Book: Caring for the Country: Family Doctors in Small Towns
Authors: John Gillies
Journal: BMJ (2005)

This book is about the lives and work of family doctors in rural towns, mostly in Pennsylvania. I live and work in a small rural town in Scotland and became aware of Howard Rabinowitz's contribution to rural health care in the mid-1990s, when I did a literature review of recruitment and retention of doctors to rural areas throughout the developed world.​world.




Figure 1



Howard K Rabinowitz

Springer, $29.95, pp 262 ISBN 0 387 20978 6 www.springeronline.com

Rating: ★★★




The physician area shortage programme started by Jefferson Medical College, Philadelphia, in 1974 was one of the first, and its fruits are described in this engaging book. Rabinowitz has been its committed director for 27 years, has published extensively on it, and has known all of the 300 students who have since graduated.

The programme recruits medical school applicants who have grown up in rural areas and who demonstrate a commitment to return to work there. The book profiles 10 graduates of varying ages and attitudes. They are impressive people. Words like commitment, vocation, and service came to mind as I read details of their working lives. The context is different to that in the United Kingdom, of course, but the impression I have is that they are more free to serve their individual patients because their agenda is not clouded by a contract founded on population based targets. However, it is possible that the HbA1c levels of their diabetic patients are not so good. There's potential for some interesting international research there.

The programme is one example of many initiatives throughout the world aiming to improve the quality and numbers of healthcare professionals in remote and rural areas. In Australia rural clinical schools and departments of rural health (such as www.greaterhealth.org/) are now well established. On the western seaboard of the United States the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) group of medical schools “helps the sparsely populated states with a stream of badly needed doctors by offering roving clerkships to medical students throughout the north-west, along with incentives to practice in rural areas once they finish their education” (www.uwmedicine.org/Education/WWAMI). Canada has a long history of initiatives, and a new rural medical school in Northern Ontario (www.normed.ca) will admit its first intake of students shortly. The World Organisation of National Colleges and Academies of Family Medicine/General Practice (WONCA) has had a very active rural working group for a number of years. It has produced seminal documents on many aspects of rural medicine and health care (www.globalfamilydoctor.com/aboutWonca).

In Europe the fledgling European Rural and Isolated Practitioners Association (EURIPA) organisation, hosted by the Institute for Rural Health in Wales (www.rural-health.ac.uk), has considerably raised the profile of rural health and rural workforce issues. In Scotland the Remote and Rural Areas Resource Initiative (RARARI), now completed, spawned many continuing projects on rural health and medicine. The impression that I have, however, is that remote and rural health issues have, in general, a higher profile and better funding outside Europe. Doctors mostly train in cities. The message of many of these initiatives is that if people are given the chance to train in rural areas many will enjoy the experience and stay on or return. I'm not sure that we've yet learnt that in Europe.