I have always felt that rural kids have an advantage of having leadership opportunities, since there were fewer kids to take the usual positions in academics and athletics, etc.
I still remember research from the early efforts at the KC school where they admit from high school. Studies showed that the rural high school students had more extracurricular activities and a bit lower GPA when compare with urban. The extracurricular gives the leadership possibilities. An academic focus can take it away, or at least focus in in academics rather than service. Studies in Utah were similar by Dona Harris.
As we have admitted more from smaller towns and some more older kids, we seem to have had a tremendous growth in non-curricular curriculum. The Sharing Clinic is a weekly evening clinic staffed by med, nursing, pharmacy students. It won national awards. The Student Alliance for Global Health began with a trip on spring break to Jamaica. Jamaica and SAGH 300 students show up in the fall for the first few meetings of this group. After Jamaica in the M-1 year, they have a choice of 4 or 5 other locations. Rural kids, some, service driven kids, definitely, better fp match, you bet. Better doctors, absolutely, partially what we do, but mainly in who the kids are.
Back to born vs early experiences vs trained in later.
As a late blooming leader with a lot of past failures, I vote for all three.
The Rural Difference?
Also I think in a small town, there are more opportunities for physicians and other professionals to lead.
Sadly though, in tough economic times or when populations are declining, the number of leadership positions expected can overwhelm the fewer leaders, especially before new leaders rise to the occasion. Or the new leaders that arise can get burned out for lack of examples and too much too soon.
Small churches and other small group operations also experience much the same. Churches are more active in many rural areas and states, another leadership opportunity.
Rural areas are also places where values tend to be held a bit higher or perhaps there is slower penetration of the more crazy stuff in society. This can work both ways on leadership. It can perhaps depress the number of rural people with values choosing certain leadership positions, especially when people who hold values high see situations where values are not appreciated or where people with values are being persecuted. It can also make help rural leaders rise to the fore in business, military, and politics. Times of great national stress can bring on good leaders who have learned to delegate and rely on others.
Clearly in family medicine, the rural folks do have some standing. Many if not most of the doctors of the year and presidents have come from rural areas, the docs of the year remaining have come from underserved areas.
One of the key frustrations expressed by 3 docs of the year and 2 past AAFP presidents was their inability to make headway in some needed areas for rural health. This is unfortunate because some 30% of AAFP is rural docs and perhaps close to 50% are rural or have been rural or come from rural areas. This is one of the most significant groups in the AAFP in sheer size. Somehow we must work to translate this leadership and numbers into change. This is not just at the national level.
At a recent department meeting, some noted that the same few came to faculty meetings and business meetings. One item noted was that our current leaders have always taken good care of us. Perhaps there is a possibility that leaders can do too good a job. I suspect that family medicine, with a lot of amiables, has indeed depended too much on the fewer number of drivers, especially in the good times that we have had. The question is, can we amiables and expressives step up to the plate where needed, or will we sit back and allow our local, state, and national leaders to get isolated and overwhelmed.
I have had the opportunity to observe the development of a rural network over a 5 year period. Early on I had fears that the young docs going out, would not engage at the leadership level. After all, many of them were employed instead of employers and many professed great needs in helping with their families.
I am gratified to see some new young leaders involved. Don't know whether they were born, or trained, but they have seen the need to maintain quality health care in their rural areas and are working toward it.
Not surprisingly, research shows that leadership positions are important for future rural and primary care physicians, particularly leadership positions on admissions committees Leadership Factors in Developing RME
rbowman@unmc.eduMessage To Students and Residents
Education - the entire pipeline