Rural Versus Urban Distribution of Obstetrics and Gynecology Residency Training and Associated Rural Community Characteristics

Abstract

Purpose

To assess the distribution of OB/GYN residency program training sites and compare community characteristics in rural counties with and without training sites.

Methods

Using data from the Accreditation Council for Graduate Medical Education (ACGME), the locations of all accredited obstetrician/gynecologist (OB/GYN) residency training sites for the 2023–2024 academic year (AY 23–24) were geocoded. They were classified as rural or urban according to the Federal Office of Rural Health Policy and Core-Based Statistical Area categories. The percentage of time spent training in rural areas was calculated for each program. Programs with at least 50% rural training were also identified. Bivariate analyses, including Pearson's chi-square tests and Wilcoxon rank-sum tests, were conducted using the Area Health Resource File (AHRF, 2022–23) to compare community characteristics between rural counties with and without OB/GYN residency training sites.

Results

In AY 23–24, there were 294 OB/GYN residency programs utilizing 1052 training sites. There were 19 programs (6.5% of programs) offering a total of 25 training sites in rural areas (2.4% of all training sites). In programs that offered rural training sites, the rural experience accounted for an average of 4.8% of total training time in those programs. Regarding community characteristics, rural counties that did not have a residency training site were less populated than rural counties with a training site (15,742 vs. 50,886; p < 0.001). Compared with rural counties that had an OB/GYN training site, rural counties without a training site had a higher proportion of uninsured people less than 65 years old (8.0% vs. 11.5%; p < 0.001), a higher proportion of uninsured people less than 19 years old (3.8% vs. 6.4%; p < 0.001), lower median number of primary care physicians (40.6 vs. 55.1 per 100,000; p = 0.005), fewer median number of psychiatrists (0.0 vs. 2.5 per 100,000; p < 0.001), and were more likely for the entire county be a mental Health Professional Shortage Area (HPSA; 35.3% vs. 69.0%; p<0.001).

Conclusion

OB/GYN residency training is highly urbanized. There are significantly less favorable health care access characteristics in rural counties without an OB/GYN residency training site compared to those with residency training sites. The findings identify rural communities without OB/GYN training sites that may represent opportunities for future rural training expansion. A comprehensive strategy to increase rural OB/GYN training experiences may increase the number of rural obstetricians.