Rural Internal Medicine Residencies: Models, Facilitators, Barriers, and Equity Considerations

Rural communities in the USA on average experience higher mortality rates and greater physician shortages than urban communities, especially rural communities that are historically Black, American Indian, and Alaska Native. Graduate medical education resources in the USA are concentrated within teaching hospitals in non-rural settings. The federal government has recently established several pathways to expand rural graduate medical education. In the 2010s, most of the expansion and innovation in rural graduate medical education occurred in family medicine. In the 2020s, internal medicine has also begun to increase its rural graduate medical education footprint. Rural internal medicine residency training models include Rural Track Programs (RTPs), in which training is split between urban and rural training sites. RTPs, though the cornerstone of rural residency expansion in family medicine, raise complex issues in internal medicine. We review the structure of RTPs, alternate rural residency training pathways, and the facilitators and challenges of each pathway with respect to internal medicine training.