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Letters |

Addressing Physician Specialty Maldistribution

Howard K. Rabinowitz, MD
JAMA. 2009;302(12):1270-1270. 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

AUTHOR INFORMATION

Financial Disclosures: Dr Rabinowitz reported receiving Health Resources and Services Administration training grants, which in part provide support for the Thomas Jefferson University rural program.

REFERENCES

DeAngelis CD. Commitment to care for the community.  JAMA. 2009;301(18):1929-1930
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Hazelwood CE. A program to increase the number of family physicians in rural and underserved areas: impact after 22 years.  JAMA. 1999;281(3):255-260
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication.  Acad Med. 2008;83(3):235-243
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long term retention of graduates from a program to increase the supply of rural family physicians.  Acad Med. 2005;80(8):728-732
PubMedCrossRef
Ko M, Heslin KC, Edelstein RA, Grumbach K. The role of medical education in reducing health care disparities: the first ten years of the UCLA/Drew medical education program.  J Gen Intern Med. 2007;22(5):625-631
PubMedCrossRef

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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DeAngelis CD. Commitment to care for the community.  JAMA. 2009;301(18):1929-1930
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Hazelwood CE. A program to increase the number of family physicians in rural and underserved areas: impact after 22 years.  JAMA. 1999;281(3):255-260
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication.  Acad Med. 2008;83(3):235-243
PubMedCrossRef
Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long term retention of graduates from a program to increase the supply of rural family physicians.  Acad Med. 2005;80(8):728-732
PubMedCrossRef
Ko M, Heslin KC, Edelstein RA, Grumbach K. The role of medical education in reducing health care disparities: the first ten years of the UCLA/Drew medical education program.  J Gen Intern Med. 2007;22(5):625-631
PubMedCrossRef
September 23, 2009
Catherine D. DeAngelis, MD, MPH
JAMA. 2009;302(12):1270-1270.
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