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Rural GPs: getting them and keeping them

Most of us live in towns or cities. Some of us are lucky enough to live in the country (though that is Bandolier's subjective view). Recruiting GPs to towns and county is hard enough, especially now in the UK. The general shortage of doctors, early retirement, large older cohorts of GPs coming up to retirement, and the demands for more hospital specialists all mean that recruiting GPs anywhere will be difficult.

In the USA, even though some of those special factors do not apply, recruitment to rural practices has been difficult, and is getting more difficult. A literature review [1] has examined factors that might influence recruitment and retention of rural GPs.


The literature search was extensive, and limited to the years 1990-2000 in order to be contemporary. Examining bibliographies and communication with selected authors extended the search. The definition of rural was that of original authors. The analysis examined factors before medical school, in medical school, and postgraduate factors.


There were 21 studies, all cohorts or cross-sectional studies, often with controls, often with multivariate analysis, often of high quality, and often large (the biggest involving almost 600,000 US physicians). The main results are shown in Table 1, which is no more than an overall summary of some detailed studies.

Table 1: Main finding of studies examining recruitment and retention of rural GPs, according to pre-medical school, medical school and postgraduate factors

Number of studies



Pre-medical school 6 Rural upbringing and intention to practice as a GP increase rural recruitment No factor clearly linked with retention
Medical school 15 Specialised programmes for experience in rural primary care, and specialised curriculum, plus physician shortage programmes increased likelihood of recruitment Specialised programmes for experience in rural primary care, and specialised curriculum increased likelihood of retention
Postgraduate 6 Residence programmes with more rural rotations and obstetric training Rural rotation and residency emphasising underserved health care, and preparedness for small-town living increased retention

In the main, having a rural upbringing and having the intention to practice as a GP increased recruitment to rural practices. In medical school specialised programmes giving experience in rural primary care were helpful, and postgraduate rotations with rural experience and obstetric training improved recruitment. Some of these also influenced retention.


No summary can give full justice to this review. One particular facet was that it described several specialist programmes to increase physician activity to areas under-served by doctors. This would be fertile ground for getting to grips with other areas of difficulty, like inner-city provision of primary care.

Of course there will be other issues beyond choosing the right candidates for medical school, and training them in particular ways in medical school and afterwards. House prices and local education provision are two that spring to mind. But those societal factors apart, this paper would be an interesting read for those organising medical school and postgraduate teaching programmes.


  1. RG Brooks et al. The roles of nature and nurture in the recruitment and retention of primary care physicians in rural areas: a review of the literature. Academic Medicine 2002 77: 790-798.
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