Is GME Snubbing Rural America?

John Commins, for HealthLeaders Media , June 19, 2013


Candice Chen, MD

Theories abound as to why young physicians won't practice in rural areas: less money, horribly long or erratic working hours, massive medical school debts to repay, a lack of cultural diversity and other social chasms with the populations they serve, practicing in isolation, a lack of professional support, and generally poorer schools for their children and fewer career options for spouses, to name a few.

The failures continue despite the efforts and financial incentives by the federal and state governments to encourage medical students and residents to practice in underserved areas both rural and urban. The key reason why young physicians don't take up these obvious and dire needs is a lack of accountability in publicly funded Graduate Medical Education programs, researchers suggest.

Chen and her colleagues studied the career paths of 8,977 physicians who had graduated from 759 medical residency sites from 2006 to 2008. The researchers analyzed data to find out where these new physicians ended up practicing three to five years after graduation. They found that overall only 25.2% of the physicians in this study worked as primary care physicians.  

Chen says this number likely too high because it includes hospitalists. The researchers found that 198 of 759 institutions produced no rural physicians during the study period. And 283 institutions graduated no doctors practicing in the Federally Qualified Health Centers that serve low-income or destitute patients in underserved urban and rural areas.

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8 comments on "Is GME Snubbing Rural America?"

Robert C. Bowman, M.D. (7/2/2013 at 3:45 PM)
GME snubs about half of Americans who are most in need of primary care and workforce trained in their state and in locations where they live. 3.5% of the land area or 3400 zip codes with 35% of the population has 95% of GME positions, 72% of physicians, over 75% of health spending, and over 85% of GME positions. Medical Education economic impact was tracked by AAMC and you can estimate 100 zip codes with half of this impact or 250 billion a year of 500 billion total. All but a few states have insufficient to grossly insufficient GME to meet state needs - and we know that instate GME is the best predictor of instate practice location. Family medicine is also the best instate multiplier, the best primary care multiplier, and the best primary care where needed multiplier but FM remains 3000 annual graduates - because of the designs. It is not just rural, and frankly there are about 9 rural counties that do very well because the do GME like the big institutions. It is about most Americans left behind by design - especially GME.

Anthony Day (6/21/2013 at 10:07 AM)
The problem with this article is the idea that GME is a monolithic institution that chooses what to train physicians to do. It is simply supply and demand. There is still enough demand for specialist physicians (and enough pay) to convince medical students to compete for those positions rather than the primary care positions for training. We can't add more positions for primary care training unless their are physicians to fill them. We could shift GME funding out of lucrative specialties and fund the training of primary care physicians effectively. That is a legislative problem with our system of Government control of healthcare - not a GME problem.

Steven (6/20/2013 at 8:36 PM)
This article makes very little sense. The problem is not trying to justify the training dollar amounts to why physicians want to practice in rural areas. The truth is that less than 5% of the population wants to live in communities of 10,000 or less. In order to sacrifice amenities (schools, restaurants, lifestyle options, etc.) there must be an incentive. Unfortunately, the compensation, quality of life (call), etc. do not justify living in a small community for most. Money or training will not solve this problem. Incentives can help. It will be a sad day for rural America when pay is equal in desired and undesired areas. The effect will result in even fewer rural physicians.




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