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Comment & Response
August 9, 2016

Highly Educated Spouses and Physician Practice in Rural Areas

Author Affiliations
  • 1Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington
  • 2Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;316(6):664. doi:10.1001/jama.2016.6721

To the Editor Dr Staiger and colleagues highlighted one of the challenges to physician recruitment in rural communities: the difficulty in recruiting and retaining physicians with highly educated spouses.1 We have 2 concerns with the study.

First, we were disappointed that the variable of rural origin was not included in the final analysis. Although decisions regarding practice location are complex, rural origin has repeatedly been shown to be the strongest predictor of physicians’ eventual rural practice.2 Students from rural backgrounds are consistently underrepresented in medical schools. Like other disadvantaged and underrepresented populations, rural students have often experienced longstanding educational and socioeconomic barriers to success.3 By excluding this important demographic variable (which may correlate with a spouse’s education), the authors cannot guarantee that spousal educational level is independently related to eventual rural practice.

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