Lessons Learned

    • October 13, 2009

  • Establishing vacation backup services is difficult. Two RWJF national programs—Practice Sights and the Southern Rural Access Program—established locum tenens services that provide temporary professional backup for health practitioners in underserved areas, giving them the opportunity to attend conferences or take vacations. The results were mixed. Some states in the Practice Sights program successfully recruited practitioners to fill that role. (See Program Results on Practice Sights and the Southern Rural Access Program.)
    • In Nebraska, for example, professionals took advantage of 140 days of services in the programs first year, far exceeding the target of 75 days. But the Southern Rural Access Program found the services difficult to develop and sustain. SRAP sites had trouble finding physicians willing to travel and substitute. The sites also discovered that many doctors are workaholics; they either don't want to take vacation or are afraid of losing their patients to competitors.
  • Recruit midlevel practitioners, not just physicians. Nurse practitioners, certified nurse-midwives, and physician assistants can provide selected medical services equivalent to those provided by primary care physicians and at lower cost. If the goal is to expand access to primary care, then efforts to increase the supply of midlevel practitioners might be just as important, especially in areas geographically isolated from hospitals and/or of low population density. (See Program Results on ID# 024365 and ID# 026305.)
  • Maintaining quality control of distant training sites is a challenge. Rural training programs typically place students in community settings for real-world experience. Some Partnerships for Training sites found it challenging to ensure that the educational experience was high across all community settings. The site found that an award program for the participating physicians and their practices recognized the time and effort provided by the community physicians and increased their willingness to participate. (See Program Results on ID# 031650.)
  • Work with Area Health Education Centers when recruiting health care students and providers to work in underserved areas. Area Health Education Center staff members are familiar with their areas, have key contacts and know what their areas need. (See Program Results on ID# 030882.)
  • Medical students who grew up in rural areas are more likely to return to rural areas to practice. The Physician Shortage Area Program of Jefferson Medical College in Philadelphia selects applicants based on their commitment to practicing in rural areas and their personal experience living in rural areas. The program's graduates are eight times more likely to practice rural family medicine than their non-rural peers.2

Other Relevant Program Results
See Program Results on these other distance learning programs that targeted rural areas:

  • A quality improvement distance education program for rural practitioners (ID# 040709).
  • Project L.I.N.C. distance learning and recruitment programs for nurses in rural areas of North Dakota, South Carolina and Texas. (ID# 021762 and ID# 021763 and ID# 021764).


2 Rabinowitz HK. Caring for the Country: Family Doctors in Small Rural Towns. New York: Springer-Verlag, 2004.