Hoping to Inspire

By Stephen M. Petrany, MD, Family and Community Health, Marshall University Joan C. Edwards School of Medicine

As I considered Academic Medicine’s invitation to comment on the creative efforts of medical educators to engage the imagination of their students and residents with respect to rural and small town practice, I could not help but ponder just how this native of Brooklyn, New York, ended up deeply entrenched in a department and medical school committed to changing the landscape of rural health. I find myself in West Virginia surrounded by extraordinarily talented people who share an uncompromising dedication to that important mission. I am just one positive outcome of a specific program (the National Health Service Corp Scholarship Program) that sparked the fire that has become my passion for rural and underserved health care.  This experience underlies my confidence that efforts to encourage quality medical students and residents to fill the national need for rural practitioners can and will be successful.

In the August issue of Academic Medicine, Crump and colleagues and Kane and colleagues describe the tangible accomplishments of two rural education initiatives. They represent very different approaches to a shared mission. Whether it be a rural rotation, a rural campus, or a rural residency track, these programs are designed to inspire physicians in training to choose the less traveled path of small town practice. The efforts at the University of Louisville and the University of Missouri, as well as at my own Marshall University, described in an article in the June issue, have been uniquely designed around the distinct infrastructures of their particular institutions. As such, they may not be precisely reproducible in other places. Yet, I have no doubt that something of their success can offer important insights that may be creatively applied in other schools and communities.

I believe that we must expand our efforts to share our successes, and just as importantly, our disappointments, if we are going to continue to make advances in solving the formidable national problem of physician access in rural populations.  This is no small task.  The mundane tedium of collecting and maintaining piles of sometimes vague information and data for long intervals and applying complex statistical methods to identify potentially small effects, can be daunting to resource-strapped, busy faculty.   This kind of research may not appear as enticing as traditional medical research along the lines of the quest for cancer cures. But in reality it may be no less important given the abundance of evidence that enhancing primary care’s presence in rural areas significantly improves the health and lives of the people living in these underserved communities. Adding just one quality primary care physician to a rural area can transform that community. Every individual placement is a major triumph.

At my own medical school, we have no less than 20 serious initiatives designed to encourage and support students’ and residents’ interest in rural medicine. Providing grants for student-focused rural research projects and establishing a rural practice advisory panel that provides interested students with resources for everything from identifying potential educational experiences to personal financial advice are just two of our most recent additions. The challenge is to continue to experiment, to apply the creative process in the face of some significant barriers, understanding that not everything we try will work. Sometimes in the past I have felt like we have been living out the cliché about throwing mud at the wall and watching to see just what sticks and what does not. What excites me as I read the two articles in the August issue is that we appear to be getting better at designing mud that sticks. My hope is that these successes may inspire us in academic medicine to invest the energy needed to publish our labors and double our efforts to graduate physicians who embrace the challenges and joys of rural medicine.

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One Comment

  1. Kemi Tomobi
    July 24, 2013 at 4:52 PM

    I am glad that this post presents a different perspective on academic medicine.  I find that many start out interested in academic medicine, but perhaps it is the bureaucracy, lack of interest in research, less income, less community service oriented nature, or lack of mentors that keeps people away.  

    At the same time, I learned that one has more options in academic medicine than in private practice.  If you start out in academic medicine, you can later go off into private practice.  You can also pursue medical missions, public policy, community service endeavors, and other aspects of medicine, such with the rural track you mention.  However, if you start off in private practice after residency, it is harder to go off into academic medicine later.  Therefore, if one had to choose academic medicine or private practice, one may initially have more options with academic medicine.

    Academic medicine is great for those who want to be experts in their field, collaborate with other experts, work fewer clinical hours, and have a balance of teaching, caregiving, and research, and increasingly public policy.  One issue I have with major academic centers is medical student training.  If you compare medical students on a clerkship or elective experience, at a major academic health center vs. a community hospital, the students at the community hospital are more likely to value the experience at a community hospital because it is not as busy, students are closer to attending faculty (and maybe a few residents) and you learn more and students are more likely to have an important role.  At the larger academic centers with several patients, residents and different attendings from various services, students don’t get as much out of the clerkship, unless they are looking at the really odd cases, or they really want to see how different specialists collaborate on a case.

    Again, I am glad with the perspective provided by this post, because it shows that academic medicine can still attempt to reach out to rural populations and provide more career pathways.  I look forward to how academic medicine develops in the future.

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