Medical School Program Sparks Rural Residencies

When medical students shadow the doctors at Hermann Area District Hospital in Hermann, Missouri, the experience not only teaches them the ins and out of patient care; they also get a taste of what rural medicine is really like.

"It lets them see that rural medicine's not that much different than urban medicine," Dan McKinney, administrator of Hermann Area District Hospital tells HealthLeaders. "From what they get exposed to at school to what they get exposed to out in a clinic setting are a little bit different."

Hermann Area District Hospital is among the Missouri hospitals that participate in the University of Missouri School of Medicine's Rural Track Pipeline, which prepares college and medical students for practicing medicine in rural areas. Overall, more than 450 medical students have participated in the program, which is funded by the University of Missouri School of Medicine; by local, rural community health care systems; and by a Health Services Resource Administration grant.

The program, which began in 1995, just published its first outcomes paper in the November issue of Academic Medicine. The study finds that 65% percent of students who participated in the program practice in Missouri, and 43% practice in rural areas of the state. In and outside of Missouri, more than 57% of participating students practice in rural areas.

"That's huge because in comparison, 9% of physicians practice in rural areas nationwide, and only 3% of medical school matriculants plan to practice in a rural area," Kathleen Quinn, Ph.D., lead author of the article and director of the program, tells HealthLeaders. "So when you say 57% of our students end up in rural, that's a pretty big deal."

The Rural Track Pipeline consists of several components, including medical school preadmissions for undergraduate college students who have a rural background and an interest in becoming a physician in a rural area.

According to the study 90% of preadmissions students are now physicians in Missouri. The rest of the pipeline includes a summer community program for second-year medical students; a six-month rural track clerkship for third-year medical students; and a rural track elective program for fourth-year medical students.

According to Quinn, the study finds that providing these multiple rural clinical experiences is associated with higher rates of students entering family medicine, which is important because that's the most common specialty in rural practice.

"If you just have one experience during your third year you're going to be less likely to enter family medicine in rural areas," she says. "We offer them so many opportunities."

Although the study contained few real surprises for Quinn, she says she hopes the paper can boost local and national focus on training rural physicians, especially since the Affordable Care Act will increase the number of people with health insurance. One goal is for other medical schools to replicate their program

"If there were 10 more students in each class in each medical school nationwide, we would double the amount of rural physicians," she says.

Quinn also hopes that policymakers will see that funding these relatively inexpensive programs not only provides good healthcare to their constituents but could also create jobs; she adds that having a physician in a rural area brings about $1.3 million into the community annually.

Quinn adds that there will be an increased focus on filling all of the program's preadmission slots "now that we know the preadmissions piece of the pipeline is definitely an added benefit because the highest percentage of those students end up in Missouri."

Although scholarships are a small aspect of the program, Quinn believes that financial incentives are less important to rural physician retention than making sure those physicians become part of the community in which they work.

"I think the only way for physicians to stay long term is to train them and get them integrated into communities so they can actually influence health behaviors and outcomes," she says.

McKinney agrees.

"As a hospital administrator, you want to see them stay," he says. "It helps build that part of the community."