Rural Healthcare Can Entice the Best and Brightest

Ali Chisti intends to pursue a career as an internist and a population health specialist providing care in underserved and rural areas—not as a neurosurgeon as he had originally planned. He changed his mind when he came to understand the gap in resources between rural and urban areas.

Medical student Ali Chisti had planned a career as a neurosurgeon when the real world stepped in and offered a decidedly different career path.

A friend and coworker at a Bandon golf course along the rural southern coast of Oregon where Chisti caddied broke his wrist and had to declare bankruptcy because he couldn't pay the $12,000 in medical bills he'd incurred.

"That's when I saw that resources were different in rural versus urban areas," Chisti says.

In fact, there was a community health center, the Waterfall Clinic, serving the Bandon area, but its Web site wasn't working, their phone lines were often busy and they didn't have the staff or the technical support to fix the problem. As a result, Chisti's friend couldn't find out about reduced fee services they provided.

So he had to go with a more expensive option that left him with a huge bill relative to his income and few options beyond bankruptcy.

"It really is a group of good-hearted people that just didn't have the resources of the federally qualified health centers in Portland, where there is a staff of physicians," Chisti says.

"At Waterfall there was one physician who oversaw eight nurse practitioners and the physician comes in one day a week. They were trying to recruit more, but they were having problems getting people to come out there. I was thinking if I was a doctor trying to come out and work at this clinic, the first thing I would do is look for their website. Or if I was a patient I'd want to know if they have the resources so I would look them up on the website to see what they have. But those things weren't there."

Chisti saw where he could help and he volunteered to reboot the clinic's Web presence. "I used to build websites in college to pay for my MCATs, so I could do one thing really [easily] and build them a website, get them some web presence, put in some software that lets you know how long people are sitting on each page—the analytics. That is when I saw that their employment page was the top hit after I launched it, and still is. People sit there for a few minutes and they are reading it. They are getting a lot more people responding."

Chisti also helped to build a referral network, but it didn't quite develop as well as he wanted. "I saw a need to address access issues, programs, and interventions, but I realized I didn't have any formal training," he says. "Some of the initiatives I started failed. And that is when I realized that I am capable of performing these tasks but I couldn't. I wanted to make sure they were sustainable and done the right way."

So he took a year off from medical school at the Oregon Health & Science University to attend the Harvard School of Public Health, where he will earn a master's in public health this month before returning to OHSU for his fourth year of medical school. "The Harvard School of Public Health is good for health policy management, the track that helps me realize how to manage a program and how to study it to know whether or not it is good enough for a policy intervention to upscale it."

When he graduates from medical school next year, Chisti, 27, will pursue a career as an internist and a population health specialist providing care in underserved and rural areas like Bandon. Eventually he hopes to serve on the faculty of OHSU while maintaining an active practice.

Chisti's story is impressive and even inspiring. It is also plainly illustrates the sacrifices that young physicians are forced to make if they want to provide primary care in rural America.

For starters, Chisti is not wealthy. He had to work summers as a caddie and find other odd jobs to help pay for his education. He will graduate from medical school with more than $150,000 in student loan obligations. And he is planning to enter a medical field that will pay significantly less than he could otherwise earn.

Physician recruiter Merritt Hawkins says that the starting salary for a neurosurgeon in coastal Oregon is about $450,000 while an internist can expect to earn about $190,000 or "probably less if they are practicing at a community health center."

Chisti is a notable exception, but it is not realistic to expect too many young physicians already mired in debt to take up a career path that offers long, uneven hours and a huge pay cut.

"For me, I don't really count the hours when I am doing something that is very rewarding," Chisti says. "When people ask you for a favor and you are in a position to do that for them, whether it's helping a friend navigate a healthcare system, it's not something that I consider being on the clock for that. I actually know the answer to these questions so I can help. Or I can help somebody create a program that will help stop kids from taking drugs, if I can do that as a job it's a no brainer."

Chisti says the Rotary Club in Bandon asked him what would make a physician stay in a community. "You can make people feel like it's their community, which it is," he says. "Get them out there and involved and they will realize how special it is and how it is a gem to be there."

What about a family? What about meeting a spouse who'd be willing to settle down in rural America and put up with the longer hours without the frills and distractions of urban life? Chisti says "that's the hard part. Whoever chooses or agrees to be with me will know what is important to me, so that will self-select somebody, I think."