Rural Practice Made Attractive: A Scoping Review of Rural Primary Care Physician Recruitment and Retention Incentives

Background

Workforce development programs aim to address the disparity in the number of primary care physicians (PCPs) practicing in rural U.S. areas. Both publicly and privately funded rural recruitment and retention programs have worked for decades to enhance healthcare access. However, little is known about their comparative effectiveness in retaining PCPs long term. This scoping review assessed the success of programs in retaining rural PCPs.

Methods

We searched PubMed, Embase, and Health Business Elite for peer-reviewed literature, published between 2013 and 2023, focusing on PCPs’ rural recruitment and retention in the U.S. The gray literature search included sources like the Rural Health Information Hub and the Rural Medical Training Collaborative, followed by a Google search. Articles were screened by two authors, with discrepancies resolved by a third.

Results

From 2227 articles identified, only 10 met the inclusion criteria, with 7 additional programs found through gray literature, totaling 17 programs. Financial incentives, such as state loan repayment programs (n = 2) and scholarships (n = 2), showed the highest reported retention rates (50–100%) in rural areas; however, these results should be interpreted cautiously due to small sample sizes and substantial variability in follow-up periods across programs.

Discussion

Most rural PCP workforce development programs did not report retention outcomes. Among those that did, financial incentive programs had higher retention rates than rural education and residency programs. These findings are limited by the heterogeneity of results reported and the variability in program sample sizes. Additionally, many education programs reported the number of clinicians in rural areas but did not specify whether they were in primary care. Future program reports and research should standardize reporting to include the number of individuals who completed the program, their specialty, duration of rural practice post service time commitment, and current practice status in rural areas.