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James Stevermer, MU AHEC medical education director, discusses treatment options with patient Martha Kirk at his Callaway Physicians office, a University Physicians group in Fulton. Stevermer, who grew up on a farm in southern Minnesota, said serving in a smaller community was an appealing option due to the shortage of rural physicians and his family's preference for rural life.

Peering Inside Physicians' Decisions to Serve Rural Areas

In-depth interviews reveal that rural background, a sense of service and family ties play prominent role

Twenty percent of the U.S. population lives in a rural setting, but only 9 percent of physicians make their homes in rural areas. As the U.S. health care system addresses this imbalance, MU researchers delve deeper into the issue by talking directly to doctors about factors influencing their choice of practice location. The results appear in a study published in the Spring 2010 issue of the Annals of Behavioral Science and Medical Education.

"Research shows that medical schools' development of rural training programs has a positive effect on the number of medical graduates entering rural practice," said Kathleen Quinn, PhD, director of MU's Area Health Education Center (AHEC). "This study supports a lot of the quantitative findings, but it also provides what they call a 'thicker' description of the whys and the stories."

Quinn and Michael Hosokawa, EdD, a professor of family and community medicine at the medical school, conducted a qualitative study, interviewing 15 physicians regarding their choice of practice location. Participants were MU School of Medicine alumni from the graduating classes of 1997 to 2004 who practice medicine in communities of less than 18,000 people. Researchers selected this timeframe to correspond with the years that MU medical students have had the opportunity to participate in the school's Rural Track Pipeline Program and complete residency training.

Quinn and Hosokawa approached the interviews using transcendental phenomenology, a research method that involved using interviewees' stories and experiences to develop an overall essence of who rural physicians are and common themes regarding their experiences. In all cases, the physicians' sense of rural background, a need to serve, or family ties eventually influenced their practice location.

"Where you're from, where you train and who you marry are three major factors that determine where you practice," Quinn said. "Regardless of where you train and where you're from, family is a big determinant of where you end up practicing medicine. We hope this study framework will help us understand which students accepted into medical school are more likely to choose and maintain rural medical practices."

Quinn leads MU-AHEC with the goal of improving the supply and distribution of primary care providers, particularly in rural areas of Missouri. MU-AHEC offers five programs during medical school as part of the MU Rural Track Pipeline Program, including: the Bryant Scholars Pre-Admissions Program, the Summer Community Program, the Rural Track Clerkship Program, the Rural Track Elective Program and the Missouri Physician Placement Service. These programs give students the opportunity to train and work in rural communities throughout the state, exposing them to the life of a rural physician in the hope they will return to practice in rural Missouri.

AHEC regional offices are located in Rolla, Kirksville, Poplar Bluff, Springfield, St. Joseph, St. Louis and Kansas City, and more than 100 rural physicians across the state serve as community-based faculty, hosting MU medical students at their practices through AHEC's rural track clerkship program.

The article by Quinn, assistant professor in the medical school's Department of Family and Community Medicine, is available online at
MU Health Magazine


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