Motivations and barriers for recruitment of new emergency medicine residency graduates to rural emergency departments.

Study Objective: We sought to understand the motivations and barriers for recruitment of new emergency medicine residency graduates to rural emergency departments (EDs).

Methods: We used the American Medical Association Physician Masterfile to identify 2006 to 2008 emergency medicine residency graduates and then surveyed everyone currently practicing in rural EDs and a random sample of those practicing in urban EDs. We asked these emergency physicians about the importance of various factors in their choice of practice location.

Results: We received responses from 197 (67%) of 296 eligible emergency physicians in 47 states. The factors most often rated as "somewhat" or "very" important in choice of practice location were lifestyle (98%), access to amenities/recreation (95%), ED volume/acuity (93%), and family/spouse (90%). Access to specialists was the biggest difference between groups (very important=20% for rural versus 44% for urban; Δ24%; 95% confidence interval -37% to -11%). More rural emergency physicians spent their entire childhood in rural areas than urban emergency physicians. The changes that would have most influenced urban emergency physicians to practice in rural communities were family/spouse connection (92%), higher salary/signing bonus (90%), and increased access to specialists (90%). Of urban emergency physicians who did not participate in a rural rotation during residency, 44% said they would have, if it had been available.

Conclusion: Promising strategies for recruiting new emergency medicine residency graduates to rural EDs are emergency medicine residency selection of individuals with a rural upbringing and higher salaries. Increasing the availability of rural rotations during emergency medicine residency also may help to motivate and prepare some new graduates to practice in rural EDs.