www.ruralmedicaleducation.org/RMEPost/status_of_rme.htm
I. SWOT Strengths Weaknesses Opportunities Threats
II. Associations and Value of Associations
III. Accrediting Bodies
See others below on this page
IV. National Efforts and Studies
V. Medical Education Timeline, Advantages and Obstacles see below
VI. Policies - see below
VII. Rural Communities
VIII. Rural Physicians
Preprofessional – few significant efforts to encourage rural background students
Admissions – minimal efforts to admit the students likely to choose rural practice, only significant at a few schools. Research on the Declining Match
Obstacle – education in many areas of the US does not adequately prepare rural students for health professions in quality of education and health career orientation
Obstacle – centralization of education resources in the state make it difficult for applicants from rural colleges to compete with large urban or private colleges Centralization and Regionalization
The above two result in candidates with less polish, less academics, and slightly lower MCAT. Without special consideration, fewer would be admitted. Many schools give no special consideration.
Basic sciences – rural experiences in only a few school in the first two years
Integrated primary care curricula – only in a few schools
Clinical years, preceptorships – few schools have a 2 month rural experience in the M-3 year
Advantage Rural – great clinical opportunities and higher quality education in some studies
Obstacle - short term preceptorships expose students to the complete doctor experience, including all of the professional and personal challenges of being a physician. Students rarely see this side in academic locations.
Clinical years, long term preceptorships, few schools have 6 – 9 months
Obstacle – few medical schools have the critical minimum of 6 months of primary care necessary to help students overcome being overwhelmed by the complexity
Advantage – likely the best medical education on the planet, specific prep for rural practice, one of the best rural economic development programs known
Accelerated rural training programs – only one, great outcomes in terms of education and practice location, stymied from replication by ABFP moratorium, threatened with termination if ACGME continues
Graduate programs in rural locations – a challenge to gather the resources required
Graduate rural training track programs – same challenge, also few students know about rural training and fewer students are being admitted that might choose such programs
Obstacle - overall approach is not responsive or the kind of partnership needed.
Community Driven Approach is a different and better approach that will align mission and programs and also assist academics.
Accreditation and Demands of Rural Practice
Should the federal government encourage the recruitment of international physicians for underserved rural areas?
Yes or
No or
Yes, if the physician commits to 4 years, demonstrates the ability to function as a physician serving underserved rural populations, and continues to serve as a primary care physician. Physicians who are not meeting productivity guidelines, who do not stay their commitment, or who vary from primary care careers will be subject to return to their home country, substantial monetary penalties, and loss of licensure. Physicians who fit these guidelines must be given reasonable salaries and benefits throughout their 4 year commitment and will be eligible for bonuses in their 4th year and subsequent years if they continue to stay in their location.
How should the National Health Service Corps function?
The NHSC should prioritize efforts to improve admissions of the students that are most likely to go to underserved areas. Medical schools who desire to have NHSC scholars must allow NHSC participation in admissions. Medical schools may find it advantageous to create special tracks for NHSC scholars and others who are interested in careers in underserved location.
The Role of the Rural Community and Practitioner
To those medical schools who are planning to improve their efforts in rural development it is suggested that a broad-brush approach be used in which faculty, students, and administrative officials equally are expected to participate in planning and implementing the program. There must be a serious and visible commitment from the medical school to make a contribution to rural medicine and to support the existing rural practitioners. To those legislative groups: finance properly the regional educational centers, sponsor incentive programs for rural hospitals, clinics, and professionals which have been carefully coordinated with the educational ventures and look at better ways to support rather than undercut rural medical care. To professional societies: address professional isolation, CME, the need for support groups and consultations. To rural communities: do not rely on outside efforts, work with the leadership of your town to analyze problems and carry out a logical plan to remedy the problems and work to develop new leaders to carry on. Bruce and Norton, Improving Rural Health P 168 – 169 1984
Hope: Students From the Underserved, For the Underserved
Do you know who Marcus Welby was
Types of physicians: Critical Mass Issues Point to 4
It takes 4 physicians to share call for a facility that has emergency care.
It takes 4 family physicians to provide the patient numbers needed for a rural hospital.
A county of 10,000 needs about 4 family physicians.
Internists and pediatricians need about 5000 people to support each physician. Surgeons and other specialties need 20,000 or more in a reasonable proximity to be supported. This and the need and desire to share call make it difficult to find, retain, and support such physicians.
States with several counties with less than 10,000 and still a hospital and a doctor (s) include Texas with 60, Nebraska and Kansas with 40 each. Counties with such frontier distributions need special flexibility for shortage designation, because the differences between those above and below threshold minimums is small and the need to maintain a critical mass is high.
Objectives for Rural Programs and Curricula