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It is well-known that rural communities across the United States face a severe healthcare workforce shortage, which in turn restricts access to healthcare for rural communities. This makes it important to learn whether and how we can motivate health care workers to practice in rural areas. We know from previous studies that having grown up in a rural area is the strongest factor that influences people to “practice rural”—but are there other factors that entice healthcare providers to serve rural communities? This article summarizes the findings from an in-depth study which looked at this question for more than 30,000 Minnesota health professionals.
The findings are based on a 2022 survey of physicians, physician assistants (PAs), advanced practice registered nurses (APRNs) and registered nurses (RNs). The survey asked respondents what things they considered when making decisions about where to live and work. Survey respondents were asked to rate a list of considerations, ranking each from “not important at all” to “very important.” They were also asked to report on the type of area where they grew up. Figure 1 below shows the items that have a statistically significant impact on the odds of working in a rural area.
Across all four professions, we see that having grown up in a rural area was the most important factor that makes providers choose to practice in a rural area (for example, among physicians, those who grew up in a rural area were 2.4 times more likely to currently be practicing in a rural area). But that isn’t the whole story. Other things matter too, such as:
- loan forgiveness;
- educational programs that prepared students for rural practice;
- the ability to have autonomy in one’s work; and
- the ability to have a broad scope of practice.
It is also crucial to note that these factors don’t affect all healthcare professionals in the same way.
Figure 1
Factors that increase the odds of choosing to work in a rural area, for Physicians, PAs, APRNs, and RNs (n=32,086)
According to survey respondents, physicians and PAs are particularly drawn to rural areas by the promise of having their student loans forgiven, whereas loan forgiveness had a slightly smaller impact on the two nursing professions. Similarly, having attended an educational program that prepared students for rural practice was most important for PAs and slightly less important for the other three professions in this study. The nature of one’s practice (having a broad scope of practice and having autonomy at work) was most important for physicians and APRNS, but was not a driver of rural practice for either PAs or RNs. Surprisingly, lifestyle and area considerations don’t have any significant effects on rural practice, and family considerations influence rural practice only in registered nurses (these last two findings are not shown in Figure 1 above).
These findings show that there’s more to attracting healthcare workers to rural areas than just where they grew up. Recognizing and enhancing these incentives (loan forgiveness programs and educational programs that prepare students for rural practice) could be crucial in designing effective policies that help solve the shortage of healthcare workers in rural Minnesota, ensuring everyone has access to the care they need.
Additional information
Expanded information can be found in this article Should I Stay or Should I Go? Factors Associated with Health Care Professionals’ Choice to Practice in Rural Minnesota / Minnesota Department of Employment and Economic Development (mn.gov)
Rural Health Care in Minnesota: Data Highlights, Nov 2023 (state.mn.us), Minnesota Department of Health, 2023, November
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