Rural practice. Preference, perception, and reality

Numerous studies have approached the geographic maldistribution of physicians in the United States by evaluating factors associated with rural placement and retention, with "rural" being variably defined. To our knowledge, no one has qualitatively investigated physicians' perceptions of rurality or how closely those perceptions fit commonly used definitions of rurality. In addition, no one has evaluated physicians' preference for rural practice or the association between this preference and the rurality of their practice as they perceive it. This descriptive study uses a questionnaire mailed to graduates of a community hospital, university-affiliated Family Medicine residency program to evaluate physician perception and preference regarding rural practice. The participation rate was 83.1%. Agreement between the rurality of practice sites, as perceived, and definitions of rural was greatest when defined as a "nonurban population center of less than 25,000." Twenty-one (44.7%) of 47 respondents who preferred rural practice sites perceived themselves to be in urban practice sites. Respondents identified a nonurban population center of less than 25,000 as their perceived threshold between rural and urban practice settings. This threshold should be further evaluated as a potential operational standard. Nearly one half of the respondents who preferred rural practice perceived themselves to be in urban practice, indicating significant barriers to rural practice in this population. Potentially many more physicians may settle in rural practices if barriers for those who prefer rural practice can be identified and eliminated.