Students from rural counties that are not medically underserved have greater opportunities to receive mentoring from local physicians, which fosters interest in a medical career. This is the basis of expanding the definition of "rural background" beyond the PEPP-designated counties. Although not extensive, the available literature supports the concept that medical students from small towns are more likely to practice in small towns after completion of their training. Frequently, they return not to their hometown, but one that is very similar. This finding is true even if their hometown had an adequate number of primary care physicians. In fact, in the most popular "affinity model" (1), a student with good role models of small town practice would actually be more likely to choose small town practice later. This means that requiring a Health Professions Shortage Area (HPSA) designation to define "rural" for admissions purposes is counter-intuitive.

If there is any basis for providing special consideration in admissions for rural students, it is based on possible academic disadvantages inherent in small town schools. Even in a town with an adequate number of physicians, small town schools lack the resources of larger towns and are historically weak in math and science education. This logically leads to slightly lower math and science college GPA and MCAT scores. This has been the finding of those medical schools that have a special rural admissions track, including Jefferson Medical College, University of Alabama at Tuscaloosa, and University of Illinois at Rockford. However, once admitted to medical school, these students perform on par with their classmates from larger cities.

During the 2002 admissions process at the U of L medical school, the category "Rural non-PEPP" was used for the first time. Eighteen students were admitted in this category. The table shows the counties in the category, using the Rural-Urban Continuum Codes (RUCC) categorization (2).

References

1. Elam CL, Rosenbaum ME, Johnson MMS. Geographic Origin and Its Impact on Practice Location in Kentucky. Journal of the Kentucky Medical Association 1996; 94:446-450.
2. Economic Research Service, U.S. Dept. of Agriculture. ERS Web Page. Rural-Urban Continuum Codes. http://www.ers.usda.gov/briefing/Rurality/RuralUrbCon/. 27 Feb. 2002