Abstract
There is a longstanding and well documented shortage and maldistribution of rural physicians in the United States. Students from rural backgrounds are underrepresented in U.S. medical schools and rural practice interest declines collectively for students between matriculation and graduation. Understanding characteristics of institutions that sustain rural interest will inform strategies to support medical students' rural career goals.
The authors collected rural practice intent for a three-year cohort of all U.S. medical students using the Matriculating Student Questionnaire (MSQ: 2013-2015) and Graduation Questionnaire (GQ: 2017-2019). Authors analyzed students' change in rural intent from matriculation to graduation among all schools individually by calculating, for each 3-year cohort, proportions of students expressing rural interest on the MSQ (or GQ) divided by the total number of students completing the MSQ (or GQ) and displaying this data graphically. Authors also explored characteristics of those schools that matriculated and sustained a high proportion of students with rural interest.
Student cohorts at almost all medical schools became less interested in rural practice during their medical education. The mean of the average percentages of students with rural practice intent for all schools declined from matriculation (9.1%, SD 7.1) to graduation (7.7%, SD 5.9; P < .001). Twenty-five schools matriculated or graduated a high proportion of students interested in rural practice. Those schools with the strongest maintenance of rural interest had large rural cohorts, admissions preference for rural students, and defined rural programs.
The decline in rural practice interest during medical school, combined with underrepresentation of rural medical students, exacerbates the U.S. rural physician workforce shortage. Medical schools admitting students interested in rural practice should target strategies to foster this interest throughout training, including building cohorts of students of rural origin within medical school classes and providing opportunities for rural training through defined rural programs.