New Research Points to a Reduction in Medical Students from Rural Backgrounds

Scott Shipman, MD, MPH

Despite the substantial growth seen in the overall number of medical students over the past 15 years, the number of matriculating medical students from rural backgrounds has been in steady decline, according to a new Dartmouth-affiliated study published this week in the December issue of Health Affairs, a theme issue with the focus on rural health.

The need for more rural physicians is well-established. Studies have shown that rural populations are less likely to receive recommended preventative services, have higher rates of many chronic illnesses, and have not made the same gains in life expectancy as urban populations in recent decades.

At the same time, a growing number of rural residents are members of racial and ethnic minority groups, which bear even higher chronic disease burdens and worse access to care than white rural residents.

“There’s a long history of research that demonstrates that those from rural backgrounds are most likely to go back and practice in rural communities—a key to meeting physician workforce needs in these areas,” explains lead author Scott Shipman, MD, MPH, who directs primary care initiatives and clinical innovations at the Association of American Medical Colleges (AAMC) and is an assistant professor of pediatrics and community and family medicine at Dartmouth’s Geisel School of Medicine and of The Dartmouth Institute for Health Policy and Clinical Practice.

The study is one of the first to examine this issue on a national scale, says Shipman, who collaborated with colleagues from the AAMC and Michigan State University on the research.

The investigators found that while overall medical school positions grew by more than 30 percent from 2002 to 2017, medical school enrollment among students from rural backgrounds decreased 28 percent. In 2017, students from rural backgrounds comprised only about 4 percent of incoming medical students, and those in underrepresented racial and ethnic minority groups in medicine from rural backgrounds accounted for only 1 out of 200 incoming students.

“One of the most important things we can do to help stem this decline is to prioritize efforts that reinforce the rural pipeline into medicine,” he says. “Medical schools can play a critical role in this by partnering with their rural communities to offer physician role models, targeted educational programs, and longitudinal support to young students. Additionally, considering the rural background of applicants as a component of diversity in the admissions process can further support growth of the rural physician workforce.”

This is particularly true for the relatively small number of medical schools that exist in rural communities and in states that have large rural populations.

“There’s an opportunity for rural schools to be centers of excellence for reinforcing the pipeline into medicine for those from rural backgrounds and providing an exceptional training experience that models what the practice of medicine in rural communities is all about,” says Shipman.

Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America’s leading medical schools, Dartmouth’s Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.