Request for Proposals –
The Graduate Medical Education Consortium of Southwest Virginia has proposed a collection of essays to McFarland Press. Titled Healing Ourselves, with a tentative subtitle along the lines of Physicians Respond to the Opioid Crisis in Appalachia or Healthcare Providers tell their stories of Appalachia’s Opioid Epidemic.
We are looking for a wide range of approaches to the topic, with the intent that these individual narratives should tell together the larger story of what is happening in the region. If you are actively involved in treating pain and/or addiction in Appalachia, we would like to hear from you. We are particularly interested in stories that focus on reflective awareness or solution-driven activity. If you’ve been part of a working solution, tell us about it.
We understand that many substances continue to play a role in Appalachia’s addiction story; your proposed story should not focus on other substances to the exclusion of opioids.
Please send a one-page write-up of your approach to telling a piece of the big story on opioids/substance abuse in Appalachia. Do not put your name on this page but please include why you are well-positioned to write this unique piece.
On a separate page, please give us your name, profession and titles, geographic location, work location (are you based out of a hospital, private or free clinic, college or university, etc.) and why you are interested in writing for this collection. Please include e-mail and phone contact details.
McFarland is primarily an academic publisher; we are looking for writers who can address their topic with narrative skill and present data or complicated terms in language appealing to readers overloaded with faceless statistics. Tell us a story. Tell us YOUR story.
We look forward to reading your proposals on Monday, Sept. 9. Email them to firstname.lastname@example.org
Tom Morris – HRSA’s Associate Administrator for Rural Health Policy – has a stump speech about rural healthcare vs. urban healthcare entitled; “Rural is NOT Mini Urban.”
To underline his point, he puts a picture on the screen of a huge tractor next to a lawn mower. Guess which one is intended for use in rural areas?
By the same token, emergency medicine is different in rural communities. A hospital in Idaho has recognized that difference in creating a rural emergency medicine program.
St. Luke’s Hospital and the University of Washington created the program after the university decided its students should be exposed more to rural medicine. The students are overseen by emergency physicians and the students are able to help out in the ER during busy times.
Read more about this unique program.
The Rural Health Research & Policy Centers recently published, Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice. This policy brief identified family medicine residencies providing rural training and the practice locations of their graduates.
- Family medicine physicians who graduated from rural-centric residency programs—those that actively recruit medical students with an interest in rural practice and require at least eight weeks of rural training—practiced in rural areas during the first five years after graduation at much higher rates than the entire population of family physicians.
- No single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice.
- Graduates of rural-centric family medicine residencies also chose to practice in Primary Care Health Professional Shortage Areas (both rural and urban) at high rates, up to 54% three years post-graduation, declining by five years post-graduation to 42%.
- The combination of a program mission to produce rural physicians with required rural training experiences may help to account for similar outcomes among a diverse group of residency programs that produce family physicians who choose rural practice.
- More research is needed to determine whether rural practice choices are sustained beyond five years post-graduation, the time period of this study.
The last point is of particular interest as the paper notes:
It is not known the extent to which these high rates of practice in shortage areas are the result of incentive programs, such as the National Health Service Corps, or Conrad 30 Waiver Program, or other factors. If incentives are driving this trend, we do not know whether these physicians will remain in shortage areas once incentive obligations are fulfilled, since incentive programs typically involve two to six years of service in underserved locations.
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!
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?
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?
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.
“Grow your own” is a popular phrase for those trying to improve the supply of health professionals in rural areas. But does it work? The USDA recently released a report titled “Factors Affecting Former Residents’ Returning to Rural Communities“.
Factors which encouraged residents to return to their rural roots:
- presence of parents
- desire to raise their children back home
- easy-going environment
- outdoor recreation
Local schools also played an important role. People who had a positive outlook on rural schools came back; those who felt that urban schools would better fit their child’s needs, did not.
The report summary goes on to say:
Family motivations dominated, but returning home also depended on securing a job, often involving creative strategies to overcome employment limitations. Return migrants frequently mentioned their acceptance of financial and career sacrifices for returning home. Most nonreturnees who may have considered coming home cited low wages and lack of career opportunities as the primary barriers to their return.
So the challenge for rural recruiters is: what can be done to improve the factors that can be controlled – school systems and economic environment?
Recently HRSA released the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm”
We’ll spend the next few weeks providing some highlights and commentary.
Challenges and Opportunities in Expanding GME Experience (p.17)
“Although the data on the impact of training sites on the quality of care provided by GME graduates is limited, there is a common misperception that only training in large academic centers can produce graduates who have the skills to provide high quality care. Asch and colleagues have found obstetrical outcomes are affected by training site, linking quality of training site with the outcomes of care provided by the trainees. However, other studies on this topic leave doubt about which markers should be used to evaluate physician practice quality in relation to residency training sites.
“In addition to concerns about quality of teaching and patient care in community and ambulatory settings, another barrier to expanding GME training to these sites is the lack of financial support for community-based programs. Present payment and training incentives for community-based training are insufficient to develop and maintain these ambulatory and community-based programs, even though it costs less to provide patient care and GME training in these sites, than AHCs and other teaching hospitals. The increased costs of AHCs and other teaching hospitals are in part due to their higher patient care costs. This includes the number of underinsured, biomedical research missions, and the maintenance of standby capacity for medically complex patients, in addition to the expenses incurred by teaching programs.”
For GMEC, this is key as training in Southwest Virginia offers the local, ambulatory, outpatient experience. On page 23, the report states, people “expect the medical education system to produce physician specialists who reflect the cultural and economic characteristics of the patients they serve“.
With this expectation in mind – the medical education community needs to recognize that the only way to fully prepare a future physician to serve in rural Appalachia is to train that student in Appalachia. Reviewing information about rural Southwest Virginia is not sufficient to produce a culturally competent doctor – immersion is required.