Chapter 3
Types of Rural Family Medicine Training
Types of Rural Family
Medicine Training by Location
Family medicine residency programs have developed a
variety of special curricula and training options to
prepare physicians for practice in rural settings.
RURAL RESIDENCIES (RURAL MODEL FAMILY
PRACTICE): Some residency programs are located in
rural communities and have an explicit mission to
train rural physicians. All of these programs’ residents
are exposed to rural practice throughout their
inpatient and outpatient training experiences.
RURAL TRAINING TRACKS: Some residency
programs have specific training positions and threeyear curricula to prepare residents for rural practice.
These rural training tracks are frequently modified
versions of the primary residency curriculum and are
offered to one or two residents per year. The residents
who are in the rural training tracks often spend
portions of their first year and all of their second and
third years in a rural community hospital and family
medicine clinic.
RURAL ROTATIONS: Many residency programs
offer elective clinical rotations in rural sites. These
block rotations usually last for one or two months and
are available to any resident in the primary program.
These rotations expose residents to practice
opportunities in rural communities.
RURAL CONTINUITY CLINICS: Residency
programs may offer a rural continuity clinic that serves
as the family medicine clinic and primary outpatient
training site for a subset of its residents. These
residents have their three-year continuity clinic
experience in a rural site even if their hospital
rotations are in a metropolitan area.
RURAL FELLOWSHIPS: Although this survey
considered only residency training, it is important to
note that several family medicine residencies have
developed post-residency rural fellowships (Norris and
Acosta, 1997).
This chapter reports on the different types of rural
family medicine training experiences that are offered,
by their geographic location.
Figure 3-1: Rural FM Residency FTE Training by Type of Training Experience
(2000 FM Residency Director Survey, n= 435)
450
448.2 (85.4%)
400
FTEs of Rural Training
350
300
By far the most
common rural
training track
experience
involves rural
model family
practice
(85.4%).
250
200
150
100
45.5 (8.7%)
50
21.9 (4.2%)
9.0 (1.7%)
0
Rural Model Family
Practice
Rural Training Track
Rural Block Rotation
Rural Continuity Clinic
Rural Training Experience Type
25
Types of Rural Family Medicine Training by Location
Figure 3-2: Rural FM Residency FTE Training by Training Experience Type
and Parent Residency Location
(2000 FM Residency Director Survey, n= 435)
500
454.5 (61.6%) 7.5
450
9.4
31.7
400
FTEs of Rural Training
The mix of the
rural training
experiences
provided by the
family medicine
residency
parent
programs varies
by their
locations.
Rural Continuity Clinic
Rural Block Rotation
Rural Training Track
350
Rural Model Family Practice
300
250
212.9 (28.9%)
405.9
200
18.8
150
104.9
100
70.0 (9.5%)
50
89.2
1.5
12.5
13.8
42.3
0
Urban (402)
Large Rural (28)
Small Rural (5)
Location of Parent Program
Figure 3-3: Location of Rural Model Family Practice Training Sites
(2000 FM Residency Director Survey, n= 435)
FTEs of Rural Model Family Practice Training
Over 90 percent
of rural model
family practice
training sites
takes place in
large rural areas,
with just over 9
percent in small
rural areas and
none in isolated
small rural areas.
450
405.9 (90.6%)
400
350
300
250
200
150
100
42.3 (9.4%)
50
0
Large Rural
Small Rural
0.0 (0.0%)
Isolated Small Rural
Training Location
Figure 3-4: Location of Rural Training Track FM Training
(2000 FM Residency Director Survey, n= 435)
90
84.6 (62.8%)
FTEs of Rural Training Track Training
Almost twothirds (62.8%) of
rural training
track family
medicine
residency
training occurs in
large rural areas,
with about onethird (32.0%)
taking place in
small rural areas.
80
70
60
50
43.1 (32.0%)
40
30
20
10
7.0 (5.2%)
0
Large Rural
Small Rural
Training Location
26
Isolated Small Rural
Types of Rural Family Medicine Training by Location
Figure 3-5: Location of Rural Block Rotation FM Training
Over half (58.7%)
of rural block
rotation family
medicine training
takes place in
small rural areas,
with one quarter
(24.3%) located
in isolated small
rural areas.
