Robert C. Bowman, M.D.
Current efforts tend to attract those most likely to choose rural practice to military programs.
Those who are white, rural background, lower income origin, a bit older, osteopathic, and with high financial needs tend to choose the same careers
In addition the male black and Hispanic family physicians also share the highest levels of urban underserved distribution. Comparisons are helpful.
For medical students with families, debts, and immediate needs, the military package is the earliest and best solution. These are also the physicians with the highest levels of rural and rural underserved distribution. Service Orientation is common to both careers and the Rural Interested types of students as well.
Improvements designed to give those most interested in rural practice an similar level playing field option, would likely add 50 - 80 rural FP doctors a year. Military needs could be met by any number of options other than those most likely to choose rural areas or urban underserved areas.
Currently the National Health Service Corps is going the other way in terms of those likely to prefer urban. Few of the white rural background students are chosen by NHSC. Changes in this preference would help rural shortage areas most. Until admissions committees work at all levels to be able to admit more minority students from rural areas, this will continue to be a problem and rural areas with poverty and high percentages of minority will continue to remain underserved. Reservations are another area of great need.
Just as an example, NHSC selections that are minority are three times the number of whites with military being 4 times more likely white than minority.
Also military regulations will not allow their residents to moonlight or do after work hours physician work. Often rural hospitals employ such labor. In addition, this is great training and a real opportunity to see what you need to learn regarding triage, acute care, and more. This policy was put into place because the privilege was abused in the past. Better regulation would allow more workforce for rural areas and better training.
For more on shared characteristics of military and rural - Characteristics of Rural Interested Students AAMC GQ 1995)