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?