Preventive Medicine for Rural America: Why More Training Programs Must Be Here.

While there is a well-recognized national shortage of Preventive Medicine (PM) physicians, there is also a marked maldistribution. Since 47.5% of physicians were active in the state where they completed their most Graduate Medical Education (GME), one approach to address the disparity in PM specialists in practice within rural regions such as Appalachia is by supporting a greater number of GME programs based within these regions. Currently, of the 64 accredited civilian PM residency programs, only 4 are located in rural areas. The only PM residency programs based in the entire Appalachian region are based at West Virginia University. Several threats to the establishment and sustainability of rural-based PM GME programs have been identified, including challenges in securing support through competitive national grants, the limited number of board-certified community preceptors, and difficulty in recruiting and retaining both core program faculty and trainees. Targeted efforts to promote and support GME programs that are based in rural areas of need, such as the Health Resources and Services Administration's Rural Residency Planning and Development Program, will help address this disparity.