Four residents from the medical school at Quinnipiac University in Connecticut will spend next school year at hospitals in Aroostook County.

It is Quinnipiac’s first family medicine residency program, and it places them among the 20 percent of medical schools with initiatives aimed at steering doctors toward positions in rural areas, where the lack of physicians is making it difficult to keep residents healthy.

Rural America is facing a number of workforce shortages, but perhaps none are as dire as the shortage of family physicians. Initiatives like Quinnipiac’s are part of the solution — but they won’t solve it alone.

Programs that send young doctors to rural areas are part of the solution, but it will take even more to deliver health services in those areas. Getty Images/iStockphoto

There is a nationwide shortage of primary care physicians, but it is felt most acutely in rural areas, which have always depended more on family physicians than the rest of the country, and are now having trouble replacing those who are reaching retirement.

According to the New England Journal of Medicine, more than half of the rural doctor population is age 50 or older; it is estimated there will be 23 percent fewer rural doctors working in 2030. The U.S. Department of Health and Human Services says there is an overall shortage of 4,000 physicians and growing, and it is concentrated in rural areas.

Why? First, the number of medical school graduates isn’t keeping up with the demand for doctors presented by aging baby boomers. The doctors who are coming out of school are gravitating more toward specialties than general practice, and more toward urban hospital networks than rural practice, both because they want and need higher salaries — medical school loans are no joke — and because they’d rather live in a city.

Overcoming those barriers will not be easy, but initiatives like Quinnipiac’s, or a similar one at Maine Medical Center, are a big part of the solution.

Students who are inclined to consider a career in rural medicine say medical schools often seem indifferent to that track of study. Rural residency programs allow those students to pursue their interests, while giving others a taste of a career that perhaps they had not considered before.

In any case, studies have shown that students who choose rural practice almost always completed a rotation in a rural area.

The Quinnipiac initiative is supported by a federal grant, and more investment is needed. A bill co-sponsored by Maine Sen. Susan Collins would provide hundreds of millions of dollars for residencies in underserved areas.

But even if a doctor wants to work in rural Maine, that may not be enough — the presence of student loans and prospect of lower pay has to be overcome too.

Some hospitals are now offering signing bonuses as high as $100,000. Certainly a robust student loan forgiveness program for rural doctors is warranted — it’s hard to see the problem being solved without one.

There are also ways to support primary care in general, by increasing federal reimbursements and by centering the health care system on the kind of preventive care that family physicians excel in. Both of those moves would increase pay for primary care physicians, and make that professional route more attractive.

The slow erosion of family medicine is bad for health care. In rural areas, it is leaving a huge hole in the delivery of health care. It’s going to take a lot to fill it.