Duke Medical Ethics Journal   

These changes started in the 1920’s when the effects of smaller medical school output coupled with increased relocation to cities as a result of urban sprawl diminished the population of physicians practicing in rural areas.3 As larger medical centers in urban areas received the bulk of the attention, many rural health facilities became largely neglected, as did the health of their patients.

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To remedy such health disparities, it is time to put the spotlight back on these rural health centers serving vulnerable populations and allow greater physician access to the neglected populations that need it the most. Such a remedy must tackle the problem early on in the form of medical education. First, students from small and underserved communities that lack access to such services must be incentivized and funneled into the medical school pipeline. These students are more likely to return to these areas and practice medicine than their peers.4 More than simply increasing the number of doctors that practice in these areas, this practice secures doctors who understand their surrounding communities and who are naturally better equipped to deal with the unique situations that arise. Second, increasing the presence of programs that train physicians specifically to practice in rural areas such as the Columbia-Basset Track at The Vagelos College of Physicians and Surgeons would also help mitigate the problem. These programs directly funnel medical students into rural areas, which will otherwise never materialize. As Flexner writes, “the question is, then, not merely to define the ideal training of the physician; it is just as much, [to] … distribute as widely as possible the best type of physician so distributable.”5 It is not enough to simply train physicians and leave the distribution process up to a laissez-faire system. Future reform must create avenues where trained physicians are present in all parts of the country to provide equitable care for all patients.