Strategies to attract Primary Care Physicians to rural, underserved areas. A review of policies in nine high-income countries

Background: Across the US, the UK, and other high-income countries, Primary Care Physicians (PCPs) are unevenly distributed. Rural and deprived areas record lower densities of PCPs per inhabitants than their urban and affluent counterparts. These disparities have persisted for decades. Poorer access to PCPs can contribute to greater health inequalities and unmet care, thus leaving underserved areas worse off.

Objective: This paper reviews policies the US, the UK, and seven other high-income countries (Australia, Canada, Denmark, France, Germany, Norway, Japan) have in place to attract PCPs to rural, underserved areas. It assesses their effectiveness and formulates policy recommendations.

Methods: We investigated government and non-government documents on the federal, state, and local levels. In addition to that, we systematically reviewed literature in four databases. Furthermore, we conducted interviews with several Ministries of Health. We focused our search on PCPs as the first point of contact for patients.

Results and discussion: We identified 292 policies across nine high-income countries. We could identify five types of policies, them being 1) education policies, which intend to influence the cohort composition by selecting students based on their rural affiliation, and/or their willingness to practice in a rural area, and to increase their willingness by increasing their rural exposure, 2) financial incentives to improve recruitment of PCPs to, and retention in rural areas, 3) regulation of PCPs’ location choices, 4) migration policies by offering easier access to medical practice to international medical graduates in exchange for working in a rural, underserved area, and 5) new ways to organize care, e.g., by delegating tasks to other health professions, or by bridging geographic distances with telemedicine. To date, education policies can be identified as the most successful and sustainable approach. Financial incentives and migration policies seem to function only to a very limited degree, but evidence is scarce. New modes of reorganizing the delivery of care represent a promising approach, but evidence is limited. 

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