Background: The German healthcare system is facing challenges to safeguard medical care in rural areas. In addition to supply control, financial incentives and other control mechanisms, rural-health interventions in undergraduate medical education are expected to increase the number of rural physicians.Methods: This paper presents the results of a systematic literature search in relevant databases looking for measurable effects of rural training tracks in medical school on later practice in rural areas. Results: The search identified 38 studies which matched the inclusion criteria. These studies showed quite heterogeneous interventions, endpoints and outcomes. The majority were cross-sectional and controlled studies (39.5 % each); in addition, five were longitudinal, two mixed-methods and one quasi-experimental studies. Overall, there were predominantly positive, but rather weak correlations between rural internships or placements during undergraduate medical education, and later rural practice. The largest effect was seen in students with a rural background. The review confirmed rural upbringing being the strongest predictor of later taking up rural practice.Conclusions: Rural-health tracks during undergraduate medical education contribute only to a small or moderate extent to improving the availability of medical staff in rural areas. At best, they can measurably increase the share of rural practitioners if combined with other measures, and they are particularly effective for students with rural upbringing.
Abstract: The increasing shortage of family physicians has tightened consequences for rural areas. And beyond any doubt the ongoing decline of villages will be accelerated. Islands will especially suffer from that situation since people have no possibility to get access to distant surgeries. The example of the North Sea island of Pellworm demonstrates possible options to secure physician supply and consequently the complete medical care in rural areas. Political will and the energy of those directly affected are required to put those options into reality.
Results of a Workshop with Family Practitioner TraineesBackground: In Germany, lack of family practitioners threatens health care. Previous surveys on the question of how to recruit young professionals did not offer final recommendations. The situation is difficult particularly in rural areas. The present study performed a qualitative exploration of young family practitioner trainees’ motivation for setting up a practice in rural areas.Methods: During two vocational training workshops hosted by the KoStA (center for family medicine in Bavaria), 43 young family medicine trainees were asked to design a virtual publicity campaign. It should motivate medical trainees for working as a family practitioner in rural areas. The participants were allocated to small teams. They were asked to develop a slogan and between three and five core elements of their virtual campaign. The results of the teams were then discussed in the plenum. After assigning codes by two independent scientists, final categories have been agreed.Results: Irrespective of the preferred area for the future practice (urban vs. rural), the participants expressed the same arguments for a practice in rural areas. The positive arguments identified were associated with professional aspects, like better frame conditions and diversified job content. Private aspects were adressed to the same extent, important themes were cheaper living conditions, family-friendly surroundings, living in the open air and life satisfaction. During the subsequent discussion disadvantages were also brought up: Cutback of privacy, perceived permanent availability or pressure of work, and fear of overextended expertise. Furthermore, it turned out that almost 70 % (n = 29) of the participants in the study could imagine setting up a practice in rural areas.Conclusions: The aspects considered as positive by the participants correspond greatly with the experience of already practicing family doctors. However, the barriers mentioned include serious fears, future family doctors are afraid of running a single-handed practice. The ideal campaign should therefore emphasize the advantages of the life of a country doctor, but should also include the fears brought up. It should deliver information and emotion at the same time. Future family practitioners should be informed comprehensively on new developments concerning the framework of practicing.
