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Rural education helps attract urban-raised docs to practice in rural areas


Exposing physicians who grew up in urban areas to rural medical education or residency programs can be an important strategy to help increase the number who will want to practice in rural areas, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.

Researchers surveyed 651 rural family physicians that had graduated from a Canadian medical school between 1991 and 2000, and were practicing in 2002. They examined where rural physicians grew up, when during their training they became interested in rural medicine, what factors influenced their decision to practice rural medicine, and what the differences were between these measures by rural versus urban upbringing.

Key Results:

  • Many doctors currently working in rural areas actually grew up in larger cities. Among rural physicians, 33% grew up in rural communities with populations under 10,000, but 44% grew up in cities with populations of 10,000 to 499,999, and 23% in cities with populations over 500,000.
  • Rural education has a more pronounced impact on the decision to enter rural practice for urban-raised rather than rural-raised physicians. Urban-raised physicians were more likely than rural-raised physicians to cite that rural medical training was the most influential factor in choosing rural practice (19% vs. 9%, respectively).
  • Both urban-raised and rural-raised physicians are attracted by the challenges of rural practice and the rural lifestyle. Twenty-four per cent of urban-raised and rural-raised doctors cited the challenge of rural practice as the most influential factor in choosing to work in a rural area. Fourteen per cent of urban-raised and 18% of rural-raised physicians said that the rural lifestyle attracted them to rural medicine.
  • Money plays a relatively small role in getting doctors to work in rural areas. Financial incentives were more infrequently cited as the most influential factor in the decision to go into rural practice (7.5% for urban-raised physicians, and 4.9% for rural-raised physicians).

“Our survey results suggest that exposure of potential urban candidates to rural education appears to be one very important factor in enhancing the rural medical workforce,” said lead author and ICES senior scientist Dr. Ben Chan.

“Because physicians with a rural upbringing are still more likely to practice rural medicine, there remains a lot of merit to giving preference to rural-raised candidates for medical school,” notes Dr. Chan. “But, until we can get more rural-raised persons into medical training, the reality is that urban-raised physicians are the main source of human resources for rural communities. Training programs can do a great deal to steer at least some of these urban-raised individuals towards rural practice.”

The study, “Factors influencing family physicians with rural and urban backgrounds entering rural practice”, is in the September 2005 issue of Canadian Family Physician.

Author affiliations: ICES (Dr. Chan and Ms. Degani); Faculty of Medicine, University of Toronto (Dr. Chan); Saskatchewan Health Quality Council (Dr. Chan); College of Medicine, University of Saskatchewan (Dr. Chan); North Eastern Ontario Family Medicine Program, University of Ottawa (Dr. Crichton); Centre for Rural and Northern Health Research, Laurentian University (Dr. Pong); Southwestern Ontario Rural Medicine Unit, Faculty of Medicine and Dentistry, University of Western Ontario (Dr. Rourke); Faculty of Medicine, Memorial University of Newfoundland (Dr. Rourke); Northwestern Ontario Medical Programme (Drs. Goertzen and McCready), and Faculty of Health Sciences (Drs. Goertzen and McCready), McMaster University).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


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