I intended to answer the original poster's question. In the old days, a person could graduate from medical school and do either no residency or just a one year internship and practice as a generalist. Those days are basically gone. I do not think there are any states that allow you to do this anymore. In order to get your liscence to practice in a state, you first have to complete a PGY-1 year and then take USMLE-III to get a liscence to practice medicine. Your talking about a NHSC- scholar prgram which REQUIRES you to do a residency in FP,IM,Peds, Psych, or OB/GYN. I have looked at their online list of positions and they all require BC or BE status. So my answer is yes you do need a residency. Those people you are talking about who practice in the rural U.S. are mostly BC FP.