Students from rural areas made up only 4.3% of all incoming medical students in 2017, according to a study published online yesterday in Health Affairs.
There were even fewer students from underrepresented racial/ethnic minority groups who came from rural backgrounds — less than 0.5% of students.
"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," write Scott A. Shipman, MD, MPH, director of primary care initiatives and clinical innovations at the Association of American Medical Colleges in Washington, DC, and colleagues.
The 2017 numbers cap off a 15-year decline in rural students entering medical school, the authors point out, and that is particularly concerning because medical students who grow up in a rural setting are much more likely to practice there and are more likely to enter primary care, research has shown.
The combination of heightened healthcare needs in rural areas and the worsening physician shortages in these areas underscores the importance of the findings.
The authors note that rural populations have higher rates of many chronic illness, get fewer recommended preventive services, and have seen fewer gains in life expectancy than urban populations. They also have higher rates of maternal and infant deaths.
In the current physician workforce, only 11% practice in rural communities. Yet more than 62% of all federally designated primary care Health Professional Shortage Areas are in rural parts of the country.
"This gap in access to physician care is likely to be an important contributor to increased rural morbidity and mortality," the authors write.
The urban–rural gap is also widening in the application process for medical schools. The number of rural applicants dropped by 18% from 2002 to 2017. During the same period, the number of urban applicants increased by 59%.
"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," the authors write.
They suggest that high schools increase awareness of medical careers and help students prepare their college applications. Colleges can offer MCAT preparation courses and opportunities to shadow physicians and offer financial aid education to introduce medical education as an attainable goal instead of a pipe dream, they say.
The researchers note that the decline in medical students coming from rural backgrounds has happened even against a backdrop of substantial medical school expansion.
Rural Students May Be Missed Among Traditional Minority Groups
New schools may be focusing more on recruiting the traditionally unrepresented minority students and those from lower-income households but may be missing an important underrepresented group, the researchers suggest.
"Having new and established schools consider rural background as an important component of a diverse student body and tracking the schools' effectiveness in increasing diversity in this area could have a significant impact on the dearth of rural students, thereby supporting the future adequacy of the rural workforce," they explain.
The authors acknowledge that situating medical school campuses in rural areas has cost constraints, but more clinical rotations could be offered there, "especially longitudinal integrated clerkships."
Not included in this analysis were some factors that may influence admission decisions. For instance, prior research has shown that rural students don't tend to do as well as their urban counterparts in multiple "mini-interviews." They may also have less research experience and that may be highly valued by some medical schools.
"These factors require further study and potential interventions to ensure that rural applicants are competitive," Shipman and colleagues write.
The researchers used the 2013 Rural-Urban Continuum Codes of each medical school applicant's birth and high school graduation county to set the definition for rural background in this study.
The study had no specific funding. The study authors have disclosed no relevant financial relationships.
Health Aff. Published online December 3, 2019. Abstract
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