Idaho AFP Champions Rural, Underserved Opportunities Program

FPs Win Students' Hearts, Woo Many to Rural Family Medicine

April 29, 2013 05:00 pm Sheri Porter

A program's longevity often is an indication of its success.

Such is the case with the 24-four-year run of the Idaho Rural/Underserved Opportunities Program (R/UOP), which represents a successful collaboration between the University of Washington School of Medicine in Seattle and the Idaho AFP.

Etasha Bhatt, right, now a second-year medical student, enjoys some downtime during her R/UOP experience in the summer of 2012 under the tutelage of Mikael Bedell, M.D.

The medical school has administrative control of R/UOP, and each year since its inception, the Idaho AFP has allocated $5,000 toward the program, which aims to alleviate physician shortages in a state known for its wilderness areas and rural lifestyle.

The end goal -- to fill the primary care pipeline with young physicians who will stay in the state to practice -- is so important to Idaho family physicians that for years a strong core of volunteers have introduced medical students to rural family medicine.

After more than two decades, the Idaho R/UOP has seen the placement of some 400 medical students in small Idaho towns with names like Sandpoint, Cottonwood, Shoshone and Blackfoot for four-week summer rotations between a student's first and second years of medical school.

According to an Idaho chapter evaluation of the program, an estimated 63 percent of R/UOP students matched to primary care residencies compared to 47 percent of students who didn't have that experience.

story highlights

  • The Idaho AFP strongly supports the University of Washington School of Medicine's Rural/Underserved Opportunities Program (R/UOP).
  • The chapter has allocated $5,000 every year for 24 years to the program and relied on a cadre of its family physician members to precept medical students for four weeks during the summer.
  • The goal of the program, which the chapter deems a success, is to fill the primary care pipeline in Idaho with young physicians who will stay in the largely rural state to practice medicine.

The program's popularity and success were recognized by the Academy in October 2012 when the Idaho R/UOP was awarded the AAFP Foundation's Outstanding Program Award(www.aafpfoundation.org).

Preceptors Make Program Perk

The Idaho program would not exist but for family physicians such as Mikael Bedell, M.D., of Cascade, Idaho, who for the past decade has welcomed students not only into his town of 1,000 but also into his home.

"I've housed many of the students, and we get to have conversations about the state of health care in our country and the role of family physicians," said Bedell in an interview with AAFP News Now. "The students interact like they are part of the family, for sure, and that's family medicine in a small town."

Bedell serves as the only full-time physician at Cascade's 10-bed critical access hospital, which also has a rural health clinic component. So why does this busy FP further complicate his life with precepting duties?

"First off, we need future family physicians, and we need to create enthusiasm for the specialty," said Bedell. "Secondly, I offer a small town perspective that most medical students won't see."

That's important, said Bedell, because most students attend medical school in cities with large medical campuses. When students come to Cascade, "they begin to realize that practicing medicine is different out in the country."

Seattle native and second-year medical student Etasha Bhatt spent a month under Bedell's tutelage in the summer of 2012. Cascade provided Bhatt with her first look at life in a rural community.

"I got to see what family medicine is about on a day-to-day basis," said Bhatt. She helped Bedell tend to children, adults and geriatric patients, and he gave her hands-on time with patients. She said that it was perfectly normal for emergency room activity to interrupt their clinic appointments and send the pair scurrying across the parking lot.

In 2002, (then) medical student Clay Joseph, left, accompanies FP Rich Paris, M.D., the pilot, on a flight to see patients in Challis, Idaho, a mountain outpost 130 miles from Paris' home in Hailey.

On four occasions, Bhatt helped stabilize emergency patients who required helicopter transport to Boise. "Anyone who needed immediate specialized surgical attention was airlifted out," said Bhatt.

Another 2012 R/UOP participant, Alice Bremner, also gave her experience a huge thumbs-up. The second-year medical student worked with James Dardis, M.D., in McCall, Idaho, a town with almost 3,000 residents.

Bremner grew up on Mercer Island, Wash. -- considered part of Seattle -- an area that was anything but rural.

"The kind of medicine I saw on my R/UOP (rotation) was the kind of medicine I want to practice," said Bremner. Caring for pregnant patients, delivering babies, watching kids grow up is what drew her to medicine, she said. "It's nice to know that kind of practice still exists."

Sitting alongside Dardis during patient visits "was like sitting down with your best friends over coffee and catching up on the last three to six months of their lives."

As a physician-in-training, Bremner was concerned about lifestyle issues as a small-town physician, but she was pleased to have found female physician role models in McCall who were content and happy in their careers. "I was seeing what the 'future me' could look like," she said.

Community Embraces Students

In Weiser, Idaho, Lore Wootton, M.D., said her town of about 5,500 is the largest in the county and has one hospital. She runs a rural health clinic in Weiser and a satellite clinic in a tiny town 30 miles to the north.

