Canadian rural family medicine training programs: growth and variation in recruitment.

OBJECTIVE To document the proliferation of rural family medicine residency programs and to note differences in design as they affect rural recruitment.

DESIGN Descriptive study using semistructured telephone interviews.

SETTING All family medicine residency programs in Canada in 2002.

PARTICIPANTS Directors of Canadian family medicine residency programs.

MAIN OUTCOME MEASURES Number of rural training programs and positions; months of rural exposure, degree of remoteness, and specialist support of rural communities within rural training programs.

RESULTS The number of rural training programs rose from one in 1973 to 12 in 2002. Most medical schools now offer dedicated rural training streams. From 1989 to 2002, the number of rural residency positions quadrupled from 36 to 144; large jumps in capacity occurred from 1989 to 1991 and then from 1999 to 2001. Rural positions now represent 20% of all family medicine residency positions. Among rural programs, minimum rural exposure ranged from 4 to 12 months, and the median distance between rural training communities and referral sites ranged from 50 to 440 km (median 187 km). Rotations in communities with no hospital were mandatory in five of 12 rural programs, optional in five, and unavailable in two. The proportion of training communities used by rural programs that had family physicians only (ie, no immediate specialty backup) ranged from 0 to 78% (mean 44%). Most training communities (78%) used by rural programs had fewer than 10 000 residents. Four of 12 rural programs offered various specialty medicine rotations in small communities.

CONCLUSION Rural residency programs have proliferated in Canada. The percentage of residency positions that are rural now equals the proportion of the general population in Canada living in rural areas. National guidelines for rural programs recommend at least 6 months of rural rotations and at least some training in communities without hospitals. Major variations among programs exist, and most program designs differ from designs recommended in national guidelines in at least one aspect.