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Friday Nov 14, 2014

Exposing Students to Rural Health Key to Producing Rural Docs

Less than half an hour from the U.S.-Mexico border, the tiny town of Patagonia, Ariz., lies nestled between a sprawling state park and a massive national forest. Although I was born and raised in Tucson and started my practice there, I came to Patagonia in the 1990s when I was offered the opportunity to work at the small town's federally qualified health center.

Why would a big-city physician leave home to come to a town that was literally 1,000 times smaller?

I liked the idea of practicing full-scope family medicine. I liked the challenge of doing more with fewer resources, putting pressure on myself to become a better clinician. And I wanted the chance to develop true, close relationships with my patients. I got all that in Patagonia because in a town of less than 1,000 people, it didn't take long to become a vital part of the community. I stayed for 13 years.

Photo courtesy Chandra Tontsch
University of Arizona College of Medicine student Chandra Tontsch, right, completed a family medicine rotation in Lakeside, Ariz., with preceptor Elizabeth Bierer, M.D. The college places medical students in rural settings in hopes that they will later choose to practice in underserved areas. 

In 2006, the University of Arizona recruited me to teach rural health in Tucson. Earlier this year, I took on the role of director of the university's Rural Health Professions Program(medicine.arizona.edu). Although I am no longer providing rural health care as an individual physician, my goal is to show medical students the rewards this area of medicine offers and hopefully draw more of them to this important practice setting.

More than 20 percent of the U.S. population lives in rural areas, but rural physicians account for only about 10 percent of the physician workforce. Compounding the problem is the fact that many of the physicians practicing in these areas are approaching retirement and not enough young physicians are stepping up to take their place. In fact, less than 5 percent of physicians(journals.lww.com) who graduated from medical schools from 2006-08 went on to practice in rural areas.

At the state level, as much as one-third of Arizona's population lives in primary care health professional shortage areas. The state has more than 140 primary care shortage areas (including some inner-city areas), and it has been estimated that Arizona would need more than 300 additional primary care physicians to address the problem.

In our Rural Health Professions Program, 22 students are selected at the end of their first year and placed in rural settings, primarily working with family physicians. During their third year, students are required to complete a clinical rotation in a rural setting in family medicine, internal medicine, pediatrics, obstetrics, or surgery. (Many do more than one rotation in rural areas.) Finally, during their fourth year, students are encouraged to go back to rural settings for a four-week preceptorship, and roughly three-fourths of them do. It's worth noting that the university's Phoenix campus runs its own similar program.

One of the challenges in my new role will be tracking outcomes to see how many of our graduates are practicing in rural areas. In the past few years, we have added a number of new physician preceptors who participated in the Rural Health Professions Program as students. Having been through the program, they can provide good mentorship to new students and encourage them to stay on this path.

Students who have questions about rural health may be interested in an American Medical Student Association webinar(www.youtube.com) that (then) AAFP President-elect Robert Wergin, M.D., of Milford, Neb., participated in last month during National Primary Care Week.

Finally, the AAFP created member interest groups earlier this year as a forum for family physicians to share their mutual interests and address common concerns. One of the six groups that has already been established focuses on rural health. You can learn more on the AAFP website.

Carlos Gonzales, M.D., is a member of the AAFP Board of Directors.

Posted at 02:39PM Nov 14, 2014 by Carlos Gonzales, M.D.

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