There is a relative shortage of physicians in rural areas of the U.S. About 20% of the population lives in rural areas, but only 9% of physicians practice in these communities.
This problem stems from two challenges:
1. While managed care systems have proliferated in urban areas, their growth has been impeded in rural communities by a higher population of uninsured.
2. The tendency for health care professionals (HCP) to gravitate to more affluent urban and suburban areas.
Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that the biennial turnover rate of younger physicians (45 years and under) in rural areas was twice that (17%) of older physicians (9%). Physicians were also more likely to move out of rural areas if they were female, international medical graduates, not born in a rural setting, or working in a community adjacent to a metropolitan area. Also, the more highly specialized the physician, the less likely he or she would settle in a rural area; family medicine is the key discipline of rural health care.
Recruiting and retaining doctors in rural areas is no easy task. Recruiters need to consider the characteristics of candidates that are likely to be attracted to a rural setting. A student with a rural background, trained in primary care, is more likely to return to a rural setting; a resident trained in a rural area is more likely to remain in a comparable area. Younger doctors whose training includes the use of technology may be attracted to positions in rural locations where telehealth tools are already in place.
A powerful mechanism to improve the flow of HCP’s to rural areas is the use of targeted incentives. Initiatives such as J-1 visa waivers for international medical students; loan repayment, and scholarship programs can help attract physicians to rural areas, but keeping them there remains a challenge. Compensation and benefits packages must be designed to reward longevity.
It is difficult to predict when managed care services will reach rural areas. In the meantime, rural communities will continue to have shortages of physicians unless the issue is addressed by government-sponsored health care services. Public policy must focus on health workforce development at all levels of the educational system, aligning investment in academic, public, and private health workforce to respond to current and future crisis.