State support of rural sites Funds at the state level could be added for rural medical education or they could be earmarked out of current family medicine funds. These would be used to develop rural sites for training. These could be regular block rotation sites of two months in length or ambulatory rural sites with residents commuting out for part or all of their continuity clinics. Some or all of these sites could be shortage sites. Urban hospitals and clinics could also be convinced of the value of this outreach as they compete for market share. Indiana and Colorado have set up rural sites.  The Case for Rural Ambulatory Teaching Sites

Locum tenens support At least for the next few years, many urban sites will pay premiums to residents to do evening and weekend duties. Eventually this may reverse, but the current impact is significant. Residents who used to go to rural sites to moonlight, now have higher paying more convenient locations to serve. Rural communities are losing a source of service, a source of support for their doctors, and a potential recruitment device. Residents are losing out on the interactions with rural communities that could influence their career choices as well as their skills and confidence. Some programs have established official moonlighting support and more could do so. Assistance with liability insurance, withholding, and financial planning would be helpful. State support could match rural hospital dollars to support resident locums activities. A private sector approach is also a possibility. A larger rural health system or consortium of rural hospitals could offer an extra $6000 - $7000 a year to be paid to second and third year residents who signed up to provide a week of locums coverage during that year. This encourages residents to sign up and go. It levels out resident finances. Some residents would likely continue on serving who might not otherwise make the effort. It also guarantees a certain amount of support for rural doctors and their communities.  Locum Tenens