AAMC Reporter, October 2000: Med Schools Prepare Students to Practice in Rural Areas

VOLUME 9, NUMBER 13

JORDAN J. COHEN, M.D., PRESIDENT

OCTOBER 2000

Med Schools Prepare Students to Practice in Rural Areas

by Jennifer Proctor

Maria Loerzel, a third-year medical student at the University of North Dakota School of Medicine and Health Sciences, examines a child at Mercy Medical Center, in the rural community of Devils Lake, N.D. Loerzel takes part in one of the school's rural medicine education programs.

Physicians are in increasingly short supply in rural communities nationwide. A staggering 20 million Americans in rural communities have inadequate access to health care services, according to Health Resources and Services Administration estimates.

Not only are salaries lower in rural communities but a host of potential drawbacks - including poor employment opportunities for partners and spouses, quality of education concerns for children, and lack of a supportive physician community - cause doctors to shy away from bucolic practice.

Concerned that rural areas are dangerously underserved, medical schools are striving to provide students with both the requisite experience and funding for rural practice. Here's what three schools, all of which are the only medical school in an underserved state, are doing to prepare future physicians to care for their states' rural residents.

The University of Vermont College of Medicine

"The economic realities of Vermont create a cycle that discourages graduates from practicing here," says Mildred Reardon, M.D., University of Vermont's associate dean for Primary Care.

Eight of Vermont's 14 counties fall below federal standards for the ratio of primary care physicians to area residents. Below average salaries in those counties haven't helped matters, particularly given the fact that Vermont medical students graduate with loan debt higher than the national average.

With an $8 million gift from the Stowe, Vt.-based Freeman Foundation, the University of Vermont College of Medicine has established a scholarship program that will help make practicing medicine in the state fiscally viable. The gift will provide $1.6 million in scholarships annually for the next four years to in-state students and a select group of out-of-staters who demonstrate a willingness to commit to practicing medicine in Vermont. Dr. Reardon adds that the College of Medicine will try to actively place these students in communities that have medical needs that match their specialization.

The remaining funds, $400,000 per year, will support programs aimed at educating students about rural health care - an area in which Dr. Reardon says the school is already well-versed. The school's existing rural health promotion strategies include a mentoring program in which first- and second-year students are paired with a community physician and numerous clerkship rotations in rural communities across the state.

The University of Mississippi School of Medicine.

In Mississippi, almost every area is rural and underserved. The University of Mississippi School of Medicine's efforts to promote rural medicine got a large boost last January when Mississippi Gov. Ronnie Musgrove signed into law House Bill 729. The legislation provides annually 20 $20,000 scholarships to medical school students who pledge to serve 10 years in an underserved area of the state.

"Students will graduate with no or minimal debt, making them feel more liberated to practice in an underserved community that might not be able to offer a competitive salary," says Melessa Phillips, M.D., chair of Family Medicine at the University of Mississippi School of Medicine.

Because of the state's rural health care needs, the school has been working for more than 20 years to incorporate aspects of rural medicine into its curriculum, Dr. Phillips says. For example, third-year medical students can work in a rural practice, oftentimes living with a community physician, to experience the day-to-day life of a Mississippi doctor.

The University of North Dakota School of Medicine

Money isn't everything, as North Dakota has learned. Despite higher than average physician salaries and several state loan repayment programs, North Dakota has trouble attracting physicians to rural practice. As a state-owned and supported school, the University of North Dakota aims to help, says Mary Amundson, director of the Office of Primary Care at the university's School of Medicine.

The school has incorporated rural medicine into its curriculum and developed in-depth rural medicine experiences, including an eight-month, self-directed learning experience for third-year students. Amundson says this community-based learning approach has been successful in acclimating students to rural environments.

The University of North Dakota's Center for Rural Health also works to improve access to primary care for underserved and vulnerable populations by, among others, developing a primary care access plan for all of North Dakota's counties, organizing a statewide recruitment fair for health care professionals, and coordinating the state's loan repayment program for physicians and nurses.

But given the fact that more than 7 percent of rural Americans don't have sufficient access to health care services, medical schools still have a long road ahead of them when it comes to remedying the dearth of physicians in underserved areas. "We're a very rural state, and we continue to have a shortage of doctors," Mississippi's Dr. Phillips says. "Everything helps, and sometimes we just get lucky."