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Context: Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying provider types, practice locations, and practice productivity. Purpose: To identify mental health shortage areas using existing licensing and survey data. Methods: The 1998-1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Census data, and the results of the 1990-1992 National Comorbidity Survey were used to calculate supply and requirements for mental health services in 2 types of geographic units in Washington state--61 rural and urban core health service areas and 13 larger mental health regions. Both the number of 9 types of mental health professionals and their full-time equivalents (FTEs) per 100,000 population measured supply in the health service areas and mental health regions. Findings: Notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio (10.4 FTEs per 100,000 and 306.5 FTEs per 100,000, respectively). Ten of the 13 mental health regions were more than 10% below the state ratio of psychiatrist FTEs per 100,000. Conclusions: States gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.

The term 'rural' suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density. However, defining 'rural' for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places--differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of 'rural' is required for effectively targeting policy and research aimed at improving the health of rural Americans. doi:10.2105/AJPH.2004.042432)

Objectives. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. Methods. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. Results. The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. Conclusions. The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes. (AmJ Public Health. 1993;83:322-328), The number of medical school graduates who choose to practice primary care medicine has not increased since the 1970s despite federal funding to increase the number of primary care physicians. Title VII of the Health Professions Educational Assistance Act of 1976 established special funding to encourage medical students to practice primary care medicine. A study examined the specialities chosen by medical school graduates between 1960 and 1985. Nineteen percent of medical school graduates chose to practice primary care medicine in 1967, compared with 31% in 1976. However, the number of medical school graduates who chose to practice primary care medicine did not increase significantly between 1976 and 1985. About $460 million in grants for general pediatrics, family medicine and general internal medicine did little to effect the distribution of medical students into primary care practices.

Medical students who graduate from medical schools in rural areas that emphasize family medicine are more likely to practice in a rural area than those who graduate from other schools. There is a shortage of physicians who choose to practice medicine in a rural setting in the US. A study of physicians who graduated from medical school between 1976 and 1985 found that 15,375 (12.6%) choose to practice medicine in a rural setting. Among the graduates who practiced medicine in a rural setting, 52% practiced some form of primary care medicine. More men chose to practice medicine in a rural setting, compared with women. Twelve medical schools produced more than 25% of the graduates who chose to practice rural medicine. These schools were more likely to be located in a rural state, to be owned by the public and to emphasize family medicine. They also received less funding by the National Institutes of Health (NIH)., Objective.--To examine the hypothesis that medical schools vary systematically and predictably in the proportion of their graduates who enter rural practice. Design.--The December 1991 version of the American Medical Association Physician Masterfile was used to examine the rural and urban practice locations of physicians who graduated from American medical schools between 1976 and 1985. Selected characteristics of the medical schools--including location, ownership, and funding--were linked to the Physician Masterfile. Main Outrome Measures.--The percentage of the graduates from each medical school who were practicing in rural areas in December 1991, disaggregated by physician specialty. Results.--Of the practicing graduates from our study, 12.6% were located in rural counties; family physicians were much more likely than members of other specialties to select rural practice, particularly in the smallest and most isolated rural counties. Women were much less likely than men to enter rural practice. Medical schools varied greatly in the percentage of their graduates who entered rural practice, ranging from 41.2% to 2.3% of the graduating classes studied. Twelve medical schools accounted for over one quarter of the physicians entering rural practice in this time period. Four variables were strongly associated with a tendency to produce rural graduates: location in a rural state, public ownership, production of family physicians, and smaller amounts of funding from the National Institutes of Health. Discussion.--The organization, location, and mission of medical schools is closely related to the propensity of their graduates to select rural practice. Increasing policy coordination among medical schools and state and federal governmental entities would most effectively address residual problems of rural physician shortages.