RURAL FAMILY DOCTOR
STFM Group Meeting in Chicago
The Group held a seminar to examine rural medical education at all levels. Tom Rosenthal outlined pre-professional preparation, Rick Blondell highlighted Kentucky's innovative approach to admissions, Jeff Stearns reviewed early rural exposures, David Acosta and Deb Phillips spoke on residency and fellowship issues, and Hal Williamson and Bob Bowman summarized the various stages and their relationship to community practitioners. This presentation was compacted from a Theme Day into a two hour seminar, but it was by far the Group's best effort. About 20 attended including some of the community practitioners that were sponsored by STFM to come to the meeting. A similar format also was presented at Orlando at the National Rural Health Association meeting. Rural faculty networked at the Program Director's meeting in June and will meet again on July 31 at the AAFP Student-Resident meeting. The final event of the year is the Annual AAFP meeting.
NRHA to Meet in Orlando
Gail Bellamy, the incoming president of NRHA has worked closely with rural faculty on several occasions. This is a great opportunity to advance rural medical education efforts.
Preparing for Rural Practice 1998
If you plan to be at the NCFPR-NCSM Annual Meeting in Kansas City, please contact Bob Bowman. We will again be doing the "The Preparing for Rural Practice" presentation. We expect about 100-200 students and residents to attend the two presentations on July 31st at 11 AM and 1:15 PM. This is the only chance for many to explore a rural career. Rural faculty participate in small groups to help students and residents with career questions about rural lifestyle, choosing a rural-oriented residency, using residencies to prepare for rural practice, and choosing a rural practice site.
Dr. Bob Boyer continues to give an outstanding presentation . He is a gifted storyteller and the stories illustrate the challenges and rewards of rural practice. Our thanks to him. We also have a video of this presentation. If you need a great speaker for your family practice or rural group, please contact Dr. Boyer at 131 West Copeland, Kingman KS 67068 or 316-532-1839
AAFP to Rerun Making a Difference
"You Can Make a Difference" is now available through AAFP. This brochure will make an excellent resource material for a rural presentation at student interest meetings, especially for a rural student group.
Barriers to Rural Graduate Training
Barry Saver has worked long and hard to review this area for the Federal Office of Rural Health. The pamphlet reviews many of the areas that inhibit rural training. Contact the federal office or one of the STFM Group officers for information on this work.
This newsletter is the work of the editor, Robert Bowman, who is a Co-Chairman of the STFM Group on Rural Health. The views expressed in RFD may not represent the policies of either the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the National Rural Health Association, or the UNMC Department of Family Medicine.
Last Chance for a Rural Voice in Health Care
In the past few years multiple factors conspire to make it difficult for rural communities and physicians to keep the reins of health care within their reach.
* Managed care continues to extend its reach from urban bases, including new emphasis on Medicaid and Medicare patients.
* Urban networks in need of primary care base have made attractive offers to rural practitioners, with ownership leaving rural communities. Practitioners near retirement have seemed particularly vulnerable to such efforts.
* Mergermania continues throughout the business world, and medicine is no longer immune to the business aspects of American society. Bigger may not always mean better when it comes to rural health.
Countering these massive forces are a few small voices, but the numbers are growing. These include:
* State initiatives to build rural networks for improving rural services, bidding on care contracts, or even providing insurance products;
* Rural practitioner and provider-based initiatives to provide alternatives to urban based interests;
* Academic "facilitators" that gather rural providers together for training and support.
The stakes are high. Few think that federal- or state- sponsored plans can meet the various individual needs of rural communities. Evidence is mounting from demonstrations that local initiatives can get organized, buy the needed expertise, provide effective care, and meet the unique needs of their communities. Evidence also points to many problems when local physicians grow more distant from the control process. this issue will highlight efforts that can make a difference.
STFM Group on Rural Health Co-Chairs
Robert C. Bowman, M.D.
UNMC Department of Family Medicine
600 South 42nd Street Phone (402) 559-8873 Fax -8118
Omaha, NE 68198-3075 RBOWMAN@MAIL.UNMC.EDU
Jeffrey A. Stearns, MD, Director, Rural Medical Education Program
University of Illinois College of Medicine at Rockford
1601 Parkview Ave. Phone 815-395-5780 fax -5781
Rockford, Il. 61107 E-mail jstearns@uic.edu
Rocky Mountain HMO
Nebraska Networks
Nebraska Center for Rural Health
Texas Statewide Rural HMO
The Rural Hospital Project and Bruce Amundson
Amundson, Bruce A.; Hagopian, Amy; and Robertson, Deborah G. Implementing a Community-Based Approach to Strengthening Rural Health Services: The Community Health Services Development Model (Parts I and II). No. 11, February 1991. http://www.fammed.washington.edu/wamirhrc/publications/rhrcwp.html
Family Medicine Residency Programs and the Graduation of Rural Family Physicians
This publication in the April issue of Family Medicine is the culmanation of years of work by STFM Group officers. For an expanded version and some additional items from the publication, ask Bob Bowman.
