New Study: Decline in Rural Medical Students Threatens the Future of the Rural MD Workforce

Dec. 11, 2019
A new study predicts a growing crisis in attracting individuals with rural personal backgrounds into medicine—with a rural personal background a strong predictor of willingness to practice rurally

A new study published in the December issue of Health Affairs points to potentially greater trouble in rural healthcare nationwide. A team of healthcare policy researchers sees trouble ahead, as fewer medical students are coming to medical school from rural backgrounds, with personal rural background a strong predictor of willingness to practice in rural areas.

The study was published by Scott A. Shipman, Andrea Wendling, Karen C. Jones, Iris Kovar-Gough, Janis M. Orlowski, and Julie Phillips, under the headline, “The Decline in Rural Medical Students: A Growing Gap in Geographic Diversity Threatens The Rural Physician Workforce.”

The researchers write that “Growing up in a rural setting is a strong predictor of future rural practice for physicians. This study reports on the fifteen-year decline in the number of rural medical students, culminating in rural students’ representing less than 5 percent of all incoming medical students in 2017. Furthermore, students from underrepresented racial/ethnic minority groups in medicine (URM) with rural backgrounds made up less than 0.5 percent of new medical students in 2017. Both URM and non-URM students with rural backgrounds are substantially and increasingly underrepresented in medical school,” the researchers note. If the number of rural students entering medical school were to become proportional to the share of rural residents in the US population, the number would have to quadruple. To date, medical schools’ efforts to recognize and value a rural background have been insufficient to stem the decline in the number of rural medical students. Policy makers and other stakeholders should recognize the exacerbated risk to rural access created by this trend. Efforts to reinforce the rural pipeline into medicine warrant further investment and ongoing evaluation.”

As the researchers write, “Physician shortages in rural settings, which are magnified by the disproportionate health care needs of rural communities, have been a widespread and perennial challenge. Only 11 percent of the physician workforce practices in rural communities,11 and as of 2019 over 62 percent of all federally designated primary care Health Professional Shortage Areas were in rural areas.12 This gap in access to physician care is likely to be an important contributor to increased rural morbidity and mortality.” And those facts, they note, are in play despite the fact that nearly 60 million Americans, or one in five, continue to live in rural areas, a percentage of the overall population that has remained relatively stable over decades.

“The recent significant growth in the number of new US medical schools and the increase in size of existing ones presents an opportunity to train a workforce better suited to meeting the needs of rural communities,” the researchers write. “Unfortunately, that growth has been accompanied by a decrease in the percentage of students who report an interest in practicing in small towns and rural communities.13 This decline in interest in rural practice may be because medical education, most of which is based in metropolitan areas, disproportionately exposes future physicians to medical practice in urban and suburban settings. It may also be driven by a paucity of incoming students who have experienced a rural lifestyle, including being familiar with the distinct cultural aspects of small-town life. This is important because multiple studies have demonstrated that students from rural backgrounds are much more likely to decide to practice in rural settings.”

What’s more, they urge, “The declining pool of rural applicants suggests that more needs to be done to help rural children and young adults identify a pathway to becoming a physician. Support for premedical pipeline programs for people from rural backgrounds may help bridge gaps in achievement and readiness for medical school, helping rural students overcome educational disparities that prevent them from seeking careers in medicine.”

In the end, the researchers write, “From a workforce pipeline perspective, this study has made it clear that students from a rural background are an increasingly underrepresented group in medical school. Four times the number of rural medical students would be required for these students to be proportional to rural representation in the overall US population. Given that trends over time have been in the opposite direction, we believe that efforts to enhance the rural pipeline warrant consideration. Policy makers and other stakeholders,” they state, “should recognize the growing risk created by the decline in medical students with rural backgrounds, particularly in the absence of robust options to enhance the rural workforce. Rural background is strongly associated with service to rural and underserved populations, as well as entry into primary care.19,20 These represent two of the most persistent areas of unmet health care workforce needs in the United States.”