MONTGOMERY Ala.As a physician in a rural area, Dr. Deanah Maxwell knows
there are times she’ll be stopped in the grocery store or at church for advice
sometimes not even medical advice. But for her, that’s half the appeal of being
a small-town doctor.
native plans to return to her hometown, with its population of under 12,000, to
set up practice after finishing her residency in Tuscaloosa.
But Maxwell acknowledges that the increased social obligations that come with
being a rural doctor aren’t for everyone.
“When you go back into a rural area as a professional,
you can’t just go back as a person in that profession,” Maxwell said.
“People look to you for guidance in areas other than, say, just medicine,
so there’s a greater sense of responsibility.”
To help prepare for the role, Maxwell has participated in
the Rural Health Leaders Pipeline programs at the University
of Alabama. The programs, like
similar ones elsewhere in the country, recruit students from rural areas, give
them specific medical training and help prepare them to be community leaders.
Expanding and improving rural health care is a cause that is
dear to program founder and director Dr. John Wheat, who received the
Distinguished Educator Award from the National Rural Health Association in May.
“I am a product of rural Alabama, and I am very much
aware of the different opportunities to get medical care that exist there
versus in urban and suburban Alabama,” said Wheat, who grew up mostly in
rural Sumter County outside Livingston.
Dale Quinney of the Alabama Office of Primary Care and Rural
Health said that in 2006 there were 907 primary care physicians in Alabama’s
55 rural counties and 2,137 primary care physicians in the state’s 12 urban
counties. Primary care physicians are those who work in family practice,
internal medicine, pediatrics and obstetrics-gynecology.
Dr. Donald Kollisch of the Rural Health Scholars program at Dartmouth
College in New
Hampshire said the ratio of patients to doctors is
about twice as high in rural areas as it is in urban areas nationwide. He said
rural areas account for about 20 percent of the country’s population but only
have 10 percent of the nation’s doctors.
Wheat said studies have shown that students from rural
backgrounds are more likely to live and work in rural areas than students who
are not from a rural area.
The pipeline program begins targeting rural students long
before they are eligible to enroll, putting on puppet shows and presentations
in rural elementary schools to make children aware of the different medical
professions that exist.
Another reason for the early start is to motivate rural
students to work hard to get the grades that will allow them to enroll in the
program down the road. Wheat said many rural children don’t feel higher
education is even an option for them as they are bombarded with statistics
showing high rates of failure among rural students.
“We decided we needed to start early to break through
that and to let them know they can, that they have a shot, and can make good on
their dreams,” Wheat said.
He said rural physicians typically end up making about the
same amount of money as those in big cities. But rural doctors, he said,
generally end up having to work longer hours and to perform a greater variety
Because rural areas tend to lack specialists, Wheat
encourages medical students who plan to work there to do extended residencies
and to do more internships to gain experience in as many different types of
medicine as possible.
The Rural Health Leaders Pipeline is actually a group of
three different programs, each designed to help a specific group of rural
Since 1993, the Rural Health Scholars program has selected
25 high school students each year to participate in a five-week program the
summer after they finish 11th grade. The students live on the University
of Alabama campus and take courses
for college credit. They also attend presentations and go on field trips to
expose them to the different medical professions.
As of last August, 364 students had participated in the
program. Of those students, 23 were in medical school or had medical degrees.
Others had entered nursing, health care management, dentistry, pharmacy, and
public health careers.
The Minority Rural Health Scholars program began in 2001.
Minority high school graduates from rural Alabama
who plan to attend college in the fall are eligible, and some students return
in the summers during college. The students take classes and tutorials to
increase knowledge and test-taking skills to help them get competitive scores
on the MCAT.
The Rural Medical Scholars program, started in 1996, each
year accepts 10 medical school students who have lived in rural Alabama
for at least eight years and who are interested in practicing in rural areas.
The program is five years long, instead of the typical four, because it
includes a year of policy and leadership training.
Wheat said that in the last four years, the program has
turned out 15 doctors who are currently practicing in rural Alabama.
Maxwell, the medical resident, participated in both the
Rural Health Scholars and the Rural Medical Scholars programs. She said the
programs made her feel less isolated and more confident in her goals.
“I think it was good for me to meet other students from
other small towns with similar backgrounds who had also set high educational
goals,” she said. “This program looks at rural students and takes
into account that these students might not have had the same education
opportunities and facilities as other students going into college.”
Dr. Clifton Garris, who grew up in Leroy and is now an
obstetrician in Sylacauga, credits the Rural Medical Scholars program with
helping him get into medical school and allowing him to live out his dream of
being a doctor.
“I can’t say enough about the program,” Garris
said. “I think it’s great. I think every state should have a program like
this because every state has underserved rural areas.”
Dr. Randy Longenecker of the Ohio State University Rural
Program said the University of Alabama
program is one of the most extensive, but that there are a number of similar
programs throughout the country, including those at the University
of Colorado, the University
of Wisconsin, Dartmouth
College and West
at Morgantown, among others.
But Longenecker said simply attracting students to rural
medical programs is not enough because “there are so many ways the
pipeline can leak.”
He said a relatively small number of rural students get into
medical school in the first place and many who do see medical school as their
ticket out of a rural area. Others initially plan to go back but then get their
education and do their residency in urban areas and end up meeting a spouse and
establishing a life in the city instead.
Kollisch and Longenecker both said they are aware of the
draw of living in an urban area and the challenges faced by doctors in rural
areas lack of equipment, lack of funding, lower levels of insurance
reimbursement, to name a few. But, for them, the benefits of living in a rural
area far outweigh the negatives.
“For me, as a rural physician, I can think of no more
rewarding career,” Longenecker said. “It’s more a 9-to-5 job in an
urban environment, whereas for us, in a rural area, it’s a way of life.”
– Associated Press
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