(2000 FM Residency Director Survey, n= 435)
80
FTEs of Rural Block Rotation Training
74.6 (58.7%)
70
60
50
40
30.8 (24.3%)
30
21.6 (17.0%)
20
10
0
Large Rural
Small Rural
Isolated Small Rural
Training Location
Figure 3-6: Location of Rural Continuity Clinic FM Training
Two-thirds of
the rural
continuity clinic
rural family
medicine
residency
training occurs
in small rural
areas, with the
remainder
almost equally
located in large
rural (18.7%)
and isolated
small rural
(19.1%) areas.
(2000 FM Residency Director Survey, n= 435)
FTEs of Rural Continuity Clinic Training
18
17.3 (62.2%)
16
14
12
10
8
6
5.3 (19.1%)
5.2 (18.7%)
4
2
0
Large Rural
Small Rural
Isolated Small Rural
Training Location
Figure 3-7: Location of FM Rural Training Track by Census Division
(2000 FM Residency Director Survey, n= 435)
29.8 (22.1%)
FTEs of Rural Training Track Training
30
26.0 (19.3%)
25
23.8 (17.7%)
20
15.7 (11.7%)
15.6 (11.6%)
15
11.0 (8.2%)
10.0 (7.4%)
10
5
2.8 (2.1%)
0
0.0 (0.0%)
New
Pac
Mo
Mid
Sou
Wes
East
Wes
East
ific
unt
th A
t No
t So
Atla
Nor
Sou
ain
tlan
uth
ntic
th C
th C
rth
land
tic
Cen
Cen
entr
entr
tral
tral
al
al
Eng
About 60 percent
of rural residency
family medicine
training tracks
are located in
three Census
Divisions: West
North Central
(22.1%), South
Atlantic (19.3%)
and West South
Central (17.7%),
with few in the
Pacific Division
and none in New
England.
Census Division
27
Types of Rural Family Medicine Training by Location
Figure 3-8: Location of FM Rural Block Rotations by Census Division
(2000 FM Residency Director Survey, n= 435)
29.8 (22.4%)
30
FTEs of Rural Block Rotation Training
Over 40 percent
of the family
medicine rural
block rotations
are located in
two Census
Divisions: West
North Central
(22.4%) and
South Atlantic
(19.5%), with
the smallest
numbers located
in New England
(2.4%) and the
Mid Atlantic
(2.6%).
25.9 (19.5%)
25
20
16.3 (12.3%)
16.1 (12.1%)
14.8 (11.1%)
15
12.4 (9.3%)
11.0 (8.3%)
10
5
3.5 (2.6%)
3.2 (2.4%)
0
New
Mo
Mid
Sou
East
Wes
Wes
East
unt
th A
t No
t So
Atla
Sou
Nor
ain
tlan
uth
ntic
th C
th C
rth
land
tic
Cen
Cen
entr
e
n
t
ral
tral
tral
al
Eng
Pac
ific
Census Division
Figure 3-9: Location of FM Rural Continuity Clinic by Census Division
10
9.5 (34.4%)
FTEs of Rural Continuity Clinic Training
Rural Continuity
Clinics are
predominantly
located in the
Pacific (34.4%)
and West North
Central (25.4%)
Census
Divisions.
9
8
7.0 (25.4%)
7
6
5
4
3.4 (12.3%)
3
2.6 (9.4%)
2.5 (9.1%)
2
1.7 (6.2%)
1
0.6 (2.2%)
0.3 (1.1%)
0
0.0 (0.0%)
New
Mid
Eng
land
Atla
Sou
th A
ntic
tlan
East
tic
Pac
Mo
East
Wes
Wes
ific
unt
t So
t No
Nor
Sou
ain
uth
th C
th C
rth
Cen
Cen
entr
entr
tral
tral
al
al
Census Division
Figure 3-10: Location of Rural Model Family Practice by Census Division
(2000 FM Residency Director Survey, n= 435)
FTEs of Rural Model Family Practice Training
The largest
amount of rural
model family
practice
residency
training occurs in
the East North
Central Division,
while very little
occurs in the
Pacific and
Mountain
Divisions.
89.9 (20.0%)
90
80
72.8 (16.2%)
70
67.7 (15.1%)
59.9 (13.4%)
60
53.3 (11.9%)
50
43.3 (9.7%)
30
20
16.9 (3.8%)
10
0
0.0 (0.0%)
New
Mid
Eng
land
Atla
Sou
ntic
th A
tlan
East
tic
Pac
Mo
East
Wes
Wes
ific
unt
t No
t So
Nor
ain
uth
th C
th C
rth
Cen
Cen
entr
entr
t
t
al
al
ral
ral
Sou
Census Division
28
44.6 (9.9%)
40