Rural Exposure
Across the country, and particularly in Utah, the small town doctor is disappearing. The School of Medicine is working to change that.
By Rob Lubke
Originally from Cedar City, medical student Spencer Lindsay describes himself as a “smaller-town person at heart.” So when the opportunity to complete his family-medicine rotation in rural Utah arose this past summer, he took it.
“I thought I would get the best education, hands-on,” Lindsay says.
He spent six weeks in Monticello and Blanding under the guidance of Kelly Jeppesen, MD, a family physician who’s practiced in those towns for seven years. From early morning surgical procedures to late-night baby deliveries, he got a good taste of the life of a rural doctor. And he was impressed by the way Jeppesen managed his patients and the “salt-of-the-earth people” he served. So much so, Lindsay can see himself becoming a rural doc.
“I wasn’t sure if I could ever see myself doing something like that,” he says. “After being immersed in the program...my perspective changed. Rural medicine is absolutely more of an option.”
Lindsay’s experience was part of the Rural & Underserved Utah Training Experience (RUUTE). This program of the University of Utah School of Medicine strengthens medical-education opportunities in rural and underserved areas and works to increase the number of new physicians who practice there.
Benjamin Chan, MD, the program director and associate dean of admissions at the School of Medicine, got the idea for RUUTE while speaking about the medical school to students in Utah colleges and universities. Physicians in the audience would often tell him how they’d like to see medical students from their communities return home for rotations.
“There was this yearning to have them go back,” says Chan. “That’s where this idea really came from.” There’s no question rural Utah communities need more doctors.
The American Association of Medical Colleges predicts a shortage of 120,000 physicians in the US by 2032. Most locations will likely feel the pinch. But shortages are likely to be more acute in rural and historically underserved areas, where physician-to-patient ratios are already lower than urban areas. According to the National Rural Health Association, there are roughly 5 active primary care physicians for every 10,000 people in urban areas, but only 4 in rural locations.
A lack of physicians can be especially detrimental to rural areas, where doctors are often the lifeblood of the community. But RUUTE is working to fix the doctor drought.
“Fifteen percent of all Utahns live in a rural or underserved community, and with the growing population, we predict there will be an increased shortage of providers,” says Kylie Christensen, RUUTE’s program manager.
RUUTE is the first step in getting upcoming physicians interested in a rural practice.
Why Are There Shortages?
There are many reasons for the scarcity of rural physicians. For starters, when compared to urban areas, rural areas usually have a higher proportion of older adults. Older people tend to have more health problems, need more care, and require more-frequent doctor appointments than younger people.
New doctors may not be accustomed to living in rural locations and think the lifestyle there will be unappealing with few opportunities for career advancement or a lack of career opportunities for their spouses. Physicians may also assume — often incorrectly — that rural doctors make less money.
Yet another reason rural areas get fewer physicians: Most medical campuses are centered in urban areas, and students often stay in familiar places. According to Chan, approximately one in three students will practice medicine within 100 miles of their medical school. But they are more than twice as likely to practice in the area of their medical residency.
“If we can increase the number of residency opportunities in rural areas,” Chan said, “then more physicians may choose to stay.”
Community for the Caregiver
As part of the RUUTE program, Kelsey Tolbert ’21 sees patients at the San Juan Clinic Monticello. “I was surprised at how I was welcomed into the community. The patients I saw at the clinic I then saw at the store, in restaurants, at the park... It was wonderful. And when you live, work, and play with the patients you see, you have a far richer baseline to work from to offer care.”
Options for All
Working with schools of higher education, Utah hospitals, and Area Health Education Centers (nonprofits that focus on improving care in medically underserved areas), Chan set out to help students get familiar with rural Utah. Thanks to funding from the Utah legislature in 2018, RUUTE was born.
The program currently allows students to do full or partial rural rotations in general surgery, family medicine, and OB-GYN, and plans to add more options soon.and plans to add more options soon. It’s also laying the foundation for an optional graduate certificate in rural medicine and rural residencies.
“We’re hoping that if we expose our students and residents to these communities, they will want to go back and practice there, or even the community they grew up in,” says Christensen.
Part of RUUTE’s focus is to spur interest in medical careers among young rural students. While it now partners with the College of Pharmacy, it hopes to involve other health disciplines in the future. Building on efforts of the School of Medicine’s Office of Inclusion and Outreach, the program plans to create a collection of health-science materials that students will present to grades K-12 in rural areas.
The program is also creating varied opportunities for physicians to work with medical students. They may speak to students about rural practice, spend time with them on the job, or seek their help with rural research projects. Doctors have different ideas about how they can contribute and are encouraged to share their thoughts.
“We’re trying to meet and match those expectations by having a wide variety of different experiences — a buffet if you like,” says Chan.
About 60 percent of medical students participate in RUUTE activities. Just a sample of rural medicine could nudge them to a career in a rural or underserved area.
Veronica’s Story
Third-year medical student Veronica Urbik grew up “all over the place” but nowhere rural. Still, she knew of the challenges facing underserved areas.
“I used to volunteer at a children’s hospital,” she says. “We would get a lot of patients who would drive eight, nine, 10 hours for their care, and then they’d have to stay at the hospital for a really long time because there was nowhere closer they could get care. That was heartbreaking.”
While attending a medical-school panel on rural health, Urbik’s interest in RUUTE was piqued. She completed three weeks of her family-medicine rotation in Moroni with Eileen Jackson, MD, ‘03 this July. And she found the experience exhilarating. “It was just a really special place with really kind people,” she says.
Of all her experiences, what stands out most in Urbik’s mind is Jackson.
“Even though there were really long days, and things were difficult, and there were challenges, she never let that get in the way of caring for her patients,” Urbik says. “I was just so inspired.”
Like Lindsay, Urbik doesn’t know for certain where she’ll end up practicing medicine, or in what specialty, but now thinks becoming a rural physician is a real possibility.
“Rural health is not something I would have considered before doing this rotation, but I had such a wonderful time, I was really sad to leave,” she says. “It is definitely something that will be a consideration for me.”
PHYSICIANS ARE KEY
The fact that doctors like Jackson and Jeppesen have such an impact on their students isn’t lost on RUUTE leaders.
“Our rural providers are a very big part of the core of our program,” says Christensen. “We could not continue to send our students to these commu- nities if the physicians were not willing to precept and educate them.”
They’re community pillars who assume many responsibilities for their patients, adds Chan, not- ing how they singularly manage health problems that a host of different specialists would oversee in
a larger community. Even without ideal resources, they enjoy their jobs and they inspire others.
EVERYONE WINS
Ultimately, rural residents will reap the rewards when RUUTE-trained physicians choose to work in their com- munities. But anecdotally, rural residents are already enjoying having students on their care team during rota- tions, and patient-satisfaction scores are consistently high when students are involved, according to Chan.
Patients benefit, physicians benefit, and students benefit, and those upcoming physicians express appreciation for the experience.
“I’m just really thankful for the opportunity,” says Urbik. “It’s one of those things that I really love about the University of Utah and the breadth of my education here.”