Magnolia State Grows Its Own Rural Primary Care Physicians

Patrick "Brent" Smith, M.D., is a third-year family medicine resident at the University of Mississippi Medical Center, or UMMC, in Jackson. He was also one of the first scholars in the Mississippi Rural Physicians Scholarship Program, or MRPSP. As such, he'll soon return to his Mississippi Delta hometown of Cleveland (population 12,300) to be a rural family physician.

"I'm going home -- as Bear Bryant said when people asked why he left the football team at Texas A&M to return to Alabama, 'Momma called. And when Momma calls, you just have to come runnin'," Smith said.

Getting family and other primary care physicians to sprint back home to practice in rural, underserved communities is the goal of the MRPSP. Conceived by the Mississippi AFP, the scholarship program is a way for Mississippi to grow its own physicians and alleviate crisis-level health care professional shortages in many areas of the Magnolia State.

Beth Embry, executive director of the Mississippi AFP, points to Mississippi's notoriety as "the most obese state in the nation" and its resulting "staggering rates" of cardiovascular disease, hypertension and diabetes as key reasons to nurture more FPs and other primary care physicians.

The state's current physician workforce is stretched thin, according to Embry, with physicians in 63 of the state's 82 counties having patient loads that are between two to more than four times greater than the physician-to-patient ratio recommended by the Council on Graduate Medical Education. Issaquena County in the Mississippi Delta has no physicians at all.

"Accessible primary care is fundamental to diagnosing and treating common ailments while providing follow-up care for chronic illnesses," Embry told AAFP News Now. "We need more rural physicians."

To recruit, nurture and guide those rural docs, Mississippi AFP leaders, with the support of the Mississippi State Medical Association and UMMC, researched, crafted and lobbied for legislation to create the rural physician pipeline program.

The Mississippi Legislature passed the MRPSP measure in 2007 and appropriated $300,000 for 10 scholarships. Since then, the appropriations have grown to $1.2 million and fund a total of 40 scholarships.

Janie Guice, executive director of the MRPSP, visits the state's 14 public and private colleges and universities and 16 community colleges to recruit rural students who aspire to return to their hometowns to practice primary care medicine, including family medicine, general surgery, pediatrics, internal medicine-pediatrics, OB-Gyn or general internal medicine.

In addition to high grades, a strong work ethic, and experience or background in a rural area, Guice told AAFP News Now that she looks for other personal characteristics.

"I’m looking for two personalities: the 'maverick' who will complete their training and return to fix everything that's wrong in the local health care delivery system, or the 'missionary' -- the student who says, 'I thought about going to seminary, but I've always wanted to be a doctor.'

"To which I reply, 'Have I got a mission for you -- Mississippi. We need you in the north, south, east central, west, southwest and the Delta, and you don't need a passport.'"

The longitudinal program grooms future rural physicians from college through medical school and into residency through academic enrichment and faculty and physician mentoring, including by family physicians.

Thanks to some private funding, scholars recruited in college receive Medical College Admission Test, or MCAT, preparation and participate in Medical Encounter workshops at UMMC, which include instruction in medical procedures and clinical skills. They also perform a community needs assessment. The premedical students shadow a rural physician mentor, usually a family physician, in their hometown areas.

The UMMC Department of Family Medicine is actively involved in the pipeline program.

"Our department organizes a suturing workshop to teach multiple suturing techniques," said department chair Diane Beebe, M.D. "Once in medical school, all scholars who have declared family medicine as their interest are paired with a family medicine faculty member as a mentor. The scholars can call on their mentor for support, questions and clinical experience -- even during their preclinical years," she told AAFP News Now.

At UMMC, tuition is $15,650 a year; at the new William Carey University College of Osteopathic Medicine, or WCUCOM, in Hattiesburg, Miss., it is $38,000 a year. Guice said that the medical school scholarships mean that students can complete their medical degrees at UMMC virtually debt-free. As a result, they can choose primary care specialties, including family medicine.

"The founding MAFP physicians wanted the figure to be high enough to free the future doc from the $150,000 debt that's the average amount a UMMC student departs with," Guice said. "Considerable research supports the debt burden as being a major cause of medical students seeking subspecialties as a means to free them of the debt burden.

"MRPSP allows a student to follow their missionary zeal without the ball-and-chain," she added.

Ned Miller of West Point, Miss., became a scholar during his junior year in the biomedical engineering program at Mississippi State University near Starkville and now is a student at WCUCOM.

A rural physician's son and former emergency medical technician, Miller told AAFP News Now that he would have gone to medical school without the MRPSP, but the scholarship has made it easier to choose a primary care specialty.

"I am not going to walk out of medical school with $250,000 in loans and $2,000-per- month debt payment before I even hang out a shingle," he said. "So while I would have still gone to medical school without the MRPSP, I might be choosing a higher-paying specialty.

"I have seen the effect that rural primary care doctors have had on rural Mississippi. I want to continue (to) preserve the altruistic nature and benevolence of rural primary care medicine in Mississippi."

UMMC's Smith serves on the MRPSP Commission, a comprehensive group of representatives from various primary care and other health professional organizations that oversees the program, and helps guide the undergraduate Medical Encounters at the UMMC campus. He's also a member of the AAFP Commission on Membership and Member Services.

Smith said he plans to do a fellowship in sports medicine before he returns to his hometown to practice as a family physician.

"I absolutely want to be a family doc," he explained. "I want to have the ability to care for everything that walks in the door. I think that is what is needed, in Cleveland and everywhere, and I enjoy the challenge of it, as well."

John David Bullock, M.D., of Sumrall, Miss., is one of the MRPSP's family physician mentors. He told AAFP News Now that rural scholars from The University of Southern Mississippi in Hattiesburg have shadowed him and his staff at Hattiesburg Clinic to observe office visits and procedures.

"It's good to bring these young students in with their energy and curiosity and questions," said Bullock. "It helps keep us on our toes and keeps us from getting in a rut." What's more, he added, the area just might get another FP out of the deal.

According to Guice, that's what the scholarship program is all about: It's a grassroots effort -- supported by academia -- to enlighten, engage and enlist young people to commit to caring for the neighbors they've grown up with.

"These scholars value a family, church and community-based environment where people have acreage -- not lots -- ride four-wheelers and horses, hunt, and shop at the Piggly Wiggly or Sunflower grocery store," she said. "This is the premise by which Mississippi is growing our own rural family docs."