All posts by oconnorb

Beth O'Connor is the Executive Director of the Virginia Rural Health Association.

Medical Student Checklist

Many medical students will soon be wrapping up their 3rd year.  What do you need to do to prepare for the 4th?

After three years of arduous studying, exams and clinical rotations, you’re finally in the home-stretch to completing your undergraduate medical training and transitioning to the next phase of your career in residency.

AMA has developed a 4th year student checklist.  As you apply to programs this year, keep these tasks top of mind to reduce stress and ensure you have an effective residency application process:

  • May-June: Obtain your token for the Electronic Residency Application Service (ERAS)
  • June-July: If you’re an osteopathic applicant, register for the AOA Intern/Resident Registration Program
  • July-August: Use these months to prepare supplemental application materials
  • September: Select and apply to programs accredited by the Accreditation Council for Graduate Medical Education (ACGME)
  • October-January: Schedule and travel to interviews
  • February: AOA Intern/Resident Registration Program match results will be available
  • March: NRMP main residency Match results are announced

The next year will fly fast – make sure you’re ready to soar!

Affordable Medications

One of the hard realities of serving in rural communities is that many of our patients have a hard time affording the medications they desperately need.

We’ve located a resource to help with that process.  The National Center for Farmworker Health has produced a series of easy-to-read fact sheets about the safest and most affordable medications to treat specific conditions or illnesses. Topics include diabetes, heart disease, menopause, depression, and many others.

Available in both English and Spanish, each fact sheet is based on extensive reports published by Consumer Reports Best Buy Drugs that share the results of research conducted to determine the most effective, safe and affordable medicines available in the market for each condition. Generic medicines, if available, were included in the analysis as well.

What other resources for affordable medications do you have?

Registration Now Open!

Registration for the Rural Residents Research Symposium is now open!

Scheduled for April 22nd at the Slemp Center of UVA Wise; this is a day for residents to present original research (not case studies) regarding topics of interest to rural primary care docs and their peers.

Slots at the Rural Residents Research Symposium are 30-45 minutes long; anyone interested in presenting must meet the criteria of rural focus and should apply through their residency coordinator.

A limit of two applications per residency program will be accepted with a total of 10 presentations.  The top two presentations will be invited to speak at the 2016 Head for the Hills event in October.

Click here to register.  For questions, contact GMEC Director Wendy Welch at wow6n@uvawise.edu

 

Urban Choosing Rural

A recent study noted that having a rural origin is a primary factor in medical students choosing to practice in rural areas.  The study decided to turn that information around and ask what influences urban students to also choose rural.

“Determinants of an urban origin student choosing rural practice” used a scoping review of the literature, in contrast to a traditional systematic review.  Out of these 17 studies, the following four factors that suggest why urban-origin medical students may choose rural practice were generated:

  • geographic diffusion of physicians in response to economic forces such as debt repayment and financial incentives
  • scope of practice and personal satisfaction
  • undergraduate and postgraduate rural training
  • premedical school mindset to practice rurally

The study concluded:

Urban-origin students may choose rural practice because of market forces as well as financial incentives. The participation in undergraduate and postgraduate rural training is reported to positively alter the attitude of urban-origin students. A small subset of these students has a predetermined mindset to practice rurally at the time of matriculation.

Obstacles for choosing a rural carrier include, but are not limited to lack of job and education opportunities for spouses/partners, lack of recreational and educational opportunities for children, and obscure opportunities for continuing medical education.

 

 

Remote Residency?

Last week we asked if skipping residency was the solution to addressing the doctor shortage in rural communities.  And if skipping residency wasn’t the answer; what is?

A recently published study proposed that maybe tele-residency is part of the solution.  “The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners” reviewed remote residencies from both the fiscal and student acceptability aspects.  The study introduction notes:

 Although many medical schools incorporate distance learning into their curricula, assessing students at a distance can be challenging. While some assessments are relatively simple to administer to remote students, other assessments, such as objective structured clinical exams (OSCEs) are not.

