The rural challenge
But the road to rural family medicine also includes a thing called “windshield time” – the amount of time needed to travel between clinics or head to the closest Walmart.
Then there’s figuring out just how far their patients will need to drive to get to the nearest hospital – which for Daniel Linville, MD, and Jill Corpstein Linville, MD, is a solid 4 hours for more advanced care from their new practice in Lakin, Kan. (population: 2,195).
Their outpost in southwestern Kansas can feel a little bit like a fishbowl. “We do life with some of our patients,” Dr. Corpstein Linville said.
Already, the Linvilles have delivered babies and handled a variety of ailments there.
The pair met and married during their 4 years in Salina – they jokingly call it a “full-service med school.” They completed a family medicine residency in Muncie, Ind. Then they were recruited by a rural practice that helped them avoid what Dr. Moser calls the most dreaded words in rural medicine: “solo practice.”
New doctors don’t want to practice alone, especially as they develop their sea legs, because of the strains of constantly being on call and having singular responsibility for a town. Telemedicine, where doctors can easily consult with other physicians around the country via Web video or phone, is helping, as are physician assistants.
Diverging from the path
Claire Hinrichsen Groskurth, MD, another member of the first graduating class, always intended to return to a small town similar to where she grew up.
“The first thing that threw me off was I fell in love with surgery and ob.gyn.,” she said. “Then the second thing that threw me off was marrying another doctor,” whose life goals headed in a different direction.
She’d been a member of the Scholars in Rural Health program at Kansas University that seeks out rural college students who are interested in medicine. She also had committed to the Kansas Medical Student Loan program, which promises to forgive physicians’ tuition and gives a monthly stipend if they agree to work in counties that need physicians, or in other critical capacities.
But when she realized she might specialize, she decided to take out federal loans for her final years. She had to pay back the first year of the special loan with 15% interest.
Plus, her now-husband, who went to Kansas University’s Wichita campus, needed to be in a large enough city to accommodate further training to become a surgeon. So Dr. Hinrichsen Groskurth delivers babies as she thought she would – but in Wichita.
The spousal coin can flip both ways: Dr. Ritterling Patry needed to find a place that worked for her husband’s farming of corn, sorghum, soybeans and wheat. So the smaller city of Hutchinson it was.
Flaws in the pipeline
Most medical school students come from urban areas and are destined to stay there, said Alan Morgan, the head of the National Rural Health Association. Producing doctors for the vast swaths of rural America needs to be more of a priority at every step in the education pipeline, experts said.
Many academic centers sell students on the party line that they’ll be overworked, underappreciated and underpaid, according to Mark Deutchman, MD, director of the University of Colorado School of Medicine’s rural program. “They take people who are interested in primary care or rural and beat it out of them throughout their training,” he said.
And that kind of rhetoric often influences the opinion of their medical school peers, which those in rural health might resent.
“Small does not mean stupid,” Dr. Moser said.
Medical students everywhere should be exposed to rural options, according to Randall Longenecker, MD, who runs Ohio University Heritage College of Osteopathic Medicine’s rural programs in Athens.
“If a medical student never ever goes to a rural place, they never find out,” he said. “That’s why students need to meet rural doctors who love what they do.”
The federal government recently allocated $20 million in grants to help create 27 rural residency programs – institutions where newly minted doctors go for practical training before they can be fully licensed. That’s a big jump from the 92 programs now active.
For Dr. Corpstein Linville, the pipeline also needs to start at more schools like Salina that are promoting rural medicine from day one.
“So when you hear rural medicine, you know that it’s a thing and don’t kind of cringe,” she said. “You don’t think it’s someone taking care of a cow.”
Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.