Attracting and retaining health professionals to rural practice involves a range of personal, professional, and community factors.1 These dimensions must work together for a health provider to enter, remain, and thrive in a rural environment.
Education also plays an important role in recruiting health-care providers to rural areas. Cultivating students’ interest in rural health care and preparing them for rural life and practice can have a significant impact on decisions to go, and stay, rural; in fact, in one study, it was determined that feeling prepared for small-town living was a greater indicator for physician retention than feeling prepared for rural practice.2
There are a number of factors strongly associated with entry into rural medical practice, including rural upbringing and training in a rural location.3-12 Strategies have been developed to increase the number of students from rural areas, such as creating or increasing spots for students with rural backgrounds and screening for interest in rural medicine.11-13
Because students raised in urban areas will also practise as rural physicians, positive undergraduate and postgraduate training opportunities in rural settings, as well as exposure to rural life, can encourage students from all backgrounds to consider rural practice.4,8,13,14
The study, “Cultivating Country Doctors: Preparing Learners for Rural Life and Community Leadership,” explores how medical schools successful in producing rural physicians prepare students for rural life independent of clinical skills.15
Overall, the study identifies 24 strategies that training programs may implement to successfully cultivate rural interest among students, prepare them for rural life, and help them foster a rural identity, wherein students and residents ultimately plan to enter and stay in rural practice.
These findings are also relevant for students in other health professions and for community groups similar to RhPAP’s attraction and retention (A&R) committees who support medical and allied health practitioners in their communities.
The study’s recommendations reflect five themes:
- Be intentional about strategies to prepare students for rural practice
- Identify and cultivate rural interest
- Develop confidence and competence to meet rural community needs
- Teach skills in leadership and improving community health problems
- Fully engage rural host communities throughout the training process
Rural has always been an interest of mine, but I grew up in Vancouver and then I moved to Edmonton, so I’ve never been exposed to it. And it was really exceptional to learn firsthand from the people who are up here.” – University of Alberta nursing student who participated in a Cold Lake Skills Weekend
The following strategies, highlighted in bold, align with RhPAP’s efforts to support health professionals in rural Alberta:
- Cast a wide net; urban students also go into rural practice and non-rural programs also graduate rural physicians. RhPAP works with attraction and retention committees and local health professionals to host Skills Weekends, where post-secondary health students visit rural Alberta communities and health facilities to learn specific health-care skills. Participants include nursing, medicine, pharmacy, physiotherapy, occupational therapy, and speech pathology students from rural and urban backgrounds, who learn what it is like to provide rural health care and receive firsthand exposure to what rural communities have to offer. These future health professionals discover practice sites they may wish to consider for long-term opportunities. And for participants experiencing rural communities for the first time, a Skills Weekend can be a valuable first step in choosing to live and work as a health professional in rural Alberta.
- Encourage students and medical residents to live in the community during rotations and encourage preceptors to involve them in community activities. RhPAP’s Rural Housing Program provides accommodations for medical residents and medical, nursing, pharmacy, and midwifery students in rural teaching communities so they can stay in the area where they are training and experience rural life. Attraction and retention committees often make connections with students in the community and invite them to local events and attractions.
- Expose students to quality rural experiences with well trained, experienced preceptors who understand students’ educational objectives and enjoy rural practice. In collaboration with the University of Alberta and the University of Calgary, RhPAP’s Rural Mentorship Program connects first- and second-year medical students with rural physicians. Students job-shadow experienced preceptors and learn medical skills in a rural context, receiving early awareness of, and exposure to, rural practice.
- Promote interaction among students interested in rural practice at various stages of training and across disciplines. Both High School Skills Days and Post-secondary Skills Weekends are interactive events where students can engage in common hands-on health-care activities and speak with instructors about health careers in the community. Health-care students from various disciplines experience opportunities for interprofessional learning and collaboration at Skills Weekends.
- Introduce students and medical residents to rural communities. Many attraction and retention committees include medical residents and health-care students in their activities by welcoming them to the community, inviting them to local events, and even providing information packages with coupons for local shops and businesses.
