Required Rural Rotations Influence Job Choice After Graduation

Increasing the number of residency programs that require rotations in rural areas would help address the shortage of emergency physicians who choose to work in rural U.S. emergency departments, according to a survey of 2,380 graduates of 111 residency training programs.

Based on the findings of their nationwide July-December 2009 survey, "exposure to rural emergency department (ED) rotations may positively enhance rural recruitment after graduation," wrote Dr. Brad E. Talley of the department of emergency medicine at Denver Health Medical Center, and his coauthors.

The investigators surveyed the program directors of all 126 emergency medicine residency training programs recognized by the Accreditation Council for Graduate Medical Education, with the exception of military programs and those started after 2006. Of the 111 programs that provided complete responses, only 6 (5%) required residents to have a rotation in a rural area. Of the remainder, 16 (14%) offered residents rural rotations at predesignated sites as an elective, 76 (69%) offered rural rotations as an elective but students were required to find their own site, and 13 (12%) offered no opportunity for a rural rotation.

Programs that required rural rotations had a significantly greater percentage of residents who later chose to start their careers in rural areas (22%) than did programs with electives at predesignated sites (7%), programs with electives at student-selected sites (6%), and programs with no rural rotations (7%), Dr. Talley and his coinvestigators reported.

Overall, 7% of residents took jobs in rural areas after completing their training programs (Acad. Emerg. Med. 2011;18:297-300).

A total of 197 students completed a rural rotation, and 111 of these were from the six programs that required them. In comparison, only 86 students from the 92 programs that offered rural rotations as electives chose to train in a rural location.

Of residents in programs with elective rotations, more chose a rural rotation if a predesignated site was offered (7% vs. 4% without predesignated sites).

When categorized by geographic area, a high of 19% of residents in programs in the East South Central part of the United States chose rural positions after graduation, compared with only 2% of residents who trained in the Pacific part of the country. Although students in programs located in states with high rural populations (according to U.S. Census Bureau statistics) were more likely to have completed a rural rotation, a program’s geographic area was not associated with the probability of its residents working in a rural hospital after graduation.

The low percentage of programs offering rural rotations may be due to funding patterns and resident preferences. While acknowledging that rural hospitals may have fewer resources, Dr. Talley and his colleagues noted that practicing in a rural ED "requires a unique skill set" that students without such an experience may not acquire. And despite previous criticisms, "rural EDs can provide adequate patient volume and experience to support [emergency medicine] resident education," they added.

Emergency physicians are in short supply, especially in rural areas (Ann. Emerg. Med. 2009;54:349-59). As this study "found that exposure to rural [emergency medicine] rotations through required rotations was associated with subsequent resident job selection in rural areas," increasing the number of programs that require rural rotations may be an important strategy to help alleviate the shortage, according to Dr. Talley and his colleagues.

Future studies are needed to determine the costs of such an approach, which may be prohibitive, they wrote.

Limitations of the study include the lack of data from the 15 program directors who did not participate. In addition, the researchers did not provide survey respondents with a standard definition of "rural."

The authors did not have any conflicts of interest to report.

Increasing the number of residency programs that require rotations in rural areas would help address the shortage of emergency physicians who choose to work in rural U.S. emergency departments, according to a survey of 2,380 graduates of 111 residency training programs.

Based on the findings of their nationwide July-December 2009 survey, "exposure to rural emergency department (ED) rotations may positively enhance rural recruitment after graduation," wrote Dr. Brad E. Talley of the department of emergency medicine at Denver Health Medical Center, and his coauthors.

The investigators surveyed the program directors of all 126 emergency medicine residency training programs recognized by the Accreditation Council for Graduate Medical Education, with the exception of military programs and those started after 2006. Of the 111 programs that provided complete responses, only 6 (5%) required residents to have a rotation in a rural area. Of the remainder, 16 (14%) offered residents rural rotations at predesignated sites as an elective, 76 (69%) offered rural rotations as an elective but students were required to find their own site, and 13 (12%) offered no opportunity for a rural rotation.

Programs that required rural rotations had a significantly greater percentage of residents who later chose to start their careers in rural areas (22%) than did programs with electives at predesignated sites (7%), programs with electives at student-selected sites (6%), and programs with no rural rotations (7%), Dr. Talley and his coinvestigators reported.

Overall, 7% of residents took jobs in rural areas after completing their training programs (Acad. Emerg. Med. 2011;18:297-300).

A total of 197 students completed a rural rotation, and 111 of these were from the six programs that required them. In comparison, only 86 students from the 92 programs that offered rural rotations as electives chose to train in a rural location.

