Keeping doctors in rural areas

Doctors’ reluctance to go to rural areas is not just a problem facing Bangladesh -- policymakers in the United States have faced the same problems.

However, while the US has come out with plans to overcome the challenge, Bangladesh authorities are mostly relying on threatening rhetoric to comply the unwilling doctors to fall into line.

The US medical schools, too, have devised innovative programmes to ensure doctors stay at their rural workplaces.

According to Academic Medicine, a journal published by the Association of American Medical Colleges, only nine percent of physicians practise in rural areas, even though one in every five Americans lives there.

It says the persistent shortage of physicians in rural areas “continues to have a major impact on access to medical care for those living in small communities”.

The US government waives a large part of student loans for doctors if they work in under-served or rural areas.

The medical schools offer programmes that are designed to ensure that doctors must serve in the rural counties.

The University of Arizona offers a programme called ‘Rural Health Professions Programme’.

Director of the programme, Dr Jonathan Cartsonis, said selected students undertake four years of preparation that includes seminars, mentorship, rural clerkship, and pre-clerkship clinical experience, among others.

He says in addition to the advanced medical preparation, students who successfully meet the requirements get a notation of “Distinction in Rural Health” recorded on their transcripts and in their medical student performance evaluations (Dean’s Letters).

The University encourages students to attend seminars before they enrol for the programme so that they can learn about the initiative and develop an interest to serve in rural areas.

Growing up in a rural setting, expression of a credible desire to go into rural practice, and a primary care or general surgery career planning are some of the factors that the university considers while evaluating applications.

The director of the programme said students have to attend 12 out of 16 seminars in first two years and are being taken to rural settings during almost half of their third year training.

He said those trainings help them know the under-served community and how to settle there and integrate with them.

The Academic Medicine journal found those courses useful.

It said those programmes have helped “a multi-fold increase” in supplying rural areas with physicians.

It also suggested that “widespread replication of these models could have a major impact on access to healthcare in thousands of rural communities”.