PHOENIX - Even though Darrell Brimhall has just started at the new University of Arizona medical school in downtown Phoenix, he already knows he wants to practice in his hometown of Snowflake.

"It's very tight-knit in the White Mountains. The market is so small and lots of people there know I'm coming back to be a physician," Brimhall said.

Not far from Brimhall's hometown, officials at Summit Healthcare Regional Medical Center in Show Low are eager for more doctors who want to practice in rural Arizona. Cindi Mortimer Keys, senior director of strategic and recruiting services, said turnover is high and it's tough competing with urban areas.

"We're far from an airport and we don't have a mall here or certain other amenities that some people are looking for," she said.

Part of the rationale for the new medical school is training more students like Brimhall who not only want to stay in Arizona but want to practice in smaller communities that need doctors.

"Across the state and generally across the nation there is a shortage of physicians, but in rural Arizona we're at the bottom of the ladder," Brimhall said. "It's a definite problem."

The University of Arizona College of Medicine-Phoenix in Partnership with Arizona State University welcomed its first 24 students in July.

Officials expect the school to graduate as many as 150 students a year within a decade.

The downtown campus is Arizona's second public university medical school, joining the University of Arizona College of Medicine in Tucson, which graduates 110 students each year. The private Midwestern University Arizona College of Osteopathic Medicine in Glendale graduates 130 students a year.

Arizona ranks 45th in the nation in physicians per capita, according to officials at the new medical school. And the shortage is only getting worse, according to Dr. Doug Campos-Outcalt, associate head of the school's Department of Family and Community Medicine.

"We used to import more physicians than we are now, and the population is growing like crazy, so we have to train more physicians here," Campos-Outcalt said.

But Campos-Outcalt and others say providing more doctors for rural areas and Arizona in general will involve more than opening a new medical school. One key, they say, is providing more opportunities for doctors-in-training to complete their residencies here.

"We can train all the students at UofA that we want, but if we don't have the residencies here it doesn't matter," said Roger Downey, a spokesman for the Arizona Medical Board.

Once residents spend time in a certain place and begin to network and make friends, they are more likely to stay in that place, Downey said.

Starting new residency programs can be a long and difficult process, Campos-Outcalt said.

"Somebody has to initiate the discussion. The Legislature needs to take a look at it and ask, 'How do we get more residency programs started?' " he said. "We ought to have a network of residency programs in rural parts of the state."

Midwestern University has established a residency rotation program in which third-year medical students are trained in a rural Arizona community and receive post-graduate training at hospitals in Kingman and Sierra Vista.

That residency program has been a success so far, said Kelli Ward, director of medical education at Kingman Regional Medical Center.

"The goal of residency programs in rural hospitals is to grow your own doctors, and that's what we're doing," she said. "It's opening up a lot more opportunities to reach the people of Kingman."

Arizona sponsors the Arizona Medical Student Loan Program, which gives loans to students who commit to repay the loan in medical service in underserved areas of Arizona.

Brimhall, who has applied for that loan program, doesn't need any extra incentive to practice in rural Arizona. Snowflake is where he belongs.

"This is what I want," he said. "I know my niche is in Snowflake."