Association Between Rural Attitudes in Family Medicine Residency and Rural Employment

Abstract

Background and Objectives: Rural physician shortages remain a workforce challenge. Residency is a pivotal period for shaping rural attitudes, yet little is known about how attitudes complement postgraduation employment. Our study objective was to understand how rural attitudes at residency completion are associated with rural employment after graduation. Methods: This cross-sectional study was conducted from 2021 to 2025. All postgraduate year-3 (PGY-3) family medicine residents (N = 85) from two Mountain Area Health Education Center programs in Western North Carolina were invited to complete the validated Student Attitudes to Rural Practice and Life Questionnaire (18 items, four factors). Fifty-three residents responded (62%) and analysis included 48 complete surveys. Employment location was verified through self-report and online searches. Independent t tests, one-way multivariate analyses of variance, and follow-up univariate analyses of variance compared rural attitude scores and factor scores by rural versus nonrural employment. Results: Participants with rural initial employment had significantly higher overall rural attitude scores (Mean D=–6.65, SE D = 2.70, P = 0.018) and scored higher in friendliness/support (P = 0.007) and work opportunities (P = 0.005). We observed similar findings for rural current employment (Mean D=–6.82, SE D = 2.66, P = 0.014), including higher friendliness/support (P = 0.006) and work opportunities (P = 0.006). We found no differences in the isolation/socialization or enjoyable aspects of rural life factors. Conclusions: Higher rural attitude scores at training completion were associated with increased likelihood of rural employment. Rural attitude questionnaires may help residency programs evaluate rural curriculum and shape attitudes to favor rural practice choice.