Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM On Twitter
  • JABFM On YouTube
  • JABFM On Facebook
EditorialEditorial

A Fast Track for Rural Family Physicians

Thomas E. Norris
The Journal of the American Board of Family Practice March 2003, 16 (2) 182-183; DOI: https://doi.org/10.3122/jabfm.16.2.182
Thomas E. Norris
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

There is currently a major shortage of rural physicians in the United States. Rural US citizens should receive the same quality of care and the same access to health care as are available in urban and suburban settings for the middle and upper classes. Yet, at present, substantial and increasing differences exist in access to health care for our rural citizens.1

The overall supply of physicians has increased from 1980 to 2000, but rural areas are not sharing in the same rate of growing supply as their urban counterparts.2,3 Fundamentally, medical education and residency have not adequately emphasized preparation for the realities of rural practice, and sufficient numbers of physicians are not choosing rural sites of practice. More than 50 million citizens, or 20% of the US population, live in rural places. Logically, 20% of US physicians should live in rural sites, but only 9% of US physicians practice rurally.

As the generalist physician workforce in rural areas ages and retires, training, recruitment, and retention of replacement physicians have not occurred at a rate to support the workforce vacancies.4 This shortfall in rural providers has led to a situation in which 22 million Americans now live in federally designated rural health professions shortage areas (HPSAs), with less than 1 primary care physician per 3,500 people. For these Americans, who comprise more than 10% of the US population, access to medical care is not only inferior to that of their urban counterparts—it might be absent altogether.

The key to addressing some of the problems of rural patients lies in correcting the deficits in the physician workforce. This “fix” will require more providers who are committed to the care of these populations and who have the special skills needed for successful rural practice.5 Currently the pipeline required to create a rural family physician, from college graduation to placement after residency, is at least 7 years. At the end of 7 years, many family practice residency graduates still lack the specialized, appropriate training for rural practice that will help assure their retention in rural areas. Yet the pipeline is even longer if specialized rural training is sought after residency.6

The article by Stageman and colleagues7 in this of the Journal describes an effort to place specially prepared family physicians into rural practice in the same 7 years that most family practice residents spend in preparation for undifferentiated practice. Such efforts have the capacity to create both a one-time surge, as well as a potential long-term gain, in the number of practicing rural family physician. An apt metaphor for this process is the financial bonus that accrues to a practice that successfully decreases the number of days in its accounts receivable queue. Not only is there a one-time gain of cash, but the practice also gets paid faster for all future transactions. Shortening the time required for specially designed rurally oriented training for family physicians, while maintaining the quality of that training, can pay similar dividends for the underserved rural communities that are counting on medical education programs to provide both replacements and help for their aging family physicians. Additionally, rural physicians who do not constantly feel that they are practicing at the “edge of their envelope” (to use an aviation metaphor) are more likely to remain in practice in rural sites.5

Accelerated training has been successfully employed previously in the education of family physicians. In 1991 the American Board of Family Practice approved 12 programs for participation in an experiment combining the fourth year of medical school with the first year of a family practice residency. While these programs had a few problems, the overall outcome was positive. In a report written 5 years into the experiment, the accelerated residents out-performed their peers on in-training examinations, and their clinical skills were rated as equal to or better than their peers in the standard length training.8

The training program described in this issue applies similar methodology to residents who are focusing on rural practice. If successful, accelerated, rurally oriented residency programs have great potential in helping to alleviate the severe shortages of rural family physicians.

  • Received for publication December 6, 2002.

References

  1. ↵
    Schur, Claudia L, Franco, Sheila J. Access to health care. In: Ricketts TC III, editor. Rural health in the united states. New York: Oxford University Press, 1999: 25–37.
  2. ↵
    Salsberg ES, Forte GJ. Trends in physician workforce, 1980–2000. Health Affairs (Millwood) 2002; 21: 165–73.
    OpenUrlFREE Full Text
  3. ↵
    Physician distribution and health care challenges in rural and inner-city areas: Council on Graduate Medical Education, tenth report. Rockville, Md: US Department of Health and Human Services, Public Health Service, Health Resources and Services Administration, 1998. (DHHS publication: HRSA. 97-44.)
  4. ↵
    Stearns JA, Stearns MA. Graduate medical education for rural physicians: curriculum and retention. J Rural Health 2000; 16: 273–7.
    OpenUrlPubMed
  5. ↵
    Norris TE, Coombs JB, Carline J. An educational needs assessment of rural family physicians. J Am Board Fam Pract 1996; 9: 86–93.
  6. ↵
    Norris TE, Acosta DA. A fellowship in rural family medicine: program development and outcomes. Fam Med 1997; 29: 414–20.
    OpenUrlPubMed
  7. ↵
    Stageman JH, Bowman RC, Harrison JD. An accelerated rural training program. J Am Board Fam Pract 2003; 16: 124–30.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    Galazka SS, Zweig S, Young P. A progress report on accelerated residency programs in family practice. Acad Med 1996; 71: 1253–5.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family Practice: 16 (2)
The Journal of the American Board of Family Practice
Vol. 16, Issue 2
1 Mar 2003
  • Table of Contents
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Fast Track for Rural Family Physicians
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
A Fast Track for Rural Family Physicians
Thomas E. Norris
The Journal of the American Board of Family Practice Mar 2003, 16 (2) 182-183; DOI: 10.3122/jabfm.16.2.182

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
A Fast Track for Rural Family Physicians
Thomas E. Norris
The Journal of the American Board of Family Practice Mar 2003, 16 (2) 182-183; DOI: 10.3122/jabfm.16.2.182
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Three JABFM Articles Are in the Primary Care Collaborative Curated List of 24 Essential Primary Care Research Articles
  • The Right Report from the Right Source at the Right Time – The National Academies of Sciences, Engineering, and Medicine (NASEM) Primary Care Report
  • Increasing Article Visibility: JABFM and Author Responsibilities and Possibilities
Show more Editorials

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2023 American Board of Family Medicine

Powered by HighWire