Policy Center One-Pager #1 http://www. aafppolicy.org
Accredited family practice rural training tracks place their graduates in rural settings at very high
rates: 76% overall and 88% among programs implemented in the last ten years. Favorable,
immediate results could be expected from their continuation and expansion, permitted by
adjustments in the Balanced Budget Act of 1997.
In the early 1960s, concern mounted that a physician shortage was developing. Five
comprehensive commission reports published from 1959-1970 recommended that the supply of physicians
be expanded. Assisted by public funding, 40 additional medical schools were begun and enrollment more
than doubled nationally over a period of just 20 years. Now, after years of steadily increasing this
country’s supply of doctors, there is growing consensus that it exceeds need. Even with this possible surplus of physicians, their maldistribution with respect to both practice
specialty and location continues to hinder access to primary medical care for millions of Americans. There
is broad agreement that geographically, rural (non-MSA) regions are the most disadvantaged. In 1997, 787
of the 859 counties that were Federally classified health personnel shortage areas (HPSAs) were
nonmetropolitan. Another 641 rural counties had been partially designated HPSAs. Historically, the
residents of remote, sparsely settled communities have relied on family physicians for their health care. In
many rural settings family practice is the only generalist specialty that practice is economically viable.
A variety of programs have been implemented to address this inequity in access to care. Previous research suggests that residents whose training occurs in rural areas and emphasizes services necessary for rural practice, are likely to establish practice in rural communities. Among the 474 family medicine residency programs in this country, 29 have established separately accredited rural training tracks.
Information about the practice location of graduates from these rural tracks was collected in September of 1999, by questionnaire. Data were not attained for 7 programs (1 closed, 4 new and yet to graduate residents, and 2 non-responses to the questionnaire).
Remarkably, every graduate (all 40) of half (11 of 22) of the reporting programs had established practice in a non-MSA county. Overall, 76.0% (136 of 179) of the graduated residents were serving rural communities. Benefit usually accrued to the state in which the training occurred; of the 136 rural practice sites, 95 were located in the state of residency training. The effect of the substantial success of the separately accredited rural training track components of family medicine residency programs has been limited by several variables. First, they are small. The largest graduates just 6 to 8 residents annually. Most are new; only 3 had graduated more than 5 classes. The tracks are few in number. This is of particular concern since 1 has closed and another will terminate at the end of this year. However, new starts demonstrated immediate effectiveness; among programs implemented within the past 10 years, 88% (94 of 107) of graduates provided care in a non-MSA county.
This performance for rural placement should be viewed in the context of what has otherwise
occurred. Nationally, among all non-Federal allopathic family physicians actively providing patient care in
1997, 21.0% practiced in non-MSA counties. For the other 2 primary care specialties; general internal
medicine and pediatrics, the proportions were 8.0% and 7.4% in rural practice respectively.
American Academy of Family Physicians Phone: 202-986-5708
Center for Policy Studies in Family Practice and Primary Care Fax: 202-986-7034
2023 Massachusetts Ave., NW Email: policy@aafp.org
Washington, DC 20036