of students and either (1) a focused rural admissions process and rural curriculum or (2) an extended rural clinical curriculum) are among the most successful, with more than one half of their graduates practicing in rural areas.
Retention is a key component of the rural physician supply, in part because it has a multifold impact on the rural workforce; for example, one physician practicing in the same rural area during a 35-year career has a similar impact as 5 physicians who practice for an average duration of 7 years. Despite its importance, however, published long-term outcomes regarding rural retention are limited. The only program with available long-term retention outcomes is the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) of Thomas Jefferson University, a RP with the goal of increasing the supply of rural family physicians. Prior research has shown that the 11- to 16-year retention rate for PSAP graduates in rural family medicine was 68%. The PSAP, which began in 1974, recruits and selects medical school applicants that have grown up or lived in a rural area or small town for a substantial portion of their life after college and who were committed to practicing family medicine in a similar area. During medical school, PSAP students received faculty mentorship and career support and they completed their required third-year, 6-week family medicine clerkship in a small town. During their fourth year, most PSAP students took a preceptorship in a rural location. Upon graduation, PSAP students were expected to take a family medicine residency and practice family medicine in a small town or rural area, although there is no mechanism to ensure compliance. Prior outcomes have showed that PSAP graduates were more than 8 times as likely to become rural family physicians as their non-PSAP peers, including more recent graduates. To provide further information about the critical issue of long-term rural retention, we extended our analysis of PSAP graduates to determine their retention in the same rural area after 20 to 25 years.
Abstract and Introduction
Abstract
Background: The Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) is one of a small number of comprehensive medical school rural programs that has been successful in increasing the supply of family physicians practicing in rural areas. Although retention is a critical component of the rural physician supply, published long-term outcomes are limited.
Methods: Of the 1937 JMC graduates from the classes of 1978 to 1986, we identified those who were practicing family medicine in a rural county when they were first located in practice (in 1986 for 1978–1981 graduates and in 1991 for 1982–1986 graduates). Using the Jefferson Longitudinal Study, we then compared the numbers of PSAP and non-PSAP graduates who were still practicing family medicine in the same area in 2011.
Results: Of the 92 JMC graduates initially practicing rural family medicine, 90 were alive in 2011, and specialty and location data were available for 89 (98.9%). Of the 37 PSAP graduates who originally practiced rural family medicine, 26 (70.3%) were still practicing family medicine in the same rural area in 2011 compared with 24 of 52 non-PSAP graduates (46.2%; P = .02).
Conclusion: This study provides additional support for the substantial impact of medical school rural programs, suggesting that graduates of rural programs are not only likely to enter rural family medicine but to remain in rural practice for decades.
Introduction
The shortage of primary care physicians in rural areas, especially family physicians, has been a serious problem for decades, with major implications in access to health care for a substantial proportion of the US population. It is widely accepted that this rural physician shortage will worsen over the next few years because of the increase in insured patients, as occurred in Massachusetts. Among policies aimed at addressing this problem, comprehensive medical school rural programs (RPs; ie, a defined cohort of students and either (1) a focused rural admissions process and rural curriculum or (2) an extended rural clinical curriculum) are among the most successful, with more than one half of their graduates practicing in rural areas.
Retention is a key component of the rural physician supply, in part because it has a multifold impact on the rural workforce; for example, one physician practicing in the same rural area during a 35-year career has a similar impact as 5 physicians who practice for an average duration of 7 years. Despite its importance, however, published long-term outcomes regarding rural retention are limited. The only program with available long-term retention outcomes is the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) of Thomas Jefferson University, a RP with the goal of increasing the supply of rural family physicians. Prior research has shown that the 11- to 16-year retention rate for PSAP graduates in rural family medicine was 68%. The PSAP, which began in 1974, recruits and selects medical school applicants that have grown up or lived in a rural area or small town for a substantial portion of their life after college and who were committed to practicing family medicine in a similar area. During medical school, PSAP students received faculty mentorship and career support and they completed their required third-year, 6-week family medicine clerkship in a small town. During their fourth year, most PSAP students took a preceptorship in a rural location. Upon graduation, PSAP students were expected to take a family medicine residency and practice family medicine in a small town or rural area, although there is no mechanism to ensure compliance. Prior outcomes have showed that PSAP graduates were more than 8 times as likely to become rural family physicians as their non-PSAP peers, including more recent graduates. To provide further information about the critical issue of long-term rural retention, we extended our analysis of PSAP graduates to determine their retention in the same rural area after 20 to 25 years.
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