Patient perceptions of family practice residents in rural private practice settings.

The portion of US physicians who practice primary care has been declining, and there is general agreement that the United States has a shortage of primary care physicians. In spite of this shortage, both the number of first-year residency positions in family practice residencies1,2 and the match rate for the existing family practice first-year residency positions have declined.3 In the past, rural areas relied on general practitioners for primary care. Although newly trained family physicians are locating in rural areas (42.7 percent of the 1987 class of graduating family physicians went to communities of less than 25,000),4 they are too few to replace the retiring generalists.5 Clearly, we must not only train more family physicians but also train more family physicians who will practice in rural areas. One approach to the problems of decreasing numbers of family practice residency positions and the shortages of rural family physicians is to use rural family practices as training sites for residents. Ernst and Yett6 have concluded that "physicians have high propensities to settle in areas where they have had prior personal contact," and this tendency to settle in familiar areas has been proved for rural areas in several studies.7,s A barrier to this approach has been the concern of rural family physicians that their patients might not be receptive to resident physicians practicing in their regular physician's office. The hypothesis of this study was that patients seeing family practice residents who were working as preceptees in rural famil~ physicians' ~~ces would have a positive perceptIon of the physlClanpatient interaction and w~uld ?e satisfied ~th their care. In previous studies of mternal medlClne residents working in academic practices and of