What is a Rural Program?

Physician Education and Training

A rural residency program is an accredited program in health professions education and training in which trainees spend the majority of their time training (more than 50%) in a rural place. Many rural residency programs are rurally-located, primarily anchored in a rural place with minimum training in an urban setting. Other rural programs, traditionally called RTTs, train residents in urban settings for 3-15 months or more, and train them in rural communities for the remainder of their residency. For a history of rural residency program definitions prior to 2017, including ‘integrated RTTs,’ read A Proposed Nomenclature (also referenced below). In 2021 the ACGME created a process for pre-accreditation endorsement of a new ‘Rural Track Program’ (supplanting the ‘RTT’ terminology)’ where residents have both urban and rural experiences and spend more than 50% of their training in a rural community (i.e, as defined by the federal Office of Management and Budget, a micropolitan or non-CBSA area). The Center for Medicare and Medicaid Services (CMS) as of October 1, 2022, now uses this terminology in justifying the creation of a ‘rural FTE limitation’ or ‘rural cap’ for participating hospitals, whether the track is separately accredited or not.

For a current typology of rural training visit the Typology for Rural Training page or download a PDF: Typology-for-Rural-Training-May-2023.pdf (147.95 KB pdf)

For links to resources for understanding rural graduate medical education and a history of regulations relevant to rural residency training, visit the ACGME: Selected Publications and Resources Pertaining to Rural GME and Rural Track Regulation References. For other resources relevant to understanding rural residency planning, development, and sustainability, visit the Rural Residency Planning and Development Toobox, accessible by enlisting in a free online portal.

A rural program in medical school is an organized and deliberate medical school strategy to produce physicians to rural practice and is described in an article in the Journal of Rural Health, Pipelines to Pathways (also referenced below).

For a current listing of the growing community of practice in rural medical education and training contact longenec@ohio.edu. As of July 1, 2024, there are:

  • Nine (9) schools of medicine (allopathic and osteopathic) that are located in a geographically rural community
  • Forty-eight (48) medical schools with one or more formal rural programs, for a total of sixty-six (66)
  • One hundred and thirty-three (133) accredited rural residencies in Family Medicine, sixty-nine (69) of them separately accredited rural track programs by our most recent typology, recruiting for 2025.
  • Thirty (30) accredited rural residencies in Internal Medicine and sixteen (16) in Psychiatry, and a lesser number of rural programs in other specialties (see Rural Programs map)

The RTT Collaborative maintains 2 maps:

  • For a map of Participating Programs in The RMT Collaborative, click here.
  • For a map of all the rural residencies in the specialties of Family Medicine, Internal Medicine, Psychiatry, and General Surgery, in the United States click here.

Physician Assistant Education

For a list of 26 rurally oriented Physician Assistant programs, click Rurally-Oriented-PA-directory_07.01.2022-1.xlsx (20.86 KB xlsx) . A published peer-reviewed article summarizing this work has been published in the Journal of Physician Assistant Education: Larson EH, Oster NV, Jopson AD, Andrilla CHA, Pollack SW, Patterson DG. Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants. J Physician Assist Educ. 2023 Sep 1;34(3):178-187. doi: 10.1097/JPA.0000000000000514. Epub 2023 Jul 19.

Nurse Practitioner Education

For a list of 24 rurally oriented Nurse Practitioner programs, click Rurally-Oriented-Nurse-Practitioner-Residency-Programs-12.2022.xlsx (18.36 KB xlsx) . A published peer-reviewed article summarizing this work has been published in the Journal of Rural Health: Kaplan L, Pollock S, Skillman S, Patterson DG. Is being there enough? Postgraduate nurse practitioner residencies in rural primary care, J Rural Health 2022:1-6.

What is the Rural Medical Training Collaborative (Previously The RTT Collaborative)?

The RMT Collaborative is a cooperative of rurally focused health professions education and training programs from around the United States. Participants include both undergraduate and graduate medical education programs. Although not all programs are rurally located or meet the definition of a rural program outlined above, they are all invested in producing health professionals to rural practice! For more information, follow the About tab above and the associated submenu, including an overview, video, and a map of participating programs.

Longenecker R. Rural Medical Education Programs: A Proposed Nomenclature. Journal of Graduate Medical Education June 2017;9(3):283-286. https://doi.org/10.4300/JGME-D-16-00550.1

Longenecker, R.L., Andrilla, C.H.A., Jopson, A.D., Evans, D.V., Schmitz, D., Larson, E.H. and Patterson, D.G. (2021), Pipelines to Pathways: Medical School Commitment to Producing a Rural Workforce. The Journal of Rural Health. https://doi.org/10.1111/jrh.12542

Meyers P, Wilkinson E, Petterson S, Patterson DG, Longenecker R, Schmitz D, Bazemore A. Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Program Graduates, J Grad Med Educ December 2020;12 (6): 717–726. https://doi.org/10.4300/JGME-D-20-00122.1

Patterson DG, Shipman S, Pollack SW, Andrilla CHA, Schmitz D, Evans D, Peterson L, Longenecker R. Growing a Rural Family Physician Workforce: The Contributions of Rural Background and Rural Place of Residency Training, Health Serv Res. 2023; published ahead of print May 9, 2023. https://doi.org/10.1111/1475-6773.14168