How Taking Medical Students Into Coal Mines Helps Lure New Doctors to Rural Areas

August 9, 2019, 11:05 PM UTC

On a field trip to the Birthplace of Country Music Museum, Ashish Bibireddy put on headphones and scrolled through a jukebox of music from an influential 1927 recording session.

Bibireddy and nine other medical students had already been biking and rafting on their visit to rural Appalachia organized by a nearby medical college. But it wasn’t just casual sightseeing; the tour was part of a concerted effort to attract a new generation of doctors to rural areas struggling with health care shortages.

The Quillen College of Medicine at East Tennessee State University is among a small group of medical schools across the U.S. with programs dedicated to bolstering the number of primary care doctors in rural communities.

The schools send students to live in small towns and train with rural doctors. Like Quillen, some also organize outings and cultural experiences to try to sell students on living there after they graduate.

Schools have taken students to a ranch to brand cattle, brought in an Appalachian story teller, and catered local delicacies to show students who may have never lived without the convenience of a Starbucks or Target what rural life offers.

“It’s a little sense of what the fun part of rural life can be,” said Dr. Dana King, chair of the family medicine department at West Virginia University School of Medicine, where students in the rural track go to a ski resort, visit a coal mine, and go whitewater rafting.

At the University of Colorado School of Medicine, students can meet with the mayor, police chief, or other leaders of rural communities and interview residents to learn about the town.

“We want to give the students an idea about what goes into the workings of a small community,” said Dr. Mark Deutchman, director of the school’s rural track.

Most of the more than 7,000 facilities, population groups, and areas in the U.S. facing a shortage of primary care physicians—often a patient’s first point of contact for treatment—are rural, according to the U.S. Department of Health and Human Services. They need nearly 4,000 additional physicians to close the gap.

Most of the students who came to Quillen did not grow up or attend school in rural areas, but all expressed an interest in working with underserved populations, rural programs coordinator Carolyn Sliger said.

The students spent three weeks with doctors in rural towns in eastern Tennessee and a week in June exploring the region. After the museum tour, they visited a war memorial with an eternal flame and hulking U.S. military attack helicopter. The group then headed to a rooftop bar overlooking Bristol, where the brick-lined main street straddles the Virginia-Tennessee state line.

Bibireddy, 23, grew up in suburban Edison, N.J., and attended the University of Central Florida medical college in Orlando. He never lived in a rural area but was impressed with what he saw of Appalachian life during the visit.

“The people here are genuinely caring,” he said.

He was inclined to work in a rural area after medical school but acknowledged that building relationships with a community as an outsider would be difficult.

Jason Soong, another medical student in the program, said he has “always known” that he wanted to live in a sparsely populated place with open space. Soong, 23, grew up in a Philadelphia suburb and attended California Northstate University College of Medicine outside Sacramento.

“Living out in a rural area, you can just go outside your door, and you have nature right there,” Soong said.

Katherine Schaffer and a few other students ended their day in Bristol around a patio table at a stylish downtown bakery.

Schaffer, 27, said she was excited to meet people who shared her interest in rural practice. Her medical school friends in Norfolk, Va. want to work in cities as specialists and worry they wouldn’t have a social life in a small town, she said.

“I think it’s very difficult in my medical school to find like-minded people,” she told the group.

Administrators of rural track medical school programs say their graduates go into rural practice at considerably higher rates than other doctors. But many of those students are already inclined to practice in a rural area, so the figures may exaggerate the programs’ success, said Dr. Randall Longenecker, associate project director for the Collaborative for Rural Primary care, Research, Education, and Practice.

“We skim the cream off the top,” said Longenecker, whose research has documented 39 accredited colleges of medicine and colleges of osteopathic medicine that have clearly delineated rural training tracks—about a fifth of U.S. medical schools.

For students from small towns, the programs can help maintain their enthusiasm for rural life, said Dr. Joseph Florence, director of rural programs at Quillen.

Florence said big city medical programs push students to become specialists and avoid primary care.

“They beat rural out of you by the time you leave,” he said. The rural track programs, on the other hand, give the students “a place to be rural and not only be accepted but be appreciated for it,” he said.

Dr. Darrin Nichols, 28, said the rural track program at West Virginia University School of Medicine confirmed his choice to practice near the West Virginia town of roughly 800 people where he grew up. He was struck by the camaraderie of coal miners he met during a trip organized by the school and said it reminded him of his own tight family bonds.

“I always wanted to stay near my family and practice in a community that had those types of relationships,” he said.

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