Perceived preparedness for family practice: does rural background matter?

Introduction: Rural background and the ability to adjust to rural practice are strong predictors of recruitment and retention of rural physicians. The degree to which rural background and being prepared for practice interrelate may provide insight into efforts aimed at increasing the supply of rural physicians. The purpose of this study was to examine the association between family medicine graduates' rural or urban background and their self-reported preparedness for practice.

Methods: This was a retrospective, cross-sectional survey of family medicine graduates who completed the 2-year family medicine residency program at the University of Alberta or University of Calgary from 2001 to 2005. Self-rated preparedness was examined on a 4-point Likert scale for 18 elements of clinical family practice, 8 interdisciplinary issues, 10 practice management issues and 8 nonclinical aspects of family practice. Rural background was defined as having been brought up mainly in a rural community (population < 25 000), and urban background was defined as having been brought up mainly in an urban community (population ≥ 25 000).

Results: A significantly greater proportion of rural-than urban-background graduates felt prepared for 3 nonclinical aspects of rural practice: time demands of rural practice (95.0% v. 79.3%, p = 0.03), understanding rural culture (92.5% v. 70.2%, p = 0.005) and small-community living (92.5% v. 70.2%, p = 0.003).

Conclusion: Rural background was associated with physicians feeling prepared for the nonclinical and cultural aspects of rural family practice, which suggests that focused rural exposure facilitates an understanding of rural culture. Urban-background physicians were reportedly less prepared for the nonclinical aspects of rural practice. Increased exposure of urban-background residents to the cultural aspects of rural practice may improve recruitment and retention of rural family physicians.