What happens when an eager young doctor in a rural community with a passion to make a difference becomes the medical director for the nursing home, the overseer of the town’s emergency medical service, the football team’s sideline doctor, the clinic’s medical director, and the hospital’s trauma director and chief of staff?
And has two children?
This wasn’t a scenario we made up. This is a real story highlighted in a recent article by the Rural Health Information Hub:
Randall Longenecker, MD, FAAFP, serves as assistant dean for rural and underserved programs at the Ohio University Heritage College of Osteopathic Medicine and is the Executive Director of the national RTT Collaborative. He is an advocate of teaching medical students and residents skills to build their resilience and help them deal with the stresses of rural practice.
In Longenecker’s experience, rural settings can actually encourage providers to admit they have a problem. “One of the advantages of living in a ‘glass house’ where everyone knows each other’s business is that (burnout) quickly becomes apparent to others,” said Longenecker.
Providers who build strong relationships within their community also have an advantage when dealing with burnout. “Resilience, or the ability to persist and thrive through hardship, is a competency for a rural practice,” commented Longenecker. “Hardship itself is not the most important contributing factor (to physician burnout), the lack of healthy relationships is.”
Read the full article here.
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.
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 email@example.com
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.
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.