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Last updated 8:15PM ET
March 3, 2021
UA Programs Support Rural Doctor Recruitment
(APR - Alabama Public Radio ) - 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.

The Tuskegee 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 of services.

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 students.

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 Virginia University 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."

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