Fifteen-year outcomes of a rural residency: aligning policy with national needs

Despite 30 years of policy initiatives and rural-focused programs, the number of physicians in rural practice remains unchanged and insufficient for the needs of rural communities. The practice characteristics of graduates of a rural family medicine residency program are identified, including community size, practice content and procedures, and hospital and outpatient services offered and track any changes in practice location and services.

A postgraduate survey instrument was sent to all graduates of Cascades East Family Medicine Residency beginning with the initial class of graduates and ending with the alumnae who completed the program in 2009. The response rate was 82%, and data were collated and analyzed for practice content and demographic characteristics. Changes in practice location and content were summarized.

Most graduates are located in demonstrated areas of need immediately following graduation: 60% entered practice in population centers of less than 25,000; 63% are located in health professional shortage areas (HPSAs). There was an insignificant migration from rural to urban locations and little change in practice content over the duration of the study.

As a result of this survey, we are aware of the postgraduate training design that is most successful at producing primary care physicians who enter isolated rural practice in areas of greatest need. There is a requirement for training incentives, federal funding, and Accreditation Council on Graduate Medical Education flexibility to support and accommodate the unique needs of training programs that demonstrate clear outcomes that are congruent with the needs of the rural American population and produce physicians who enter rural practice.