Breeding Young Professionals and Healthier Rural Communities
Prepared for Rural Development Commission meeting by Robert C. Bowman, M.D.
Young professionals are a key component of rural communities. They provide jobs, education, leadership, and services. They also support one another. Loss of young professionals beyond a certain threshold means that it is difficult or impossible to recruit new ones. Physicians are particularly critical to job maintenance and growth. New businesses will not locate in rural areas without good health care access.
Half of Nebraska's 93 counties are on the edge of this threshold. Recession, agriculture, international competition, and the nation's focus on other areas will increase this challenge. These counties have at least one doctor, a hospital, and less than 10,000 people. It takes about 2000 - 2500 people to support a family physician. It takes 4 family physicians to support each other with call. A community with 4 family physicians usually can support a hospital and a wider range of services. Services support job growth, and therefore more people, and then a wider range of services, etc. This can be a cycle of growth, or the reverse can be a death spiral to end a functioning community.
Many of the factors are internal to a community and are being discussed at this conference. Some are federal and national. Some of these can be impacted, others cannot. State level changes are often not considered, but are important.
Higher education has had a great influence on local education and distribution of wealth. Increasingly studies find that standardized tests are related to income levels. Medical education in particular has had a powerful impact on high schools and colleges. The changes brought about by reformers such as Flexner 100 years ago fueled the rise of education in urban areas. Unfortunately changes in medical education also gave rise to the shortage of rural physicians. This impact is not limited to the medical profession. With some changes, it is possible to reverse this situation. Local and state level education are the key reversible elements. In Minnesota for example, a Minnesota legislator called the medical center into accountability and this resulted in the Rural Physician Associate Program, one of the best medical education and rural community development programs in the nation Duluth Plus RPAP. UNMC rural programs came into being through academic leadership and the support of rural communities and doctors.
By the numbers:
Rural Doctors and Rural Economies
|
Situation |
How it impacts |
Remedy |
|
Higher education does not select the students that are likely to become professionals and return to rural areas (rural background, desire to return, family practice interest, service orientation, from lower socioeconomic) |
A rural doctor is worth $1 million in local economic impact each year. The Rural Physician Associate Program (RPAP) in Minnesota has trained 900 medical students in greater MN over the past 30 years. The legislature invested $30 million and greater Minnesota's small towns have received $2.1 billion in economic impact from the graduates that have returned to rural MN. |
Political and social pressures to get rural background kids admitted to professional schools, the ones that had good rural experiences and desire to return. Rural people and organizations participate in admissions committees. Use of small college advisors by admissions. Build up small rural colleges. RHOP programs such as UNMC has going. RPAP programs such as Minnesota has. |
|
Centralization of state college funding tends to close small rural colleges and forces them to cut pre-professional training courses that are expensive and desired by only a few students Centralization of State Educational Resources |
Few students can choose to live in a rural community and attend college, this means that students are forced into urban locations where they are urbanized as well as more likely to meet spouses who are far less likely to want to return to rural locations. (Loss of Fairbury college and impact on south central region, recent proposal to cut Peru State, UNL and UNMC cuts peripheral and rural) |
Build up small colleges. Make higher education administrators aware of what these long term subtle changes are doing, particularly in cutback years or periods. Resist the closure of small rural colleges, the breeding grounds of young professionals for rural areas.Breeding Young Professionals and Healthier Rural Communities |
|
Rural school consolidations make kids travel to more distant schools. Some kids have to leave their homes for periods of time. |
Such kids are far less likely to bond to their rural communities and appreciate rural living, and would be less likely to return. Also fewer extra curricular and leadership opportunities, one of the major advantages of rural vs urban candidates. |
Resist school consolidation Consolidation and Bonding, keep quality up by other means, continue to support local education, reverse state laws that force consolidation, work with higher education to enrich rural teacher development (UNMC and 8th grade science teachers, etc.) |
Robert C. Bowman, M.D., Co-Chairman,
Rural Medical Educators Group of the National Rural Health Association
Associate Professor in the UNMC Dept of Family Medicine and
Director of Rural Health Education. & Research
983075 Nebraska Medical Center Omaha, NE 68198‑3075
(402) 559‑8873 or fax at ‑8118 Email: rbowman@unmc.edu
http://www.ruralmedicaleducation.org more on this at http://www.ruralmedicaleducation.org/economic.htm
Young professionals, especially rural docs are the key to
Restoration of Communities, Nations, People: Role of Rural Family Docs