Of residents in programs with elective rotations, more chose a rural rotation if a predesignated site was offered (7% vs. 4% without predesignated sites).

When categorized by geographic area, a high of 19% of residents in programs in the East South Central part of the United States chose rural positions after graduation, compared with only 2% of residents who trained in the Pacific part of the country. Although students in programs located in states with high rural populations (according to U.S. Census Bureau statistics) were more likely to have completed a rural rotation, a program’s geographic area was not associated with the probability of its residents working in a rural hospital after graduation.

The low percentage of programs offering rural rotations may be due to funding patterns and resident preferences. While acknowledging that rural hospitals may have fewer resources, Dr. Talley and his colleagues noted that practicing in a rural ED "requires a unique skill set" that students without such an experience may not acquire. And despite previous criticisms, "rural EDs can provide adequate patient volume and experience to support [emergency medicine] resident education," they added.

Emergency physicians are in short supply, especially in rural areas (Ann. Emerg. Med. 2009;54:349-59). As this study "found that exposure to rural [emergency medicine] rotations through required rotations was associated with subsequent resident job selection in rural areas," increasing the number of programs that require rural rotations may be an important strategy to help alleviate the shortage, according to Dr. Talley and his colleagues.

Future studies are needed to determine the costs of such an approach, which may be prohibitive, they wrote.

Limitations of the study include the lack of data from the 15 program directors who did not participate. In addition, the researchers did not provide survey respondents with a standard definition of "rural."

The authors did not have any conflicts of interest to report.

Increasing the number of residency programs that require rotations in rural areas would help address the shortage of emergency physicians who choose to work in rural U.S. emergency departments, according to a survey of 2,380 graduates of 111 residency training programs.

Based on the findings of their nationwide July-December 2009 survey, "exposure to rural emergency department (ED) rotations may positively enhance rural recruitment after graduation," wrote Dr. Brad E. Talley of the department of emergency medicine at Denver Health Medical Center, and his coauthors.

The investigators surveyed the program directors of all 126 emergency medicine residency training programs recognized by the Accreditation Council for Graduate Medical Education, with the exception of military programs and those started after 2006. Of the 111 programs that provided complete responses, only 6 (5%) required residents to have a rotation in a rural area. Of the remainder, 16 (14%) offered residents rural rotations at predesignated sites as an elective, 76 (69%) offered rural rotations as an elective but students were required to find their own site, and 13 (12%) offered no opportunity for a rural rotation.

Programs that required rural rotations had a significantly greater percentage of residents who later chose to start their careers in rural areas (22%) than did programs with electives at predesignated sites (7%), programs with electives at student-selected sites (6%), and programs with no rural rotations (7%), Dr. Talley and his coinvestigators reported.

Overall, 7% of residents took jobs in rural areas after completing their training programs (Acad. Emerg. Med. 2011;18:297-300).

A total of 197 students completed a rural rotation, and 111 of these were from the six programs that required them. In comparison, only 86 students from the 92 programs that offered rural rotations as electives chose to train in a rural location.

Of residents in programs with elective rotations, more chose a rural rotation if a predesignated site was offered (7% vs. 4% without predesignated sites).

When categorized by geographic area, a high of 19% of residents in programs in the East South Central part of the United States chose rural positions after graduation, compared with only 2% of residents who trained in the Pacific part of the country. Although students in programs located in states with high rural populations (according to U.S. Census Bureau statistics) were more likely to have completed a rural rotation, a program’s geographic area was not associated with the probability of its residents working in a rural hospital after graduation.

The low percentage of programs offering rural rotations may be due to funding patterns and resident preferences. While acknowledging that rural hospitals may have fewer resources, Dr. Talley and his colleagues noted that practicing in a rural ED "requires a unique skill set" that students without such an experience may not acquire. And despite previous criticisms, "rural EDs can provide adequate patient volume and experience to support [emergency medicine] resident education," they added.

Emergency physicians are in short supply, especially in rural areas (Ann. Emerg. Med. 2009;54:349-59). As this study "found that exposure to rural [emergency medicine] rotations through required rotations was associated with subsequent resident job selection in rural areas," increasing the number of programs that require rural rotations may be an important strategy to help alleviate the shortage, according to Dr. Talley and his colleagues.

Future studies are needed to determine the costs of such an approach, which may be prohibitive, they wrote.

Limitations of the study include the lack of data from the 15 program directors who did not participate. In addition, the researchers did not provide survey respondents with a standard definition of "rural."

The authors did not have any conflicts of interest to report.