Thomas Jefferson University's Physician Shortage Area Program
Need: More rural doctors were needed in Pennsylvania, where nearly half of the state's physicians practice in just three large metropolitan counties.
Intervention: Sidney Kimmel Medical College at Thomas Jefferson University established the Physician Shortage Area Program (PSAP) in 1974 to recruit and support students who are from rural backgrounds and who wish to practice in rural communities.
Results: Approximately 80% of PSAP alumni have remained in rural family medicine for at least 20 to 25 years after graduation.
The PSAP selectively admits medical school applicants who
grew up in rural areas or small towns and who wish to
practice in a similar area, reserving up to 24 spots in
each class for qualified PSAP applicants. Thomas
Jefferson University works cooperatively with eight
undergraduate colleges and universities in Pennsylvania
and Delaware to recruit students for the program, but
students from non-partner colleges are also welcome to
apply. PSAP applicants complete a brief additional
application in addition to their regular medical school
application, which includes three letters of support from
people in their hometown.
Students admitted to the program receive personalized
support from faculty and peer groups, participate in a
mentorship program, and must complete a six-week rotation
in a small or rural community.
Throughout medical school, PSAP students receive ongoing
mentorship and support from PSAP faculty in the form of
email advisement, monthly peer group meetings, and
individual meetings. PSAP students are also paired with a
"Big Sib" mentor from the previous PSAP class to provide
Students in the program are additionally required to
complete a six-week rotation in a small community outside
of the Philadelphia metropolitan area, and are encouraged
to participate in a rural preceptorship or elective
rotation in their final year.
PSAP students are eligible for additional financial aid,
through need-based loans or through two scholarships.
Between five and 15 PSAP students typically enroll in
each class. PSAP students have performed similarly to
their peers throughout medical school and during
In the nearly 50 years since the program was established,
PSAP leaders have closely tracked graduate outcomes.
Fifteen papers – including three in the New England
Journal of Medicine, three in the Journal of the
American Medical Association, and seven in
Academic Medicine – and one
book have been published on the program's results.
Findings over the years include:
Approximately 70% of PSAP graduates remained in rural
family practice in the first location they began working
in for at least 20 to 25 years, with an additional 10%
staying in rural medicine but moving to another rural
PSAP graduates accounted for 21% of family physicians
practicing in rural Pennsylvania who graduated from one
of the state's seven medical schools, even though they
only made up 1% of those schools' graduates.
The PSAP produced 12% of all rural family physicians
in Pennsylvania who graduated from U.S. and international
medical schools from 1978 to 1991.
84% of PSAP graduates were practicing in either a
rural or small metropolitan area or working in primary
care, while only 2 to 3% of non-PSAP graduates were
practicing rural family medicine.
PSAP graduates from two different cohorts (the
graduating classes of 1978-1991 and 1992-2002) were more
than eight times as likely to practice rural family
medicine than their non-PSAP classmates, nearly three
times more likely to practice any specialty in a rural
area, and more than four times more likely to practice
While program leaders describe the PSAP as a relatively
inexpensive program, sustainability is an ongoing
challenge. The PSAP is funded through the University and
the Department of Family and Community Medicine, as well
as by a small endowment established years ago with
ongoing contributions to the fund by PSAP alumni and a
handful of faculty members each year in honor of the
program's graduating seniors.
The number of incoming PSAP students varies from year to
year and can be unpredictable; some classes have had as
few as two PSAP students enroll, while other years have
seen as many as 15. To encourage accepted PSAP applicants
to enroll at Thomas Jefferson University, the program has
begun assigning current students as "transitional
mentors" to reach out to accepted applicants; accepted
applicants are matched up with current students based on
geography, undergraduate schools, or other factors.
Program leaders believe that closely tracking and
analyzing student outcomes has been crucial to the
success of the PSAP. While not all programs or
universities may have the resources to carry out
extensive outcomes research, the PSAP is able to
accomplish this due to the
Jefferson Longitudinal Study of Medical Education,
which has tracked the university's medical students and
graduates since the entering class of 1964 and includes
more than 6 million pieces of data on students'
background, performance, and other information.
Recruiting and admitting students who grew up rural and
who have an established desire to work in a similar
community has also been integral to the program's ability
to produce physicians who practice and stay in rural
areas, program leaders say, with PSAP outcomes research
finding that the admissions component of the program
accounted for roughly three-quarters of its success.
Maintaining good working relationships with partnering
undergraduate universities and their faculty, through
campus visits and ongoing communication, is also
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about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
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needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.