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Is GME Snubbing Rural America?

John Commins, for HealthLeaders Media, June 19, 2013

Outcome Mapper

GME Outcome Mapper

Theories abound as to why young physicians won't practice in rural areas. But the key reason why young medical doctors don't fill these much-needed roles readily is a lack of accountability in publicly funded Graduate Medical Education programs, researchers suggest.

A new round of metrics doesn't bode well for rural healthcare.

The U.S. Census for 2010 says that one in five people —19.3% of the population, about 59.4 million people—live in rural America. Unfortunately, a new report this month from George Washington University School of Public Health and Health Services says that only 4.8% of new physicians plan to establish a practice in rural areas, despite the critical need.  

Clearly there is a disconnect between supply and demand. This is hardly news to most rural healthcare professionals, researchers on the topic, or physician recruiters serving rural areas. It's a topic that's been predicted and discussed for decades. That's what makes this persistent shortage all the more vexing. We know what the problem is but we can't fix it.

"I can't say we were terribly surprised but it does definitely confirm what a lot of us suspected. When you see the actual numbers it is hard not to be a little shocked and disturbed," says Candice Chen, MD, MPH, an assistant research professor of health policy at SPHHS, and a lead author of the study, which appeared this month in Academic Medicine.

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8 comments on "Is GME Snubbing Rural America?"


Robert C. Bowman, M.D. (7/2/2013 at 3:45 PM)
GME snubs about half of Americans who are most in need of primary care and workforce trained in their state and in locations where they live. 3.5% of the land area or 3400 zip codes with 35% of the population has 95% of GME positions, 72% of physicians, over 75% of health spending, and over 85% of GME positions. Medical Education economic impact was tracked by AAMC and you can estimate 100 zip codes with half of this impact or 250 billion a year of 500 billion total. All but a few states have insufficient to grossly insufficient GME to meet state needs - and we know that instate GME is the best predictor of instate practice location. Family medicine is also the best instate multiplier, the best primary care multiplier, and the best primary care where needed multiplier but FM remains 3000 annual graduates - because of the designs. It is not just rural, and frankly there are about 9 rural counties that do very well because the do GME like the big institutions. It is about most Americans left behind by design - especially GME.

Anthony Day (6/21/2013 at 10:07 AM)
The problem with this article is the idea that GME is a monolithic institution that chooses what to train physicians to do. It is simply supply and demand. There is still enough demand for specialist physicians (and enough pay) to convince medical students to compete for those positions rather than the primary care positions for training. We can't add more positions for primary care training unless their are physicians to fill them. We could shift GME funding out of lucrative specialties and fund the training of primary care physicians effectively. That is a legislative problem with our system of Government control of healthcare - not a GME problem.

Steven (6/20/2013 at 8:36 PM)
This article makes very little sense. The problem is not trying to justify the training dollar amounts to why physicians want to practice in rural areas. The truth is that less than 5% of the population wants to live in communities of 10,000 or less. In order to sacrifice amenities (schools, restaurants, lifestyle options, etc.) there must be an incentive. Unfortunately, the compensation, quality of life (call), etc. do not justify living in a small community for most. Money or training will not solve this problem. Incentives can help. It will be a sad day for rural America when pay is equal in desired and undesired areas. The effect will result in even fewer rural physicians.