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Addressing Physician Specialty Maldistribution

Howard K. Rabinowitz, MD
JAMA. 2009;302(12):1270. doi:10.1001/jama.2009.1351.
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To the Editor: In her Editorial on commitment to community, Dr DeAngelis1 discussed many of the reasons for the longstanding physician maldistribution by specialty (primarily primary care) and geography. She also included a number of potential solutions, many of which have been implemented in the past with limited success.

However, the Editorial did not mention comprehensive medical school programs that focus admissions on medical school applicants who intend to practice in rural areas, have a longitudinal rural clinical curriculum, or both. This approach has been in existence for decades and has been shown to successfully address both the primary care and rural physician shortage.2,3 A systematic review found that among more than 1600 graduates from 6 such medical school programs in different areas of the country, more than 50% practiced in rural areas.3 The majority of these graduates were practicing family medicine. Outcomes from the Jefferson Medical College rural program have also shown a long-term (11- to 16-year) rural family medicine retention rate of 79%,4 higher than that of the National Health Service Corps. Medical school programs focusing on the urban underserved have also been shown to be successful.5

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September 23, 2009
Catherine D. DeAngelis, MD, MPH
JAMA. 2009;302(12):1270. doi:10.1001/jama.2009.1352.
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