How can medical schools contribute to the education, recruitment and retention of rural physicians in their region?

Access to appropriate health care is often difficult for people living in rural areas because of a widespread shortage of appropriately educated local, rural healthcare workers and the distance, time and cost of travelling to larger urban health centres. This shortage is due to many factors including medical education, practice conditions, health system, regulatory, community, personal, family and financial considerations.1,2 Developing a sufficient and sustainable rural physician workforce requires commitment and cooperation from communities, governments and medical schools. Medical education can play an important role in the recruitment and retention of rural physicians.3 Most of the world’s medical schools, however, are situated in large cities; most medical students grow up in affluent urban areas, learn little about rural health-care needs and experience little or no medical learning in the rural context. Physician graduates flow almost entirely into large city practices with an insufficient trickle getting out into practice in rural areas. Some medical schools in large cities have developed specific programmes for educating physicians for rural regions. A few medical schools are located in small cities within large rural regions and have a rural regional focus. Graduates of these medical schools often also serve rural populations well outside their own regions. Unfortunately for many developing countries, especially in Africa, many graduates of their medical schools end up in rural practice, often not in Africa, but rather in developed countries where they have been enticed to serve the rural populations.