Many rural areas struggle to compete with their urban counterparts when it comes to recruiting physicians, yet these outlying areas are often where new physicians are needed most. "Unless a student or resident is from a rural area or has some very strong ties, it is difficult to consider going to a small town to practice after being trained in what are usually large medical communities with multiple specialties around for consultation and back up," says Lee Armistead, MD, who finished his residency in Tuscaloosa, AL, in June and has moved back to his home county to open a practice in Gilbertown--roughly 122 miles southwest of Montgomery. "It is a very scary proposition to finish seven years of training and consider moving to a small, unproven area," he says.
To help alleviate those fears and increase the number of med students choosing to practice in rural areas, some medical schools are creating programs that target and offer support to rural students. Armistead is a product of the Rural Health Leaders Pipeline program at the University of Alabama College of Community Health Sciences. Started in the 1990s, the program's goal is "to identify, nurture and assist rural students to enter medical and healthcare education and return to rural Alabama as primary-care physicians and health practitioners."
The "pipeline" includes various rural programs that offer opportunities to students at multiple educational levels--from high school through medical training. The Rural Medical Scholars Program, for example, is open to college seniors and graduate students who plan to attend medical school and practice medicine in a rural area. Applicants to the RMS program at UA must have lived in a rural Alabama county for at least eight years. If selected, the scholar is enrolled at UA one year prior to his or her entry into medical school, takes coursework each semester related to rural health or the practice of primary care in rural areas, and participates in special seminars, community service projects and field trips to enrich his or her knowledge of what a career in rural medicine entails.
Throughout the program, participants maintain peer support group activities, receive collegial support and mentorship from rural practitioners, and receive continued administrative contact and support. Since its inception in 1996, 100 rural medical scholars have entered medical school and 60 have graduated so far. Forty of these have entered primary-care fields. Twenty-three have completed residency training, with 16 entering a rural practice in Alabama. Building connections
For smaller hospitals struggling to attract physicians, developing a relationship with a school of medicine is a great way for the facility to attract medical students to train there and also come back as practitioners later on, says John Wheat, MD, director of the pipeline program at UA.
Wheat says students are able to witness firsthand that physicians at smaller hospitals are integral to everyday operations and have a voice--a benefit that may be lacking at many large, urban institutions. "The students need to be able to see the physicians out there working as full-fledged partners with the system," he says. "The students that go out there perceive those doctors as being very well-respected within the hospital administration and within the community. It's attractive to the students."
John Brandon, MD, medical director of the Rural Medical Scholars Program, says there are various ways for hospitals to increase recruitment of rural doctors; for instance, arranging clinical rotations for medical students and residents, offering experience in the emergency room on weekends and nights, and inviting students to the facility to meet staff firsthand.
Local community gatherings and events for medical school faculty and students are another way to welcome potential doctors, Brandon says. "There is an annual weekend, usually in January or February, at a resort hotel in Alabama where communities can rent booths and show their stuff," he says. "Residents and some medical students are given free room and board in order to entice them to attend and visit the booths, and meet the rural community representatives."On the rise
Other initiatives like the pipeline program are popping up across the country. The Pacific Northwest University of Health Sciences broke ground on the College of Osteopathic Medicine, which is expected to open in fall 2008. Central Washington’s Yakima Valley was chosen because of its proximity to many rural healthcare facilities, says William Betz, vice president, chief academic officer and dean of Pacific Northwest University of Health Sciences. He notes that in the state of Washington, 38 of 39 counties are classified as "medically underserved."
"Our mission is to train men and women in a broad-based medical education so that they will be comfortable practicing in rural and underserved areas," says Betz.
In the first two years at the College of Osteopathic Medicine, students will study clinical diagnostics in Yakima. During years three and four, the college will rotate students through hospitals (many of them rural) in the Pacific Northwest to give them experience and confidence at those sites.
"Having rural hospitals a part of training programs associated with medical school programs is really a key component in attracting future physicians to practice in the area," Betz says.
Armistead agrees, saying that he doubts "very seriously" he would be in medicine right now had he not participated in the pipeline program. He adds that identifying future doctors who are more likely to practice in rural areas--such as those who are from rural areas themselves or have an interest in family medicine--and then nurturing that interest is critical.
"I feel that more time should be spent in rural areas as med students, and even pre-med students, as a prerequisite for admission," Armistead says. "This will benefit future primary-care doctors considering these areas, but also future 'big city specialists' to understand where some of these referrals are coming from."For more on recruiting rural doctors, see next week's story for tips from physicians who have participated in the Rural Health Leaders Pipeline at the University of Alabama. Ben Cole
is associate editor with HealthLeaders Online News. He can be reached at firstname.lastname@example.org