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Roger A. Rosenblatt, MD, MPH; Michael E. Whitcomb, MD; Thomas J. Cullen, PhD; Denise M. Lishner, MSW; L. Gary Hart, PhD

JAMA. 1992;268(12):1559-1565.

Abstract
Objective.
—To examine the hypothesis that medical schools vary systematically and predictably in the proportion of their graduates who enter rural practice.

Design.
—The December 1991 version of the American Medical Association Physician Masterfile was used to examine the rural and urban practice locations of physicians who graduated from American medical schools between 1976 and 1985. Selected characteristics of the medical schools—including location, ownership, and funding—were linked to the Physician Masterfile.

Main Outcome Measures.
—The percentage of the graduates from each medical school who were practicing in rural areas in December 1991, disaggregated by physician specialty.

Results.
—Of the practicing graduates from our study, 12.6% were located in rural counties; family physicians were much more likely than members of other specialties to select rural practice, particularly in the smallest and most isolated rural counties. Women were much less likely than men to enter rural practice. Medical schools varied greatly in the percentage of their graduates who entered rural practice, ranging from 41.2% to 2.3% of the graduating classes studied. Twelve medical schools accounted for over one quarter of the physicians entering rural practice in this time period. Four variables were strongly associated with a tendency to produce rural graduates: location in a rural state, public ownership, production of family physicians, and smaller amounts of funding from the National Institutes of Health.

Discussion.
—The organization, location, and mission of medical schools is closely related to the propensity of their graduates to select rural practice. Increasing policy coordination among medical schools and state and federal governmental entities would most effectively address residual problems of rural physician shortages.

(JAMA. 1992;268:1559-1565)

Author Affiliations
From WAMI Rural Health Research Center, University of Washington School of Medicine, Seattle.

Footnotes
Reprint requests to WAMI Rural Health Research Center, Department of Family Medicine, HQ-30, University of Washington School of Medicine, Seattle, WA 98195 (Dr Rosenblatt).

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