UA Program Encourages Health Professionals to Practice in Rural Areas

Jean Spinelli
July 10, 2000

Dr. Bart Carter, former chief of staff of Mt. Graham Community Hospital in Safford, Ariz., is among a select group of more than 45 physicians in rural communities throughout Arizona who will spend part of the summer volunteering to mentor second-year medical students at their practice sites.

Carter serves as a rural faculty member in the University of Arizona College of Medicine's Rural Health Professions Program (RHPP). Established in 1997 by the Arizona Legislature, the program encourages medical school graduates to practice medicine in rural communities.

Although Arizona has no shortage of physicians, they tend to practice in urban areas, as physicians do in other states. The UA College of Medicine always has sponsored opportunities for students to work in rural Arizona, however most have chosen to work in larger communities when their education was complete.

"The health professionals who volunteer to work with our students are the key to the success of this program," said Dr. James E. Dalen, UA vice president for health sciences and dean of the College of Medicine. "These doctors are an impressive group, clearly dedicated to their communities and extremely generous to share their time with our students. Their commitment is making it possible for us to encourage students to seriously consider practicing in rural areas, fulfilling a great need in Arizona. Our students are extremely excited about this opportunity to experience life in communities where they may practice some day."

Carter, a UA College of Medicine alumnus whose specialty is general surgery, is serving as a preceptor, or mentor, to Thatcher native Lance Bryce, a second-year UA medical student who began his six-week rotation on June 1.

"I am in medical school today thanks to the doctors and nurses at Mt. Graham Community Hospital," says Lance, who is here with his wife, Shellie, and two children, Jacoby and McKenna. "I began volunteering at the hospital during the summer months at age 14. The opportunities that I was afforded there increased my desire to become a doctor and return home to serve my community."

Having grown up in rural Arizona, Lance says he is "acutely aware of the great opportunities that come to a physician who practices in these areas. I know the rewards of having an entire community hoping and praying for my successful admission to medical school. I am especially grateful for the opportunity to return to my community 'early' as an RHPP participant. This program fits my career goals perfectly." Lance's desire is to practice medicine in his hometown. "I know rural Arizona needs doctors. I know the joy of serving a community that knows you. I know that I can make a difference there."

Twenty-nine rural communities currently are participating in RHPP, and additional sites will be selected throughout the state. In addition to Safford, communities hosting students this summer include Arrivaca/Continental/Three Points, Benson, Chinle, Cibecue/Whiteriver, Cottonwood, Flagstaff, Globe, Prescott, Queen Creek, Sedona, Sierra Vista and Tuba City.

Each year, RHPP selects 15 first-year UA medical students who receive intensive training in preparation for their experience in rural communities throughout Arizona. Beginning in the summer between the first and second years of medical school, each student spends four to six weeks residing and working in a rural community. Students work with their preceptors over the course of their three years of medical training, returning to the community in the third year, either as part of one of the required clinical courses or as an elective course, and again in the fourth year as an elective course.

An advisory committee of rural physician faculty and UA College of Medicine faculty select the students. Preference is given to students who have lived in a rural community or who have been accepted into the Arizona Medical Student Loan Program, a program in which medical school loans are forgiven for periods of post-graduate service in underserved areas of Arizona. Students are matched with rural physician preceptors based on medical specialty interest and community preference. Physician specialties include family practice, pediatrics, internal medicine, obstetrics and gynecology, and surgery.

Working side-by-side with a physician -- consulting with patients, discussing lab results, helping to diagnose childhood ailments, observing surgeries -- students gain an understanding of the unique health care needs of rural populations and strategies to address these needs. By returning to the same community during each year of medical school, students learn to appreciate the area's culture and community character and begin to experience the lifestyle of residents of rural areas.

Students in communities that are linked to the Arizona Telemedicine Program -- a health care telecommunications network that allows rural physicians and patients to have real-time online medical consultations with specialists at the University of Arizona Health Sciences Center in Tucson -- receive hands-on experience using telemedicine technology. The system also allows rural physician preceptors and their students to "virtually" attend grand rounds lectures at the College of Medicine.

The challenges and opportunities of rural practice are introduced to RHPP medical students and UA nurse practitioner students in "Issues in Rural Health," a course offered in the spring semester. The course acquaints students with the complexities of dealing with managed care issues, referral needs, the impact of poverty and lack of health care, environmental health concerns, the influence of culture, issues unique to rural areas and the role of physicians in rural communities.

Rural physician preceptors enhance their teaching skills through faculty development and continuing medical education programs conducted by the UA College of Medicine and offered regionally to reduce rural faculty travel time and minimize disruption of their medical practices.

Students develop long-term relationships with their rural physician preceptors, who act as medical and career counselors. As a result of their experience, students are able to make more informed choices when they decide where they will practice medicine.

Forty-five students currently are participating in RHPP. The first group of 15 medical students to participate in RHPP graduated in May and will spend the next several years as resident-physicians. (Residency programs vary in length according to specialty, from three years for general medicine/family practice specialties to eight years for the most specialized of surgeons.)

"Certainly, this is a win-win program for everyone involved," says Dean Dalen. "Its measure of success will come in five or six years, when residencies are completed and former RHPP students 'come home' to rural Arizona."