Students were assigned mock patients in rural areas which the student would examine via telemedicine (teleOSCE).  In addition to demonstrating clinical competency, the student also had to show “understanding of the geographic and socioeconomic realities of rural patients: learners must incorporate rural circumstances into the plan of care.”

TeleOSCE  was determined to be both fiscally feasible and valuable to the students.  It also served to:

expose students to telemedicine visits as a new model of rural care, while simultaneously increasing awareness of common issues in rural population health.

So it is affordable, and the students like it – but does make up for not having residents physically present in rural communities?

 

Can We Skip Residency?

One of the concerns of those addressing rural workforce issues is residency programs for recent medical school graduates.  Finding a sufficient number of residency slots is always a challenge.  If there aren’t enough in your area, the students could leave the state – or even the country.

Since we know that doctors tend to practice in the same area where they were trained, it’s a constant challenge for those wanting to recruit in rural areas.

But what if we just skipped residency?

A new law in Missouri, Arkansas and Oklahoma offered a first-of-its-kind solution to the physician shortage plaguing thousands of U.S. communities: Medical school graduates could start treating patients immediately, without wading through years of traditional residency programs.

Yet more than 18 months after that first law passed, Missouri regulators are still trying to make it work. And not a single new doctor has gone into practice in any of the three states as a result of the new laws.

Opposition abounds from every side.  Even some rural physicians, who could potentially benefit from the help, don’t like the Missouri law.

Dr. Tammy Hart is the only physician in Missouri’s Mercer Country along the Iowa border. She opens her office at 7 a.m. to walk-in patients with urgent needs and often ends up working on days off. But Hart views the new Missouri law as “a very poor answer” to the physician shortage.

“By no means are you ready to assume being a physician when you graduate from medical school,” she said.

But if skipping residency isn’t the solution; what is?

Medical Education Challenges

Recently AMA Wire published “9 challenges medical educators want to solve right now” which were the topics identified at a AMA event when participants were asked the question, “What does the medical school of the future look and feel like—and how do we get there?”

Identified challenges included, “New ways to make medical training more patient-centered” and “Strategies for increasing diversity in medical education.”

The diversity one made us wonder – what if diversity in medical education meant more than students with a variety of colors and creeds?  What if “diversity” included rural?  Rural students, rural training, rural cultural competency.

What are the rural medical education challenges you want to solve right now?

ICD-10 Is Here – Now What?

Just like the coming of Y2K, the world did not implode when ICD-10 went live on October 1, 2015.  But that doesn’t mean there aren’t any glitches.

At Head for the Hills 2015  Debbie Poston from AMS Software talked about the challenges physicians face in making sure office staff can document patient visits correctly in her presentation, ICD-10 Is Here – Now What?

Poston reviewed how those challenges can be used to increase communication within a medical practice and assure claims can be paid in a timely manner.

Use this presentation as a starting point for making sure all of your diagnostic work is being recorded correctly to the benefit of your patients, your staff, and your cash flow.

 

Anxious Kids

What’s the difference between fear and anxiety?  What level of anxiety in a child is normal? At what stage does it need to be addressed?  When is medication appropriate for a child with anxiety?

C. Allen Musil, Jr., MD’s presentation at Head for the Hills 2015 answered these questions and reviewed risk factors for anxiety disorders, different types of anxiety disorders, treatment approaches and more.

Check out Anxious Kids: A Primary Care Approach by Dr. Musil!

 

The Big-City Guide to Small-Town Living

The GMEC blog will be taking a break for the holiday season.  We leave you with this essay from the Daily Yonder:

I watched over the last decade or so as successful big-city professionals retire and move out to the fringes of my rural town. They typically buy farms or ranchettes and imagine themselves living in a sylvan or riverine setting with big horned owls hooting and coyotes howling in the distance after a kill. Some of them learn to fit in and truly find a home. Many others make it about five years and move back to the city or elsewhere, inevitably “to be closer to their grandkids.”

I wondered, what makes for a successful transition to the small-town life that I love so much. The following 10 rules I personally pulled out of a very authoritative hat.

Read the 10 Rules for Small-Town Living.