Documents to Review and Use:
Calgary Commitment to Women in Rural Practice http://www.ruralnet.ab.ca/wrhc/Calgary%20Commitment.doc
Monash University Site http://www.med.monash.edu.au/crh/gendermed/
Draft Wonca Working Party on Women and Rural Health
In What Types of Communities Do Rural Women Physicians Practice
Women in Medicine and Dentistry at Christian Medical and Dental Associations http://www.cmdahome.org/index.cgi?cat=273&CONTEXT=cat&BISKIT=2821618936
Rural Women Physicians Less Satisfied Canadian Study
http://www.nrharural.org/search/abs/135.html
Journal of Rural
Health Spring 2000, Vol. 16, No. 2 The
Distribution of Rural Female Generalist Physicians in the United States
pp.111-118 Mark P. Doescher,
M.D., M.S.P.H., Kathleen E. Ellsbury, M.D., M.S.P.H., and L.Gary Hart, Ph.D.
Abstract: Female physicians are underrepresented in rural areas. What
impact might the increasing proportion of women in medicine have on the rural
physician shortage? To begin addressing this question, we present data
describing the geographic distribution of female physicians in the United
States. We examine the geographic distribution of all active U.S. allopathic
physicians recorded in the October 1996 update of the American Medical
Association Physician Masterfile. Percentages and numbers of female physicians
by professional activity, specialty type, and geographic location are reported.
Findings reveal there were fewer than 7,000 female allopathic physicians
practicing in rural America in 1996. The proportion of generalist female
physicians who practice in rural settings was significantly lower than the
proportion who practice in urban locations. Although the numbers of the most
recent 10-year medical school graduation cohort of female generalist physicians
were slightly more likely to practice in rural areas than members of earlier
cohorts, female physicians remained significantly underrepresented in rural
areas. States varied dramatically in rural female generalist underrepresentation.
Should female generalists continue to be underrepresented in rural locations,
the rural physician shortage will not be resolved quickly. Effective strategies
to improve rural female physician placement and retention need to be identified
and implemented to improve rural access to physician care.
Hi Dr Bowman,
The number of family practice graduates choosing rural practice has declined, even as the number of total residents has increased. It is not known how the increasing supply of female and minority residents has affected this situation, but some impact is likely. The data are not totally in regarding gender and rural practice location, but some comments can be made.
I think it is important to look at the big picture:
Role Model
With fewer female physicians in established rural practice, it is tougher for female medical students and residents to find female role models. Studies at Mercer show that the preceptor is more important than the preceptorship. I believe that trainees interested in more unconventional practices (like rural, community clinics, etc.) like to find someone who has experience in this area, before they are prepared to "take a chance". Single female residents that I have dealt with, even with rural interest and training, are still concerned about limited access to "suitable" spouses if they do go into rural practice.
The Rural Physician Associate Program (RPAP) data (1971-1993) in MN includes over 800 med students who did 9 months in a rural area, mostly with male physician-preceptors. Duluth chooses its medical students for FP and rural interest and sends some 50 students a year into the U of MN medical school 3rd year class, with half of the class going into RPAP. The female students from the Duluth program that did the RPAP program were less likely to choose rural practice than their cohort female Duluth medical students who did not do RPAP. Something about the preceptorship turned them away from rural practice. For males it was a different story. The Duluth-RPAP males were far more likely to choose rural practice than Duluth non-RPAP. Of all the 800 students, 60 chose rural practices in the town where they did their preceptorship. Again suggesting that the ones that found a role model example that addressed their career expectations, came back for more.
Gender and Minority and Inner City Training
In my study of FP programs, the multiple regression did show a gender effect, FP programs with a higher % female resident population, graduated fewer rural physicians. However, when the minority variable was added, the gender effect dropped out. Minority females rarely go outside of urban city limits. The study population was programs and not individual residents. Inclusion of minority in the values dropped both the female and the population of the training site variables from significance.
Studies from a decade ago did show that whites chose rural in higher percentages than other groups, followed closely by blacks, with hispanics and asians not even in the picture. The AAMC is quick to point out that minorities are 4 times more likely to choose underserved practices, but these are almost totally underserved urban.
Workforce Considerations, Job Affinity and Competition
During the time that more female FP residents were graduating, rural practices were hiring more PA and NP providers. This may have made it more difficult to hire a "part-time" female with family needs of her own. Also female students have and affinity for OB-Gyn, Peds, and IM where they may perceive a gender advantage.
Rural Communities and Female Graduates
Rural communities have been slow to adapt to the needs of today's graduates, whether they are female or male, and some of the responsibility of fewer FP residents choosing rural practice lies with them. My research in this area highlights the competitiveness of rural physicians regarding establishing a rural practice. There may have been concerns from existing male rural physicians regarding the competitiveness of female rural physicians, who seem to establish rural practices much sooner than their male counterparts. Also female residents who have really wanted to go into rural practice in a certain community, have not found the community willing to adapt to special needs, such as being the sole parent, etc. One had to reset her search several times before she found a rural community that she could work with. These factors may discourage female graduates.
For the Future
With increasing numbers of female physicians locating in rural practices, there will be more role models, and the potential for more female rural physicians will increase. Another trend to examine is the number of male and female residents going out to rural practices for "alternative scheduling". More and more communities are faced with residents who demand no more than 1 out of 4 call nights and a day or more off from practice from the start. As rural practices "loosen up" to accommodate these new practitioners, a precedent is set that may make it easier for others of similar lifestyle needs. Not always are these "lazy" residents. Some are in single parent families, others are anticipating a family or have infants and young children. Studies of AAFP data would be helpful.
My 9 year old son was in the bathroom and found his long lost hair gel. His high pitched whine soon filled my ears when he spied the layers of my wife’s makeup that coated the bottle like pink leprosy. In a calm voice I replied, “Son, you’ve got to understand that a woman sheds….. Sometimes she sheds makeup, and sometimes she sheds tears.” by RCB