Visit Our Web Sites
Rural Clinical Information/Discussion listing - Deb Phillips handles most of the rural medicine clinical info. This home page for the STFM Group on Rural Health is www.ruralfamilymedicine.org
Editorial: More Need for Cooperation
The families in family medicine need some family therapy regarding rural issues. Many of us at STFM have been "too busy" and often feel left out. AAFP Rural Committee folks have been busy with the brochure, but even busier in rural and academic careers. The National Rural Health Association provided the best rural sessions and networking again this year, better than STFM's Boston meeting and AAFP at New Orleans. NRHA also has advanced plans to work with STFM regarding membership and rural health issues, something AAFP has yet to really support. The past predoc meeting in Austin and most program director's meetings have some rural opportunities, but really not much for the die hard rural advocates.
Much is at stake. AAFP has most of the political muscle and staff resources, but more priority for legislative issues and practice issues. Rural workforce issues, rural medical education, and rural student interest groups are just a few areas where AAFP could really increase the potential for improvement in rural health, national workforce policy, and influencing trainees toward rural practice. Students are now more interested in this area. Will AAFP respond?
I have had a chance to meet, talk, and work with all of the past AAFP Staff people assigned to the Rural Committee. They are super folks, just very busy with other areas. I realize the AAFP employs a lot of people and has many important functions, but rural health will never get the response it deserves unless there is a staff person that is 51% rural. This is a priority for rural faculty and it should also be a priority for rural physicians in practice, those who need future colleagues, and students and residents who would or could choose rural practice in the right situations. What about a staff person working with the AAFP Rural Committee, the Division of Education, student interest groups, meeting planners, and with liaisons with STFM and NRHA?
With most of the current trends pointing away from rural practice, we can ill afford to wait to act. In recent months Nebraska's governor used his line item veto to scratch out $150,000 in funds for family medicine. The major state funding remained intact, but it is a warning to those even in a rural state with rural emphasis programs. Family medicine must produce rural physicians or suffer the consequences.
Rural Interested Students
I requested information from the 1995 AAMC Graduation Questionnaire. Michael Schuchert was gracious enough to collect the information. I received the following information on the 294 senior medical students that were interested in practicing in towns of less than 10,000 as compared to all 13000 responding graduates (of 16000 total). This cut point was a bit more rural than anticipated so it may represent those interested in really rural vs general rural. An indication of rural interest at this point may not mean eventual rural practice nor is the analysis statistically valid, but the comparisons are interesting.
Rural-interested students are slightly older and more likely to be married and have kids. A few more are from rural backgrounds and have rural spouses, but the differences are small. Higher percentages of whites and females are interested as compared to their graduating peers. Seems like specific interventions to keep females interested are in order. Lower percentages of Hispanics and Asians show rural interest. Higher percentages are interested among those who are from public medical schools. Fewer are interested in research, but when interested, they are interested in researching health care delivery or social science (but no different in impressions of health care access as compared to peers).
Family practice is by far the preferred specialty. Twice as many had decided on specialty before medical school began (30 vs 15%) so why can't we pick better? A significant number decided later though. Primary care components guided their career choice. Private group practice is also the preference with a significant group (71) interested in state/federal practice. This is three times the number of NHSC folks who responded. Twice as many rural-interested took rural and international electives. Twice as many did volunteer work at public health clinics and serving the underserved and community medicine electives. Encouraging liaisons with volunteer, Christian, and other international programs could have long term impact.
Graduates preferred the west and avoided the midwest in eventual state location plans. If you are in the midwest or southeast, few senior students are thinking about locating in your area. Programs to encourage students to stay in their states are still needed.
Rural-interested students thought basic science, research, and hospital teaching was a bit excessive, and thought clinical skills, geriatrics, preventive, HIV, public health, and primary care issues lacked enough emphasis. Perhaps the curriculum lags behind actual practice???? Twice as many were dissatisfied with their medical education as compared to peers. Rural students expected substantially less future income. There were not major differences in debt, but rural students got somewhat less support from medical school loans and more support from private or other loan sources.
What would life be like in 2020 if we got more of these rural-interested students? I would have to say we could have a much nicer workforce balance and less of a corporate mentality in medicine, although they would likely walk all over the faculty, institutions, and programs that got in their way.
New Member Registration for STFM Group on Rural Health