A Maryland native, Wootton claimed she always knew that rural family medicine was her calling, and she found the location of her dreams in Idaho. "Most of the state is pretty darned rural; you can't even drive across it east to west because the land is considered wilderness area," said Wootton. "It's a real culture shock for big city kids."

Wootton precepts R/UOP students and values the program's length. A month in a small town often affords students the opportunity to see multiple members of a single family.

"Students start to get the family connections, and they start to see how what's going on with this person could affect that person," said Wootton.

For their part, town residents warmly welcome the students. In fact, most years, a R/UOP student is living in the community during fiddle week -- that's Weiser's renowned National Oldtime Fiddler's Contest & Festival -- which has been in full swing the third week in June for the past 60 years.

"People see (the students) in the community and invite them down to this booth or that activity," said Wootton. "For me, it's just getting students to see how neat a rural area can be and how cool family practice is. They leave with an appreciation of looking at the whole patient and not just the heart or the gut."

FACTS ABOUT THE IDAHO AFP

Chapter executive director: Neva Santos, C.A.E
Number of chapter members: 639
Date chapter was chartered: July 19, 1948
Location of chapter headquarters: Boise
Website:(www.idahofamilyphysicians.org)
2013 annual meeting date/location: May 17-19, The Riverside Hotel, Boise

Residents Rave About R/UOP

"We witness many Idaho students pursuing a primary care specialty because of the influence of their R/UOP preceptors, and they characteristically maintain a special bond for many years," wrote Idaho AFP Executive Director Neva Santos in a 2012 letter to the AAFP Foundation as part of the outstanding program award nomination process.

Kathleen Wachtler, M.D., exemplifies that sentiment. As a first-year resident at the Family Medicine Residency of Idaho in Boise, Wachtler said taking care of patients in a city of 350,000 makes her long for her R/UOP days in McCall.

"I really appreciate that smaller town," said Wachtler. Born and reared in southern California, she admitted to preconceived notions about the life of a rural family physician before her time in McCall. "What that month showed me was that it's exactly those things I had in mind but a whole lot more," said Wachtler. "Dr. Dardis wasn't just a medical provider; he was one of their most respected community members.

"It's a whole different job description for a rural family physician," said Wachtler. When the closest city is three hours away, the rural physician has to be the cancer expert, the lung doctor and the kidney doctor. "Patients come to Boise for their treatment, but they go back to home for advice and all the interim treatment," she added.

The scope of practice and the community involvement she saw in McCall solidified Wachtler's commitment to family medicine in small-town America.

Ditto for Maureen "Mo" Ferguson, M.D., currently a second-year family medicine resident in Boise. She said spending a month in McCall, a mere hour-and-a-half from her hometown of Grangeville, was a reminder of why she'd always wanted to be a family physician.

She described the first year of medical school as "tons of minutia and details about everything," whereas R/UOP offered the hands-on patient care experience that she craved. "R/UOP is a phenomenal program; it's a great exposure to how real medicine is practiced in these small communities, which is very different from seeing practice in a tertiary center," said Ferguson.

Left to right: Mary Barinaga, M.D., takes time out for a recent photo with residents Kathleen Wachtler, M.D., and Maureen Ferguson, M.D., at the Family Medicine Residency of Idaho in Boise.

Recruiting Family Physician Preceptors

Mary Barinaga, M.D., of Boise, is the assistant dean for regional affairs at the University of Washington School of Medicine in Seattle. She's also the immediate past president and current treasurer of the Idaho AFP and a big supporter of R/UOP.

A R/UOP student herself back in 1992, Barinaga later paid that experience forward during a 12-year stint practicing family medicine in Plummer, Idaho, population 800. She precepted her fair share of medical students, and noted that R/UOP is successful because of its huge network of volunteer physicians -- 95 percent of whom are family physicians. "I'm a talent scout looking for those family docs who want to teach and share their lives with these students," said Barinaga. "The partnership between R/UOP and the Idaho AFP is a win-win for our state and our physician workforce needs."

Richard Paris, M.D., of Hailey, Idaho, a preceptor since the program began, still remembers his very first R/UOP student. He said, proudly, that she has been practicing family medicine in the state for more than 15 years.

Paris also was Barinaga's R/UOP preceptor and inspiration back in1992.

"I don't think we've ever had a summer where we didn't have a R/UOP student with us," said Paris, who is ready to welcome yet another student to town in July.

"These young students are so hungry to learn," he said. "When I see the enthusiasm that these barely finished first-year students come into the community with, it's rather remarkable. They energize all of us and make us feel better about what we're doing."

After many years in practice, Paris noted that sometimes it's too easy to focus on all the problems. "Sometimes we're feeling a little burned out, or our call schedule is wearing us down.

"Then this brand new person from the outside comes in and we see the practice through a student's eyes and say 'Gosh, I guess this does look pretty good. This does look like it's a lot fun, and we really are doing good things for our community.'"

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