Challenges to National Organizations

Objectives for More and Better Rural Physicians

State and National Organizations and Government

AAMC

State Health Policy Makers

AAFP

RESOLUTION #2 proposed, revised, tabled at aafp, not adopted

Whereas, there has been steady declines in the percentage of students from rural backgrounds choosing medicine and student and resident interest in rural family practice, and

Whereas, the funding of family practice training at the state level depends on the ability of its residency program to meet the needs of the state, especially the needs of rural patients,

NOW, THEREFORE BE IT RESOLVED, THAT THE AFFP

Work with the other organizations of family medicine and those organizations involved with rural health care including rural development groups, state and local governments, and others to develop a plan of improved accessibility for rural residents including but not limited to an appropriate mandate for rural health care, strategies to encourage well trained family physicians to select rural practice sites, resources to make it possible and organizational infrastructure that will support the needs of a rural health care system and,

Devote adequate staff support to provide leadership in the support and coordination activities.

Suggestions for Consideration by AAFP and AAMC

Recommendation 1: Medical schools should admit increased numbers of rural background students who are interested in family practice. They should help prepare these students prior to medical school.
Recommendation 2: Medical education should improve the admissions evaluation with a long term project requirement. Students should complete this project in a town other than their own and work with local practitioners, health facilities, or community workers on a community-determined project. The student’s evaluation would be a part of the admissions process. The intent is to assess responsibility, reliability, communications skills, true interest in caring for people and populations, and readiness for independent study and work.
Recommendation 3: Most medical schools and primary care residency training programs should adopt and integrate a mission for rural health throughout their institution or program with particular attention to admissions, curricular months involving rural health and primary care, rural faculty and faculty development, and a significant number of months away from urban academic locations.
Recommendation 4: Medical education should evaluate the various career influences during medical training and develop a continuous series of programs that will increase the likelihood that these trainees will choose and stay in rural practice.
Recommendation 5: Family medicine should encourage its residency programs to embrace a mission for rural health, more rural months, and more obstetric months.
Recommendation 6: Family medicine should urge the residency review committee to ease continuity requirements in at least one year of training to accomodate more than two rural months or rural months plus months for rural preparation such as obstetrical rotations, that might disturb continuity for as much as 4 months. These waivers should occur in the first and second year and only with sufficient documentation of intent to prepare and graduate rural physicians.
Recommendation 7: Family medicine should preferentially encourage the creation of residency programs in smaller and rural locations. Programs in more urban locations should consider developing rural training tracks.
Recommendation 8: Family practice residency programs who produce high percentages of rural graduates should receive special recognition from medical associations, government, and academic institutions.
Recommendation 9: Funding for rural medical education should be expanded consistently over the next decade. Any reforms in the financing of medical education or graduate medical education should carefully consider the impact of such reforms on the production of rural practitioners. Innovative curricula, programs, and projects that produce increased numbers of rural practitioners should be recognized, analyzed, and, most importantly, replicated. Funding in rural medical education should not go for infrastructure alone. Funds should also go into the next generation of programs that adopt proven models to their local situations including special admission programs, preceptorships and other rural community experiences, and rural graduate medical education programs.
Recommendation 10: States should work closely with medical schools, primary care organizations, and primary care training programs to prepare a strategy that will best meet the needs of their rural populations. This strategy should include a mission or mandate for rural health, adequate resources for this training, coordination of rural training between medical schools and residencies, and liaisons between rural faculty facilitators and rural practitioners, state government, and rural communities.
Recommendation 11: Community, state and federal sources should continue to support and expand the scholarship and loan repayment programs that keep trainees within the rural pipeline.
Recommendation 12: Family practice programs that produce graduates with expertise in geriatrics, sports medicine, women’s health, adolescent medicine, and mental health should work with their state to influence graduates with these skills to consider practicing in rural areas working directly with several rural practitioners in a community or region.
Recommendation 13: Family medicine program developers should examine the needs of rural communities to see if there is a need for any new types of that combine rural family practice training with general surgery, anesthesia, developmental pediatrics, and other needed areas. Family medicine should work collaboratively with other specialty disciplines in this effort.
Recommendation 14: Family medicine should take a leadership role in rural medical education and involve medical colleges, primary care specialty organizations, rural health organizations, and accreditation representatives in specific tasks groups involving rural-oriented admissions, early rural experiences, longitudinal rural experiences, rural emphasis graduate training, any new types of training needed, and infrastructure for rural medical education so that rural physicians are retained throughout training and into practice so that medical education can meet the needs of rural communities.
Recommendation 15: The various branches of family medicine should coordinate their rural efforts closely, with the assistance of the American Academy of Family Physicians.
Recommendation 16: Family medicine should review current data on residency programs and graduates and initiate studies of this information that would give more information regarding the future production of rural graduates. This should include factors such as residency sponsorship and residency location, mission, structure of the program, funding, and other areas. Related areas such as the impact of obstetrical training should also be a consideration.
Recommendation 17: Rural faculty should assist state, federal, and foundation efforts to help rural communities to become better organized so that family practice residency graduates can find out about these locations, choose them, and stay in them.
Recommendation 18: Family medicine should continue to revise its workforce estimates in light of new information about the distribution and training of primary care practitioners so the potential for excess numbers of family practitioners in certain areas are avoided and potential shortcomings in the selection, program development, and training of residency graduates are remedied.