Train Rural, Work Rural: The Potential for Advanced Fellowships in Addressing Rural VA Healthcare Workforce Shortages

The United States faces a looming nationwide shortage of healthcare workers, especially in rural areas. This is particularly concerning for the Veterans Health Administration (VHA), the US' largest integrated healthcare system, which is experiencing high vacancy rates. Professional training programs can increase recruitment and retention in rural areas. We examined the 22 Advanced Fellowships offered by the VHA's Office of Academic Affiliations to assess their potential for retaining trainees in rural areas and at the VA.

Fellow surveys were administered from June 2018 through August 2023 in this cross-sectional study. Key variables included fellowship characteristics (location, topic area, length), and post-fellowship employment, including location (rural or non-rural), and type (clinical or non-clinical, VA or non-VA). We followed STROBE guidelines in reporting.

Six (13%) of the 47 training sites are at facilities serving primarily rural veteran populations; six of the 22 programs are offered at these sites. Of the 843 fellows trained during the study period, 55 (7%) were at rural-serving VAMCs. Fellows who trained in rural-serving areas versus non-rural areas were significantly more likely to be employed in rural areas post-fellowship (63% vs. 2%, p < 0.01), and tended to remain employed at or affiliated with the VA post-fellowship at higher rates.

The Advanced Fellowship program is effective at retaining trainees in rural areas and should be considered as part of the VA's strategy to address rural workforce shortages. Additional research is needed to assess longitudinal retention and the potential for targeted program expansion in rural sites.