Increasing the Rural Physician Workforce: A Potential Role for Small Rural Medical School Campuses

To address the issue of physician maldistribution, some medical schools have rural-focused efforts, and many more are in the planning or early implementation stage. The best duration and structure of the rural immersion experience are unclear, and the relative effects of rural upbringing and rural training on subsequent rural practice choice are often difficult to determine.

To determine the effect of adding a rural clinical campus to our school, we analyzed the variables of rural upbringing, demographics, family medicine residency choice, and campus participation using a multivariate model for association with rural practice choice. We included graduates from the classes of 2001-2008 from both campuses (urban and rural) in the analysis.

We found similar associations to those reported previously of rural upbringing (OR = 2.67 [1.58-4.52]) and family medicine residency (OR = 5.08 [2.88-8.98]) with rural practice choice. Even controlling for these 2 variables, participation in the full 2 years at the rural clinical campus showed the strongest association (OR = 5.46 [2.61-11.42]). All 3 associations were significant at P < .001, and no other variables were significant.

We conclude that the investment of resources in our rural campus may add an increment to rural practice choice beyond the established associations with rural upbringing and family medicine residency. The decision of practice site choice is complex, and collaborative studies that include data from several schools with differently structured rural exposures, including those with rural clinical campuses, are needed.