Rural Scholars Program Grooms Primary Care Docs in AL

A program at the University of Alabama helps students prepare for the rigors of medical school—and careers as primary care physicians.

Mark Christensen, MD, knew he wanted a career in medicine ever since he served as an emergency medical technician with the volunteer fire department while still in high school at his tiny hometown of Toney in northern Alabama.

"I always thought it would be interesting to go the extra step and become a physician," Christensen says. "I enjoyed going into people's houses and taking care of them there and going all the way up to the hospital doors. But I wanted to see that other side of the doors as well and continue that care from inside the hospital throughout their stay."

Now a third-year resident in family practice at the University of Alabama School of Medicine, Christensen plans to return to rural Alabama when he finishes his residency in 2014. In large part, Christensen credits the University of Alabama's Rural Medical Scholars Program with helping him realize his dream of becoming a doctor. Christensen completed the scholars program during his senior year at the University of Alabama at Birmingham and it helped to prepare him for the rigors of medical school.

"They were able to help me because with the rural background and that kind of education I was at a disadvantage compared to some of the students going to bigger schools where they're doing calculus in the 8th grade it seems like," Christensen says. "We just didn't have those resources growing up and I didn't even know what I needed to know. This program definitely helps with that. They saw the potential in me and it turns out, I guess they were right."

Christensen says the tutoring and counseling he received from the program proved to be invaluable. "Coming into college was a rude awakening about how much you needed to study. I had no preparation for that coming in. They really helped you," he says.

"It takes a lot of things to get into med school, MCATs and GPA. A lot of people getting into the program have low MCATs. My MCATS were fine. I probably could have gotten in the regular way, but they help make you a better overall applicant. They understand you have a true desire to do this and they advocate for you to get in."

On Thursday, dozens of recent college graduates and college seniors from across rural Alabama will be interviewed and 24 of them will be selected to become Rural Health Scholars for the coming year. They will spend the time prepping for medical school and shadowing rural providers.

Susan Guin, RN, the associate director the Rural Scholars Program and a nurse practitioner, has been with the program for 17 years. She says interviewers try to find that mix of medical school candidates who can combine solid academics with the relationship-building and communication skills needed to thrive in rural environments.

"The common theme is that they come from a rural area so our selection criteria require that you have spent at least eight years of your life in a rural community. We try to select the student who has the desire to go back for the community and has a sense of family and home and wanting to be involved and immersed in the local community," Guin says.

"We are not necessarily looking for a GPA of 4.0 and an MCAT of 30. That is a great student and a smart person but there are also smart people who may have a 3.3 or 3.4 GPA, but they still do well and can sit down and carry on a conversation. They understand local culture and how to communicate with different people. There is value beyond the typical standardized testing idea."

While the rural scholars are not required to sign any sort of contract, Guin says there is "more of a handshake agreement" that they will commit to rural medicine when they graduate from medical school. The program appears to be working.

"[Within] general regular medical school admissions you are looking at maybe 10% of med students [who] end up going into family medicine/primary care. For us, we've got at least 60%—70% ending up in primary care, which would include family medicine and internal medicine and pediatrics and 90% that are staying in Alabama as practicing physicians. Some are cardiologist and radiologists, but they are still coming through our program and staying in the state. So we are not training physicians and seeing them go to another state. Those numbers alone are way outside the box for the norm."

The Rural Scholars program has proven so successful that it has morphed into a Rural Health Leaders Pipeline with six distinct programs that involve about 150 students of various ages at any given time, and even identifies and recruits 10th graders who've shown an interest in pursuing careers in healthcare.  

"We work with them for the nine-month school year, at least having monthly meetings with them. College students, medicals students, and residents interact with the 10th graders to be mentors for students who might be interested in some sort of health profession," Guin says.

A separate program for 25 eleventh graders includes a five-week summer program with courses in chemistry, creating writing, and visits to hospitals and physicians offices. There is also a Rural Minorities Health Scholars program that provides first-year college students with preparatory classes in biology and shadowing healthcare providers.

Although he is committed to practicing in rural Alabama, Christensen says he understands the challenges that come with living in the country.

"It's hard because as we go through medical school we accumulate so much debt. The bill I just got the other day was $187,000. I can defer that because I am in residency for another year, but after that I have to start paying $187,000," he says.

"I don't know what $187,000 is! The most we had in the bank account growing up was $26,000 a year combined. In a rural area, you feel like you want to make up what you are in debt for and then some and so rural areas might not make as much money or you might go into a specialty and they are usually in bigger cities."

"Also as you go through medicine, you decide education is important and you look back at think, 'I was in a rural area and I didn't get a good education and I want my kids to have a better education so I am going to go to a large city where they will get a better education, better cultural opportunities and all that.' So it is hard balancing all of that."

Even with those challenges, Christensen says he's excited about his career path. "The more rural you are, the more skills are in need for all aspects of family medicine, which includes taking care of a kid on the pediatrics floor and then walking over to the ICU to take care of an adult in critical condition and bring them back to life and then you go to your office and treat a family," he says.

"I love that you can practice to your maximum ability. And as long as you are good and passionate about those areas, you will do fine. I put myself against any of those specialists any day."