Robert C. Bowman, M.D. Professor
Past Co-Chair NRHA Rural Medical Educators Group Chair of STFM Group on Rural Health
Progress in Rural Medical Education 1990 to 2004
“Progress” reviewed since AAMC Rural Medical Education conference in 1990 and progress toward the goals of this conference. We had great plans however .....
Tables of Family Medicine Residency Graduates – comparisons of allopathic, osteopathic, and international medical school students who have graduated from family practice residency training programs in 1997 – 2003. Schools are ranked by rural graduation rates and total numbers given. The new leader in family practice graduation totals is Ross University in Grenada. Ross contributed over 90 of the 2003 FP Graduates. Osteopathic and international schools continue to move allopathic programs out of the top positions regarding FP grads. Regarding rural graduates, osteopathic schools share leadership with Duluth, Mercer, and a handful of allopathic public medical schools. Multiple tables and rankings
Why a Preceptorship Is Better – review of rural preceptorships and studies documenting the value of preceptorship training
Medical Education Retardation - current concerns regarding the preparation of physicians to serve the underserved, rural and urban, given the slow deterioration of medical education intensity and volume and impacts of liability and disruptions of continuity.
Accelerated Family Medicine Training Programs
Changing Rural Background and impact on Medical Education
Family Medicine Physician Distribution - Recent Graduates 1997 - 2003
New Presentations
Rural Background, Rural Interest, Rural Workforce - compilation of old and new studies documenting reasons for RME
Rural Medical Educators and Rural Workforce - challenges in RME and opportunities
Community Driven Approach: Linking Resources with True Needs
Heroes in Medicine – Docs of the year and role models
Admissions Package – for more and better rural physicians
Rural doctors have been able to eliminate colon cancer in entire counties.
AAMC GQ 1995 Rural Interested Seniors (allopathic)
Only 1000 of 16000 interested in towns of <10k
60% interest in socioeconcomically deprived
Usual med student less than 10%
Rural Interested = Service Orientation
Twice as likely volunteer locally
Twice as likely to do missions and experiences overseas,
Twice as likely to try military experiences
At all years med school
Actually can’t stop them from doing service and learning, don’t try!
Research Ethics
When a study is so effective that it would be unethical to not allow the intervention to be applied to all subjects, the usual is to terminate the study and adopt the treatment
The data is in, we need more rural docs, more rural experiences, more rural interested students, who will serve patients better – period.
Selecting for these is never a waste!
But Wait, there is more….
Economic Impact
Rural docs worth 1 million a year in impact
MN RPAP invest of 20 million by state, worth 2.2 billion to rural Minnesota
Hospital, nursing home, pharmacy
Job multiplier plus jobs kept plus opportunity to recruit jobs in towns with rural docs
Rural Community Characteristics Contributing to Success: Advantage Rural
Awareness of issues +++
Motivation from within +++
Smaller geographic area ++++
Adaptability ++
Social cohesion +++
Ability to discuss, cooperate ++
Identifiable leaders +++
Prior success
Dead Horses From Divine Humor
When riding a dead horse
Best strategy is to dismount
In our various government programs however, a whole range of far more advanced strategies is often employed.
Winston Churchill said that Americans could always be counted on to do the right thing, after they had exhausted all other possibilities.
Here are some of those Dead Horse strategies.
When you find yourself riding a dead horse, and you are not a Dakota, then you will be tempted to, (choose one or more for years):
Change riders.
Buy a stronger whip.
Do nothing: "This is the way we have always ridden dead horses".
Visit other countries to see how they ride dead horses.
Perform a productivity study to see if lighter riders improve the dead horse's performance.
Hire a contractor to ride the dead horse.
Harness several dead horses together in an attempt to increase the speed.
Provide additional funding and/or training to increase the dead horse's performance.
Re-classify the dead horse as "living-impaired".
Declare that, as the dead horse does not have to be fed, it is less costly, carries lower overheads, and therefore contributes substantially more to the bottom line.
Promote the dead horse to a supervisory position.
Examples of Making a Difference and Problems with Research and Researchers who do not take this into account
Oncologist presentation last week. Not a great presentation except for cancer docs, but take home for FP (other than Cleveland Clinic has best stuff in nation for multiple myeloma)
Amyloid heart has 3-4 month survival. Having a dedicated female cardiologist who interacted with patients resulted in a 12 - 15 month survival of amyloid (small study) with treatment, but she left
Study repeated on larger number with a mix of cardiologists and the patients only lived 5 months
Likely explanation - Patients were getting significant side effects and dropping out of studies, even beneficial ones. Educating patients thoroughly decreases reported side effects. This allows patients to actually benefit from high tech therapies instead of terminating early