Many residents complain about doing rural rotations away from the home location. Although a rural month can force a change in location, there is great potential for training and service.
The data from our program director survey of 1995:
Over 140 family practice programs require at least one rural month. Residents on required rural rotations delivered some 4000 months of care in 1996 across the US (not counting electives, moonlighting, satellite practices, etc.).
At UNMC, we do what we can to minimize the transitions and maximize the benefits for our residents who do two rural months in their second or third year: The rotation is required and discussed at interviews. The rural hospital provides a two bedroom apartment suitable for regular or at least weekend use by a resident's family.
As usual the best ambassadors are the residents themselves. Residents are highly supportive regarding what they learn. Residents and faculty feel that the rotation helps build confidence and efficiency. The sites are chosen for their potential for actual practice experience and procedures. Sites are rejected if they do not have physicians who are capable of, or willing to teach.
Faculty advisors visit the resident on site during rotations. Program directors do the initial visit to approve sites: verifying commitment, educational interest, supervision, funding, housing, etc.
Perhaps some of the success is due to the design. We do not randomly send residents across the state. Residents rotate for two months to one of four locations. Each location is short 1-2 physicians to maximize resident usage. We schedule six residents at each site (a full twelve months), building up a regular practice for the residents and maximizing community benefit. This allows sites to staff the practice with a nurse.
We try to have second year residents do rural rotations, but have to balance the sites and numbers of residents so sometimes the rotation comes in the third year. It is unknown whether this loses some rural recruiting effect. We do know that earlier rotations in students have more effect.
We do have some advantages in that we benefit from a tradition of required rural preceptorships in medical school (year 1 and 3) and a state with great rural needs.
The other type of rural rotation is based on selecting a practice. Residents often get to choose the site in this mode. While this is a benefit for residents set on rural practice, I can see how residents would balk at this effort in certain situations. The site might not be prepared and it would be more of an imposition. There is also less emphasis on educational value since the sites are somewhat random. Good rural sites have much to offer in education, perspective, confidence, etc.
For best implementation of a rural rotation, I would work to require the rotation, do the site visits, pick the best sites, and meet with the resident representatives regarding the rotation. You might need to explain some basics regarding meeting state needs and requiring state funding.
You might also point out that in the next two years there will soon be nearly 4000 physician assistants and 4000 FP residents graduating each year that are mostly heading for urban areas, not to mention the docs and nurses transitioning more toward primary care who are out there already.