Methods: Rural family physician in charge of admissions, specialized selections of those likely to return to rural practice, 2 month required rural preceptorship for over 50 years, 2 month required graduate rural preceptorship in Family Medicine for 30 years, rural graduate programming including combined IM/FP program, Lincoln Family Medicine program rural-oriented, 4 RTT programs, an accelerated rural training program with a PGY-4 procedural fellowship, an enhanced moonlighting program for FP residents, and loan repayments available for all but the most urban counties. Nebraska Rural Family Practice Programs
Newest additions yet to have impact – Only 3 years of Rural Health Opportunities Program RHOP graduates so far, 3 weeks in rural Nebraska after the M-1 year, rural preceptorship moved to the M-3 year 5 years ago, eighth grade science fair, special program for eighth grade science teachers in rural areas, rural high school health career fairs, rural student interest group, physician and hospital networks, feeder programs begun with native reservations, inner city underserved accelerated track.
Also an influence on future students: increased volunteer, international, and primary care experiences: Selection of the underserved-likely students have also resulted in other side effects, such as an award winning inner city volunteer clinic, a student association sending over 60 students a year to Jamaica and 5 other central and South American nations AAMC GQ data on Rural Interested Students about association between international and rural
Cost: RHOP program $120,000 x 10 years, Family Medicine x 30 years x 16 positions per year,
Outcomes: Increase in rural graduation rate of medical school, also family practice residencies increasing from 40% rural graduation rate to 60%. Nearly 10 FTE of rural practice provided by residents or faculty in rural areas of the state each year through graduate training, preceptorships, or moonlighting, mostly in shortage areas of the state.
Starting point –
Interpretation: Nebraska had a visionary dean, Robert Waldman, who worked with receptive faculty in family medicine and allied health to connect with rural communities. Early studies supported specialized admissions, and these efforts were implemented. A rural family practice physicians left practice to become an influential member of the admissions committeee, chair, and then dean of admissions. He continued to work to select increasing numbers of students from small towns and those likely to return to rural practice locations. The state had always supported Family Medicine residencies, but the specialized selections allowed the Department of Family Medicine to convert all funded residency positions to rural training tracks and an innovative accelerated rural training program. This is important in Nebraska because there are nearly 80 counties with less than 10,000 and 40 of these still have doctors and hospitals. The program was recognized nationally as the Rural Program of the Year by the National Rural Health Association in 2001.
Other Contributing Factors:
High retention rates, lowest public health, alcohol drug, and mental health per capita expenditures in the nation, lowest liability costs in the nation (unknown next year as a state cap is under challenge and the impacts of 911 are felt)