Rural Contributions of the UNMC Department of Family Medicine

Updated Listings of contributions at

UNMC Department of Family Medicine

Economic Contribution of UNMC Dept of Family Medicine

Nebraska faces many challenges regarding the delivery of rural health care. Half of its 93 counties have a doctor, a hospital, and less than 10,000 people. These rural health systems are in constant need of rural physicians. The department has been a leader at UNMC in facilitating the training that would meet Nebraska’s unique needs.

Over half of the population of the state is in a few metro counties along the eastern border. The remainder of Nebraska’s population lines up along the Platte River, the former Oregon Trail/Union Pacific rail lines. With such a distribution, it is often difficult to find the massive collection of health services required by medical education. Faculty have stuggled to negotiate medical education programs that fit the unique needs of the state, and still meet size and medical resource guidelines set up by national accrediting bodies.

Admissions A Family Physician, Jeff Hill, continues to direct admissions to the medical school from his position as assistant dean. Jeff practiced for years in Geneva, NE. He continues to support rural health through the Rural Health Opportunities Program, a program to facilitate admissions of those likely to choose rural communities.

Rural Health Education Network Family medicine’s Chairman, Mike Sitorius, continues to chair this group that coordinates the state’s rural health efforts through a hub and spoke arrangement of contacts between rural communities and academic communities in the state.

Community Connections - The department directs and coordinates this National Health Service Corps Fellowship program, training 30 medical, PA, and NP students to go out to 12 Nebraska rural sites. Students help communities to do needs assessments and other data collection that will help them plan and implement health projects. Projects in the past have resulted in several grant applications to state and federal programs and an award from the Public Health Service.

Rural Recruitment Fair This is an annual event sponsored by UNMC. This past year the fair involved 22 rural Nebraska communities. The communities met with 14 family practice residents, 80 PA students, and 24 NP students. This year the communities met with the residents during their teaching day. The residents had a chance to discuss their practice plans, the communities discussed their opportunity and shared information with other communities regarding recruitment. Department faculty direct and staff the fair, aided by Continuing Education. Each year the recruitment fair:

• gives information and consultation to rural communities regarding recruitment of UNMC graduates
• gives primary care graduates the most current information about job prospects in the morning and noon sessions
• allows students to explore sites for training and eventual practice in the afternoon

In recent years the fair has increased the participation of smaller communities, integrated the fair with the training of PA students and FP residents, and increased the number of practitioners at community booths (from 1 to 5).

Annual Rural High School Health Career Fair Department faculty assist Chadron State with this event each year. Four hundred high school students from four states attend this fair to find out more about various health careers. The department will assist in a rural high school career day at Omaha on April 3.

Rural Student Interest Group Department faculty resurrected this group three years ago. It now meets monthly. The group has presented to various rural high schools regarding health careers. It helps organize the Recruitment Fair. Students also receive advice from invited speakers and faculty. Bob Boyer, a retired rural doc from Kingman, Kansas, gave an outstanding session on the challenges and rewards of rural practice.

Rural Preceptorships The department continues to organize this required two month experience in the third year of medical education. The rotation, one of the longest running preceptorships in the nation, nears its 50th anniversary. Only 20% of medical schools require a rural rotation and most of these are only 4-6 weeks. UNMC added a 3 week rural experience at the end of the first year in 1994. As with the rural preceptorship, the students select this as one of the best learning experiences of the entire year.

CORE Program This is a required 2 month rural experience for all family practice residents. The department also coordinates this rotation for the Air Force residents at Offatt and the residents at the Lincoln Family Practice Program. Residents "become" rural physicians, joining 3-4 other physicians to share clinic and call. The program has several goals:

• Top notch "hands-on" training
• Rural practice and practice management experience
• Support of rural practice environments that are short of physicians

Hospitals pay for the residents stipends, housing, and travel. In return the community has residents throughout the year for up to 3 years. Communities can count on the assistance to support other physicians, keep a patient base in situations where physicians have recently left, or build a practice base for an incoming physician. Rural physicians benefit from the revenues generated by the resident. Faculty make site visits to insure quality education, housing, and supervision. Despite the inconvenience of being away, residents and faculty note major benefits from this program. Many communities have forgotten how to recruit well and the presence of a trainee gives them the chance to improve their skills. Only one community in the past 25 years has not managed to recruit a physician during the course of the CORE rotation.

Rural Physician Services and Support Each year family practice residents provide 4 FTE of rural physician services in the CORE rotation, another 2 FTE at clinics at rural training tracks, not counting electives and weekend emergency room services.

Rural Training Tracks The department now has 4 rural training tracks in communities along the Platte River. These involve 8 residency positions a year. Residents spend their first year in Omaha and then their final two years in the rural track in a large rural community. Residents commute to ambulatory clinics in small communities of less than 5000 people. The residents in these tracks train specifically for rural practice. There are 38 rural training tracks in the nation with 17 more planned and Nebraska’s were among the first.

Accelerated Rural Training Program Recognizing that students were requesting more specific rural training, the department’s program director, Jim Stageman, created this track. The program begins in the 4th year of medical school and continues for a 3 year family practice residency and a 4th year procedural fellowship. Students still have 7 total years of medical education, but the program accelerates their responsibilities, their procedural capabilities, and their rural medical education. Each year 4-5 students begin this track. The department cooperates with internal medicine in a similar track in Primary Care involving 5 students a year.

Department faculty lead the Society of Teachers of Family Medicine Group on Rural Health, assisting students from across the nation with rural career assistance by phone, fax, and email. In addition the department assisted the STFM Group by mailing information about rural programs to 120 FP Departments and 400 Family Practice residencies. Efforts this year include developing on-line internet access to this information. Faculty present rural program/faculty development seminars at annual STFM conferences.

Faculty from the department direct the Preparing for Rural Family Practice seminar at their annual meeting of the students and residents in Kansas City. Bob Bowman has given or coordinated this event for eight years. This has always been one of the best attended presentations of the conference with 100-150 attending each year to get career assistance. The speakers use their rural practice experience to motivate students, answer specific questions about selecting a program, a rural practice, or specific rural training.

Original contributions include:

• an article on rural physicians workload and retention issues that was published in the Journal of Rural Health,
• an American Family Physician Medicine and Society Editorial on Continuing the Unique Contribution of Family Medicine to Rural Health.
• a yearly distribution of information on the rural content of the nation’s family practice programs to medical students and family practice faculty nationwide.
• a submission to Family Medicine regarding Family Medicine Residency Programs and the Graduation of Rural Family Physicians. This article highlighted the changes in the nation’s family medicine programs including fewer rural physicians despite increases in residencies and residency positions. This research effort expanded to involve a multiple linear regression study showing that family practice residency programs with a rural mission, more rural months, and more ob months graduated more rural physicians. This information has also impacted on policy deliberations at the American Academy of Family Physicians, the National Rural Health Association, and is now enjoying an audience at the national level in Washington, DC. Earlier versions were presented at a national conference on state health policy in 1995.

The Department continues to influence medical education at all levels in the state, working closely with the state department of health, the Nebraska Medical Association, the Nebraska Academy of Family Physicians, the Nebraska Rural Health Association, the Extension Service, the Public Health Service, and others.