Fewer rural students apply to, or get into, medical schools

The number of students from the rural U.S. who enrolled in medical school dropped 28 percent from 2002 to 2017, according to a newly published study in Health Affairs; it's the first study to examine long-term trends in rural student enrollment in medical school.

"The findings, published Tuesday from staff at the Association of American Medical Colleges, come as the nation faces a physician shortage in rural communities," Maria Castellucci reports for Modern Healthcare. A frequently cited 2010 study from the University of Washington School of Medicine found only 11.4% of physicians practice in rural settings although 19.2% of the population lives in those areas."

The study's authors said they were interested in the trend because research shows that doctors who grew up in rural areas are more likely to practice in a rural area after medical school. So, fewer rural med students could be one reason rural areas are seeing a shortage of physicians, Castellucci reports.

"In addition to finding that the number of students from rural areas enrolled in medical school has declined, the study also found the number of applicants from a rural background dropped during the same period," Castellucci reports. "Just 2,032 people from rural areas applied to medical school in 2017, down by 18% from 2002, when 2,479 applied."

The study didn't explore the reason for the drop in applications and attendance, but co-author Scott Shipman speculated on several reasons. Fewer rural students may apply for med school because they haven't seen the diversity of medical careers that are available, they don't feel high school prepared them academically, they don't want to take on so much debt, and/or may not want to travel far from home, he told Castellucci.

Shipman said enrollment might have declined because rural students aren't as competitive as urban candidates. Though rural students applying to med schools had higher grade-point averages than urban students, they had lower average scores on the MCAT, the exam required for medical-school entry, Castellucci reports. Rural students also tended to have fewer extracurricular activities on their transcript to improve their competitiveness.

When isolated from other factors, rural residents were more likely to be accepted to medical school than urban residents. Shipman said that shows that rurality, by itself, can work in an applicant's favor, but other factors are weighing more heavily. "Shipman and his co-authors recommend several changes to increase the number of rural applicants and enrollees to medical school such as pipeline programs for high school students in rural areas to expose them to medicine as a profession early," Castellucci reports.