Will rural family medicine residency training survive?

Background and Objectives: Rural family medicine residencies may be more threatened by declining interest in family medicine than their urban counterparts. This study examines the recent performance of rural residencies in the National Resident Matching Program as an indicator of their viability. Methods: We surveyed all 30 family medicine residencies located in rural areas during the summer of 2004 and a geographically matched sample of 31 urban residencies. We gathered information about the matching process for 2002, 2003, and 2004. The response rate was 70.5%. Results: Rural programs offer about one third fewer first-year (postgraduate year 1 [PGY-1]) positions than their urban counterparts. Rural programs had lower Match rates (60.1%) than urban programs (72.5%) in 2004 but no meaningful differences in the proportion of international medical graduates (IMGs) or osteopathic physicians (DOs) who ultimately accepted positions. The 44.2% of residencies that predicted they would be thriving 2 years in the future filled an average of 81.3% of their slots on Match Day; there were no rural/urban differences. Programs with less-optimistic appraisals of their future had much lower Match rates. Two factors were associated with lower Match rates when other variables were taken into account: the proportion of IMGs in the 2 previous entering years and a stated rural mission. Conclusions: Rural programs appear to be slightly less stable than their urban counterparts, but the differences are minor. The viability of rural family medicine residency programs is probably affected more by the overall attractiveness of family medicine as a discipline rather than the rural or urban location of the residency.