Trends in subspecialization: A comparative analysis of rural and urban clinical education

Abstract

BACKGROUND AND OBJECTIVES: Medical students who train in rural communities are often exposed to physicians practicing a broad scope of care, regardless of discipline. We examined how rural education is associated with practice specialization rates for students who match in primary care or general core specialties. METHODS: We linked practice and specialty data (2016 AMA Masterfile dataset), demographics (American Medical College Application Service data), and internal college data for 1974-2011 Michigan State University College of Human Medicine graduates who received clinical education on either the Upper Peninsula (rural) or Grand Rapids (urban) campuses. Current practice was verified using internet searches. We compared specialty and practice data by rural or urban campus, controlling for multiple variables. RESULTS: More rurally-trained graduates entered primary care (PC) residencies (128/208, 61.5%) than urban-trained graduates (457/891, 51.3%; P