- Encourage students and medical residents to rotate through communities of different sizes to help their families and themselves find a good fit. RhPAP’s various programs and initiatives provide opportunities for students and residents to experience different rural communities. By doing so, they can appreciate each area’s unique attributes, understand local health needs, and determine if the setting would be a personal and professional fit. Attraction and retention committees showcase the best of rural life and what a community has to offer, which can help students, residents, and their families consider returning for future opportunities. Locum physicians and travel nurses who provide temporary coverage for doctors and nurses in rural clinics and hospitals can also be included in efforts to showcase the community. These temporary placements are a way for health professionals to explore different communities and practice options, and to see where they might like to settle in the long term.
- Share rural practice joys and success stories and address misconceptions about rural practice. RhPAP shares the good news stories about rural health and highlights the best of living and working in rural Alberta communities.
Ultimately, many factors influence medical residents and health-care students’ decisions to enter and remain in rural practice. Multiple strategies at various stages of education and training work together to cultivate interest in practising in rural areas and to improve students’ and residents’ preparedness to move into careers as rural health professionals.
RhPAP’s programs and initiatives, as well as partnerships with Alberta’s universities and colleges, rural communities, and health-care organizations, offer support to students throughout their journey into rural practice.
Is there a research area you would like to learn more about or see discussed in a future edition of Rural Health Matters? We want to hear from you! Email your suggestions to firstname.lastname@example.org.
- Cameron PJ, Este DC, Worthington CA. Professional, personal and community: 3 domains of physician retention in rural communities. Can J Rural Med. 2012;17(2):47-55. https://www.ncbi.nlm.nih.gov/pubmed/22572063.
- Pathman DE, Steiner BD, Jones BD, Konrad TR. Preparing and retaining rural physicians through medical education. Acad Med. 1999;74(7):810-820. doi:1097/00001888-199907000-00016.
- Strasser R, Neusy AJ. Context counts: training health workers in and for rural and remote areas. Bull World Health Organ. 2010;88(10):777-82. doi:10.2471/BLT.09.072462.
- Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The road to rural primary care: a narrative review of factors that help develop, recruit, and retain rural primary care physicians. Acad Med. 2018;93(1):130-140. doi:1097/ACM.0000000000001839.
- Kwan MS, Kondalsamy-Chennakesavan S, Ranmuthugala G, Toombs MR, Nicholson GC. The rural pipeline to longer-term rural practice: general practitioners and specialists. PLoS One. 2017;12(7):e0180394. doi:10.1371/journal.pone.0180394.
- Henry JA, Edwards BJ, Crotty B. Why do medical graduates choose rural careers? Rural Remote Health. 2009;9(1):1-13. https://www.ncbi.nlm.nih.gov/pubmed/19257797.
- Tate RB, Aoki FY. Rural practice and the personal and educational characteristics of medical students: survey of 1269 graduates of the University of Manitoba. Can Fam Physician. 2012;58(11):e641-e648. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498038/.
- Chan BT, Degani N, Crichton T, et al. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam Physician. 2005;51(9):1246-1247. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479469/.
- Rourke JT, Incitti F, Rourke LL, Kennard M. Relationship between practice location of Ontario family physicians and their rural background or amount of rural medical education experience. Can J Rural Med. 2005;10(4):231-40. https://www.ncbi.nlm.nih.gov/pubmed/16356384.
- Mitra G, Gowans M, Wright B, Brenneis F, Scott I. Predictors of rural family medicine practice in Canada. Can Fam Physician. 2018;64(8):588-596. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189886/.
- Kapadia RK, McGrath BM. Medical school strategies to increase recruitment of rural-oriented physicians: the Canadian experience. Can J Rural Med. 2011;16(1):13-19. https://srpc.ca/resources/Documents/CJRM/vol16n1/pg13.pdf.
- Rourke J. Increasing the number of rural physicians. CMAJ. 2008;178(3):322-325. doi:10.1503/cmaj.070293.
- Rourke J, Dewar D, Harris K, et al. Strategies to increase the enrolment of students of rural origin in medical school: recommendations from the Society of Rural Physicians of Canada. CMAJ. 2005;172(1):62-65. doi:10.1503/cmaj.1040879.
- Szafran O, Crutcher RA, Woloschuk W, Myhre DL, Konkin J. Perceived preparedness for family practice: does rural background matter? Can J Rural Med. 2013;18(2):47-55. https://www.ncbi.nlm.nih.gov/pubmed/23566862.
- Thach SB, Hodge B, Cox M, Parlier-Ahmad AB, Galvin SL. Cultivating country doctors: preparing learners for rural life and community leadership. Fam Med. 2018;50(9):685-690. doi:10.22454/FamMed.2018.972692.