Thu March 20, 2014
Building A Pipeline Of Doctors To Help The Shortage In Missouri's Rural Communities
Part three of three
For someone who was clueless about what he wanted to do after finishing high school, Luke Stephens has done quite well in life.
He’s now Dr. Luke Stephens, with a degree in cell and molecular biology from Missouri State University in 2004, and a medical degree from the University of Missouri at Columbia.
Stephens, who is in his early 30s, is a primary care doctor who specializes in rural medicine. He’s the product of a special University of Missouri program that trains more doctors to help Missouri plug some of the holes in its primary care system in rural communities. He practices in Fulton, serving many patients in rural communities near the town.
In a state with more than 5,000 primary care doctors, it would seem easy to find at least one to set up practice in each rural county that has none. But the experience of the UM Rural Track Pipeline Program, of which Stephens was a part, shows how difficult it can be to recruit and train doctors for rural assignments, said Kathleen Quinn, who helps coordinate the UM program.
Fifteen years ago, the university committed to set aside 15 slots a year for what became known as the Rural Track Pipeline Program. Unfortunately, Quinn said, only about nine of those slots are filled each year.
The relatively low participation rate is due in part to a requirement that participating students must come from rural communities and are encouraged to return to rural areas to set up practices. Rural upbringings are part of the requirement, Quinn said, because researchers have found that such students are more likely to want to settle in a rural community after med school.
“A lot of times, some students from rural areas don’t think about becoming physicians,” Quinn said. “They might not have a physician role model in their town; they may not have a lot of advanced course work at their high school.”
Some of the recruits, like Stephens, learn about the program by accident. He admitted being “pretty uncertain about what I was going to do” after high school. The answer began to take shape the day he spotted a flier about the medical school program during a visit to the office of his mother's office, a counselor at his high school in Iberia, Mo., population 600.
Perhaps the pamphlet caught his eye because it called attention to his small-town roots, mentioning that rural students like him could be part of a pre-admissions program that put them on the path to study medicine and increase the supply of doctors in rural communities.
“It’s one of those things where you find people with natural attractions to small towns and want to go back to small towns,” Stephens said of the program. “You feel comfortable with that setting.”
Quinn said she hopes to have an easier time finding recruits now that UM has expanded the number of universities involved in the pre-admissions program. The seven additional schools include the University of Missouri campuses at St. Louis and Kansas City.
Still unclear is how many rural students attend these universities and how many of them will be interested in careers in rural medicine. Quinn said she hopes the experience these students have in the pre-admissions program, “in medical school, and in going into rural areas to learn medical care will make them fall in love with it a want to go back to rural areas and practice it.”
The program has shown mixed results so far. Quinn said that about 57 percent of students who take part in the program decided to return to rural communities to practice medicine. That compares to only about 20 percent of medical students in general having an interest in rural medicine. The findings, Quinn said, suggest that the university’s program has made a difference even if it hasn’t met its recruitment goals each year.
Not the only game in town
A different strategy for adding students to the family medicine pipeline is occurring at Saint Louis University. It is partnering with in the St. Louis area with SSM St. Mary’s and the Family Care Health Center. The partnership is training about a dozen medical residents for family medicine careers, said Dr. F. David Schneider, chair of the Department of Family and Community Medicine at Saint Louis University.
He pointed to another trend in the effort to encourage more doctors to go to rural areas. Several places are building medical schools closer to rural communities to attract more rural students. An example is Salina, Kan., where the University of Kansas opened a medical school in 2011 with a class of eight students. All are getting training in Salina, with free tuition and monthly stipends in return for starting careers in rural communities, Schneider said.
Across the river, SLU has a partnership with the U.S. Air Force to train about 42 residents. Schneider noted that SLU’s program wants to focus on people who want to stay in the metropolitan area. Some in the Air Force program will return here once they complete their military obligations. He said it’s conceivable that some residents in both programs might decide to work in underserved areas outside of cities.
Schneider said more patients will have access to care through the Affordable Care Act, and that Missouri needs to develop more data to figure out how many additional primary care doctors it will need.
“We know that people get better care sooner if they have health insurance,” he said. “They don’t wait until medical problems become dire if they have access to primary care.”
The physical and economic cost of the doctor shortage
That comment brings clarity to the relationship between poor health and longevity among women in particular. The Institute of Health Metrics and Evaluation at the University of Washington issued a report that mentions that life expectancy actually dropped between 1997 and 2007 among women in 34 Missouri counties, 27 of them rural.
Findings like these show the need for Missouri to pay more attention to the consequences of poverty and the doctor shortage in rural communities, said Martha Ray, a community services specialist with Central Missouri Community Action.
She mentioned several examples of the consequence of poverty and inadequate health services for children. She said school officials in her service area have told her that “many children, due to the family’s financial issues, who do not have access to the required sports physicals” and that are needed to take part in school sports.
Likewise, she said, “counselors tell us many of the children don’t have state-supported health care because the parents are unable to complete the application process due to literacy issues.”
Ray said a top school official “tells us that normal health screenings are not available to many of the children because their parents have transportation issues.”
Beyond the impact on people's health, there is an economic toll when rural communities lack doctors, according to the Missouri Hospital Association. A single doctor practicing in a rural county can be expected to generate an average of $1.2 million in annual revenue and 23 jobs. The loss of even a half-time doctor translates “into a community loss of more than half a million dollars and 14 jobs," the association said.
Challenges to rural health care
Medical Care Shortage.