This article first appeared in the St. Louis Beacon, Jan. 27, 2012 - At first, it sounds like a put-down when Dr. Angela Whitesell describes Lockwood, Mo., the place where she grew up. "It's a town in the middle of nowhere," she says, "and an hour away from everything." It soon becomes clear that her tone is reverential, another way of saying she was so "emotionally connected to the land" that she felt good about deciding to return home a few years ago to establish her medical practice.
Her decision to return to Lockwood, which has nearly 1,000 residents, is welcomed not only by the town but by the University of Missouri School of Medicine. For 16 years, the school has run the Rural Track Pipeline Program to boost the number of physicians serving rural parts of the state.
Whitesell is an example of the program's success. So far, more than 450 medical students have taken part in the program, and many of the 108 graduates have chosen to practice medicine in rural areas of Missouri.
"I always knew I wanted to live in a small town because I had a really good experience growing up in one," Whitesell says. "I grew up on a farm. It taught me the value of hard work, and it connected me, tied me, to the land. That's why I came back."
After finishing medical school in 2002, she practiced in a rural hospital in Nevada, Mo., before eventually moving back home to open a private practice. She and her husband, a historian at Missouri State University, have three children, a 7-year-old and twins who are 3 1/2 years old. She says everyone enjoys small-town life.
Lockwood is more fortunate than many other surrounding towns. It has a doctor. Whitesell's the only full-time physician in the town, which is about an hour's drive west of Springfield.
"We draw a lot of patients from surrounding towns that don't have doctors," she says. "A favorite part of my job is that I get to be an interpreter. (Medicine) is a whole different language. I love bringing good health care to the middle of nowhere and helping people pretty isolated from large health-care centers."
One reason for Pipeline's success is that it targets bright students from rural communities, says Kathleen Quinn, the program's director, Pipeline has four components, beginning with a pre-admission program for rural-born undergrads with strong academic backgrounds.
"The reason we pre-admit them from rural areas is because they are more likely to go back to a rural area for practice," Quinn says. "We work with them to prepare them for medical school."
The second component is a summer community program, followed by a six-month rural track clerkship for third-year medical students. In their fourth year, the students take part in an elective program that provides more training for a rural health practice.
Quinn says neither the state nor medical organizations have accurate data on where all doctors are practicing in Missouri.
"If we knew where our physicians were in the state, we could recruit kids from specific (shortage) areas and ... make sure we are getting the right people for the right places."
What she does know is that all but five Missouri counties are classified as having shortages of health professionals by the federal government.
"I can tell you that 20 percent of physicians nationwide work in rural areas, and that 57 percent of the students who go through our program work in rural areas," Quinn says.
Even so, she says the doctor shortage is getting worse nationally and that programs like the Rural Track Pipeline are important in light of research showing that only 3 percent of prospective doctors intend to practice in rural communities. Adding to the pressure, she says, is the projected 30 million new patients expected to seek care when the health-reform law takes full effect in 2014.
Quinn says that Pipeline could serve as a model for addressing the doctor shortages in pockets of urban communities. She says the university already has tapped into the Cristo Rey High School in Kansas City. Cristo Rey is a network of Catholic high schools nationwide that focuses on educating bright minority students. The school in Kansas City consists mainly of Hispanic and black students. The students attend classes four days a week and work one day a week in a private industry job. The money they earn is used solely to help defray tuition, which runs about $10,000 a year. Classes run from 7:30 a.m. to 4 p.m., and the school term runs 10 months. All students reportedly go on to college.
Quinn says some of Kansas City's Cristo Rey students are invited to the university during the summer to expose them to health careers. The goal, she says, is to interest them in attending the university as undergraduates and perhaps staying on for medical training. She says four Cristo Rey students have enrolled as undergraduates at the university since 2008.
Former students like Whitesell can attest to the value of the Pipeline program.
"I had some great college advisors who informed me of the need for doctors who were willing to practice in small communities," Whitesell says. "That's when I decided to pursue medicine. I spent time shadowing some rural doctors, and I loved to see how they were able to help patients navigate a difficult health-care system. For me, the (Pipeline) program was just an easy match and an easy fix."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.