A life in the country

James Rourke1 suggests numerous strategies for increasing the enrolment of students of rural origin, in the hope of increasing the supply of rural physicians. Yet these proposals fail to address the fact that many rural students will not return to small communities after training; furthermore, many nonrural students with the type of outdoor interests suggesting a likelihood to take up more isolated practices never leave the city where they trained. Even smaller cities are in a chronic human resource crisis.

One has only to look at the training of physicians to see why. To be accepted into medical school, candidates must already have completed a 4-year honours course, and they have often made 2 or 3 applications to med school before they are accepted. With a minimum of 6 years at medical school before they are free to decide where they will practise, these new doctors have already spent at least 10 years at school, often in the same large city. Given that many of them will have taken extra time in high school to ensure top grades for their initial university admission, the “young doctor” is, at 30 years of age, no longer young. Most will be married or in a committed relationship, with the other partner established in his or her own career. Some will have children and mortgages. Their friends and social activities will be centred close to where they trained. Is it any wonder that they don't up and move even 50 miles from a major city?

The answer is not going to be a medical school in every community, because that would dilute the enormously important “centre of excellence” function of these institutions. Rather, the solution must include reducing the length of training. Making a 2-year premedical program the prerequisite for medical school, instead of a 4-year honours degree in an often unrelated subject, would go a long way to producing the kind of younger and more adventurous physicians we require.