Wanted: small-town students who want to become country doctors. Tulane University in Louisiana is among those mounting an effort to bring more doctors to underserved rural areas...
NEW ORLEANS — Wanted: small-town students who want to become country doctors. Tulane University in Louisiana is among those mounting an effort to bring more doctors to underserved rural areas.
The school is looking for students like Dr. Margeaux Coleman Walker, who has known she wanted to be a doctor since she was a girl and helped her grandmother clean the doctor’s office in Church Point, a town of 4,700.
But she wants much more than a medical practice. “Hopefully, when I want to retire, I’ll be able to say, ‘I worked hard and I made a difference in people’s lives.’ ”
She’s finishing her three postgraduate training years in the family-medicine residency at Baton Rouge General Medical Center and would like to wind up back in Church Point.
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“She’s just the type of student we hope to identify,” said Dr. Richard Streiffer, head of Tulane Rural Medical Education. Streiffer hopes to get six to eight students a year who want to stay in rural Louisiana and perhaps surrounding areas.
The lack of rural doctors is a problem nationwide, not just in Louisiana. One-fifth of the U.S. population — about 60 million people — lives in rural areas, spread over four-fifths of the land. But only about 10 percent of doctors live in rural areas, said Marcia Brand, head of the U.S. Office of Rural Health Policy.
Louisiana is more rural than most states. About one-quarter of its 4.5 million residents live outside metropolitan areas, along with fewer than one-eighth of its doctors.
Tulane’s new program is one of only a handful nationwide designed to train doctors for rural areas and inner cities where there’s a shortage.
The University of Washington’s WWAMI program — named for Washington, Wyoming, Alaska, Montana and Idaho — takes about 65 students a year from those five states. Students take first-year basic-science courses in their home states and second-year courses in Seattle, then take third- and fourth-year rural-medicine clerkships in their home states. More information is available at www.uwmedicine.org/Education/WWAMI/
One of the first such programs was set up in 1974 by Jefferson Medical College at Thomas Jefferson University in Philadelphia. Graduates of that program are eight times more likely than other med-school graduates to become rural family doctors, says Dr. Howard Rabinowitz, its director since 1976.
Over 30 years, the program has graduated just 350 students, but most stay in rural medicine. A study of the first nine classes found that 80 percent were still country doctors.
In contrast, almost half of all doctors who are lured to needy areas with medical-school scholarships or help paying off their college loans leave such areas after their time is up.
Part of it is the culture shock illustrated in the TV show “Northern Exposure,” about a New Yorker sent to the tiny Alaskan town that paid his medical-school tuition.
“I call our program the opposite of ‘Northern Exposure,’ ” Rabinowitz says. He looks for people who love the life to start with: “If they didn’t do rural family practice, they would probably go into another profession like teaching or health care or something in a small town,” he said.
Many doctors would rather work in cities or suburbs because the hours are shorter. There are more doctors to talk to if you run into a problem, and far more specialists.
“If you’re looking for more of a 9-to-5 practice where you can sign out and someone’s going to cover for you,” rural medicine isn’t for you, said Dr. James Devlin, a graduate of the program.
He’s a solo practitioner in Brockway, Pa., (pop. 2,500) checking his hospitalized patients seven days a week. It’s hard to find someone to do that if he wants a vacation. But he knew growing up that he wanted to go into practice with his father, who has since retired.
He said he loves knowing his patients as friends, as church members, as people — being part of their community.
“I wouldn’t trade that for anything,” he said.