Introduction

Millions of Americans live in rural and urban shortage areas. Access is widening with millions more without health insurance. The lowest quintile by income dipped even lower despite a some unprecedented economic times.  The nation has failed to remedy this situation despite decades of effort and federal policies may be causing difficulties for those least able to deal with the consequences.. While there have been some indications of improving distribution of primary care practitioners in urban areas , fewer practitioners are choosing rural areas.

Recent articles describe successful rural interventions in medical schools, but little is known about interventions at the graduate medical education level that would improve the production of rural physicians.

Primary care specialties are beginning to show concern regarding their failure to produce physicians that would choose rural underserved practices and they are considering many different rural interventions. Current information about successful interventions would help them in this effort.

The author gathered information from family practice program directors in 1994-1996 regarding each residency program. This information included the number of months of required rural rotations, the existence of a required ambulatory clinic in a rural area, the number of graduating residents in the past three years, and the number of graduating residents in this three year period that choose a town of less than 25000 that was not adjacent to a larger city.