Rural Medical Students Make Up 4.3% of Future Docs, Study Finds

December 06, 2019 - Rural medical students accounted for only 4.3 percent of the total incoming medical student body in both 2016 and 2017, according to a new study from researchers at the Association of American Medical Colleges (AAMC) and Michigan State University.

Even fewer (less than 0.5 percent) of the incoming medical student body during that time were students from underrepresented racial/ethnic minority groups in medicine with rural backgrounds, the study published in Health Affairs also found.

“From a workforce pipeline perspective, this study has made it clear that students from a rural background are an increasingly underrepresented group in medical school. Four times the number of rural medical students would be required for these students to be proportional to rural representation in the overall US population,” researchers wrote.

Because growing up in a rural setting is a strong predictor of future rural practice, underrepresentation of medical students from this background spells trouble for the physician-starved communities, researchers added.

Nearly 60 million people, or one in five individuals, live in a rural area, according to census data from the CDC. However, just 11 percent of the physician workforce practices in rural communities, a study from the University of Washington Rural Health Research Center showed.

While the entire healthcare industry is facing a physician shortage, rural communities are being hit the hardest from the low supply of doctors, especially since research shows that rural populations have higher rates of chronic illness and are less likely to receive recommended preventative services versus their peers in urban communities.

Getting more rural residents to apply and graduate from medical school could reduce care disparities in rural communities. But the US will have to first work on reducing disparities among medical students, the study indicated.

The study examined data on applicants and matriculants from the American Medical College Application Service for the period 2002 to 2003 through 2017 to 2018. In total, 618,856 applicant records and 281,845 matriculants were included in the study.

The data revealed that the number of applicants from a rural background declined 18 percent from 2002 to 2017. The number of matriculants from rural backgrounds also declined during the period by 28 percent.

The problem also appeared to be localized to rural medical students. During the same period, the number of applicants and matriculants from an urban background increased by 59 percent and 35 percent, respectively.

Researchers expressed concerns over the fact that the rural medical student matriculant pool decreased faster than the applicant pool over time. The finding may indicate “a growing mismatch between the qualifications of rural applicants and medical schools’ admissions priorities.”

The study revealed “no noticeable change” in rural applicants’ qualifications. The data showed that rural applicants did perform less well on the MCAT compared to their urban peers, but the rural students had higher GPAs, on average. Researchers pointed to other qualifications not analyzed in the study that may be impacting medical school admission decisions like research experience, which may not be available in rural communities.

“These factors require further study and potential interventions to ensure that rural applicants are competitive,” they advised. “Also valuable would be more widespread adoption of holistic admissions practices that value a broad set of life and leadership experiences among applicants when assembling a student body that reflects a diverse set of skills and backgrounds.”

Researchers also urged industry stakeholders to revamp medical education and training to augment the number of rural medical students. For instance, locating medical school programs in rural communities have realized success in attracting rural applicants and graduating students, they stated.

“These models allow students to learn in rural health care systems, helping students build skills necessary for rural practice. By placing medical school campuses in rural communities, these institutions also provide academic role models in medicine to high school and college students in these communities.”

Other possible solutions advocated by the researchers included implementing pipeline programs that encourage young rural students to practice medicine and increasing funding for federal and state-run programs like Area Health Education Centers.

These efforts will also be key to encouraging more rural medical students from underrepresented racial/ethnic minority groups, researchers highlighted.

More than 15 percent of rural residents belong to a racial or ethnic minority group, and that percentage is increasing, according to cited research. Training rural physicians who are part of these communities can help to reduce care disparities present among those in underrepresented racial/ethnic minority groups, researchers stressed.