Graduating Rural Primary Care Physicians: 36 years of Outcomes from the Rural Physician Associate Program (RPAP)

Context: Medical students who choose primary care and rural practice have trended downward. Objective: To examine the outcomes of the 36-year old RPAP program in recruiting and retaining rural primary care physicians. Design: Descriptive statistics using the RPAP database including data on specialty choice and practice settings. Setting: The RPAP Program at the University of Minnesota Medical School was founded in 1971 with money from the state to increase the number of primary care physicians in rural Minnesota. Third year medical students are assigned to primary care physicians in rural communities for nine months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete on-line modules, participate in on-line discussion with their colleagues and RPAP faculty and complete two projects (evidence based medicine and community health assessment). Population: 1175 graduates of the RPAP program. Results: RPAP has consistently graduated predominantly primary care physicians who choose rural practice, with 82% choosing primary care and 68% family medicine. Without RPAP, the percent of University of MN students who chose primary care and family medicine is cut in half. Of RPAP grads currently in practice, 44% percent have practiced in a rural setting all of the time, 42% in a metro setting and 14% have chosen both with more than 50% of their time in rural practice. Fifty-nine percent of RPAP graduates are currently practice in settings that are similar to their metro or rural upbringings. This leaves 41% who practice in settings different from their upbringings (Kappa = .188 p \u3c .001). Therefore, rural origin has only a small association for choosing rural practice. Conclusion: RPAP data suggest that students who do not grow up in a rural environment can be recruited to rural practice if they have a nurturing training experience in rural communities