1. More need so trainees are needed and can take care of patients in higher volume and at higher levels of responsibility

2. More need so training programs can negotiate for support        See definition of rural, definition of shortage area

a. financial

b. political - to support state or other funding    See Funding for Rural Training

3. Less competition and usually less controversy with existing providers

4. It’s the right thing to do for all physicians, but especially those who train them

5. Patients are often more appreciative of efforts than those with high expectations

6. There is increased recruitment potential for shortage sites that are "advertised" to trainees during training, not only the ones that train there, but other residents back at the home site. In fifteen years of a two month required rural rotation with a new site rotated about every year, only one site has failed to attract a practitioner. This can be a big negotiation point for programs that desire to implement rural training.

See Why Rural Fits with Medical Education     See Facilitating Recruitment to Underserved Areas

Residents can do elective or required rural rotations that require them to move to the location, ambulatory clinics periodically or as part of their continuity clinic that require them to commute, full time rural training in one of the 33 locations in rural communties, or during the final two years of a rural training track that is in a definite rural location. The choice of sites depends on the commitment of the program and director, funding, geography, goals of training, and site characteristics. These include site needs for health care, attitudes of practitioners/providers/community leaders/local patients toward training, and existence of qualified training directors at the site.

Expect resistance, especially from those with larger families, older ones, those not interested in rural at all and those already committed to rural - did I leave anyone out? but....

Once residents have been notified prior to coming, and when a few have come back reporting (hopefully) how much they got to do and how great it was to be a "real" physician (doing what they will be doing the rest of their careers, seeing mostly ambulatory patients, doing hospital, ER, and other duties) and they see how much confidence and efficiency they gained because of increasing responsibilities - in other words accelerating their professional growth and learning curve; then they might tolerate the experience.

Even in our 20 yr plus rotation, we still have years when residents stir up the pot about having to go. In extreme cases we do allow a nearby rural experience to substitute. This is done on an individual basis, but rarely. One couple now is stirring up other residents. Both have future obligations, one feels that he lost a previous marriage due (he feels) to such an obligation, and he is really causing us grief, even when they knew when they came that they would need to go and even though they were offered a chance to go together (they home school also).

Even travelling 30 min to a rural continuity experience can stir things up. (25 min was a lot for me to commute to teach at Bartlesville OK when I was in rural practice and the 90 min one way twice a week alone to the Mountain City rural satellite at ETSU was a killer.)

Recommendations

1. Be sure faculty are fully behind it

2. Share development with resident leaders

3. Notify interviewees of the curriculum

4. Be prepared for some challenges

5. Try to pilot the experience with residents who are likely to react positively or take advantage of the experience.

6. Two months better than one cause anyone can last out a month being resentful, but two months gets even the hardiest out of a shell

7. Community involvement people (designated or voluntary, spouse of a doc, community leader) can really make a difference by getting residents to sporting and community and church events