Calling all country doctors: Study challenges assumptions about rural physician recruitment
Submitted by tim on Tue, 12/03/2024 – 05:04

Physicians choose where they want to work based on interpersonal connections, community demographics, and exposure to rural primary care during their medical training. (Photo: Shutterstock)

“Ultimately, we hope that our research will inspire academic administrators to increase rural primary care exposure during training to motivate more trainees to pursue the field.” — Katie Waeldner, Medical Class of 2026

by Janet Essman Franz, UVM Larner College of Medicine

About 20 percent of Americans live in rural areas, but only 9 percent of physicians practice medicine there, leaving many rural residents desperate for health care. The physician shortage means rural residents tend to be diagnosed with such illnesses as cancer and cardiovascular disease at later stages than city-dwellers and have worse outcomes.

Rural communities with older populations—who tend to need more medical care—struggle hardest to attract young doctors to set up practice. Residents must travel long distances to see a doctor or postpone health care. Understanding physicians’ motivations about where to live and work can help communities recruit doctors and improve the health of their residents.

A pilot study by Larner medical students working in collaboration with a healthy aging advocacy group explored the key factors influencing recruitment of primary care professionals. Their findings challenge common assumptions about health care recruitment and identify a complex interplay of factors that go into a trainee’s decision-making process about where to practice medicine.

Considerations include the satisfaction of being part of a smaller community, intrinsic rewards of interhuman connections, and prior exposure to rural primary care during medical training, such as during clinical rotations. The study, which began as an assignment for a Public Health Projects course, was published in Cureus: Journal of Medical Science on October 20, 2024.

Class of 2026 medical students Katie Waeldner, Chris Kruglik, Julia Halvorson-Phelan, and Joon Young Lee partnered with Windham Aging, a collaboration of organizations that care about older Vermonters in the Windham County region. This region, home to the state’s oldest population, struggles to sustain a primary care workforce adequate to care for residents.

The students interviewed family medicine residents and doctor of nurse practitioner (DNP) students training at the University of Vermont Medical Center who identified as interested in pursuing primary care. The interviews revealed that personal and lifestyle factors outweigh financial considerations when deciding where to work.

“Residents and nurse practitioner students did not highly rank financial incentives,” says Kruglik. “Rather, both groups ranked housing affordability, political association, and community demographics as the most important factors when choosing where to work after training.” The study also identified experiences in rural health care settings during training as crucial to attracting physicians to those communities. “Exposure to rural primary care during clinical rotations is important when folks are choosing where they want to work.”

The students presented the findings at the 2023 Health Equity Summit at the University of Vermont and as a poster at the 2023 American Medical Association Research Challenge, and they worked together to prepare the manuscript for submission to a scholarly publication.

“This research provided so many learning opportunities. We were able to conduct a group research project, learn how to engage with community members meaningfully, write an academic manuscript, and give lectures at conferences,” says Waeldner. “Ultimately, we hope that our research will inspire academic administrators to increase rural primary care exposure during medical training to motivate more trainees to pursue the field.”

The study originated as a project for Public Health Projects, a required course for first-year medical students. The course teaches learners to use practical research methods while working to address social determinants of health. Students in the course work together with faculty mentors and community partners to find creative ways to translate science into practice. The course exposes medical students to the kinds of public health challenges they will face in their future careers, says course director Jan K. Carney, M.D., M.P.H., professor of medicine and associate dean for public health and health policy.

“Conducting public health projects helps Larner College of Medicine students hear our community’s voice. This is essential for research, practice, and achieving health equity. Improving health in every part of Vermont requires listening to the unique needs and perspectives of our rural communities,” Carney says. “The students’ experiences enhance their education in medicine and public health as they help Vermont communities.”

Students in the Class of 2028 are currently working with partners at the Vermont state health and mental health departments, the American Heart Association, and organizations that address child abuse, substance abuse, gender-affirming care, veterans’ health care, developmental disabilities, and equitable access to health care products. Many of the public health projects have a statewide focus that includes rural and less-rural settings.

Participating in public health projects often inspires medical students to further explore health care puzzles and solutions. Kruglick and Waeldner have partnered with a multidisciplinary team of UVM physicians and community members to increase telehealth access throughout rural Vermont, and Lee is investigating the capabilities of artificial intelligence in the field of radiology.

Kruglick is working with physician mentors to evaluate the barriers rural populations face when seeking treatment for head and neck cancers, and Waeldner is working with the UVM Cancer Center and the Northern New England Clinical Oncology Society to explore social barriers to cancer care throughout rural Vermont.

The Robert Larner, M.D. College of Medicine | The University of Vermont