Rural medicine studies require big commitment

Snake bites, electric shocks, tractor accidents, farmerÂ’s lung and silo-fillerÂ’s disease.

Add in the usual cancer screenings, physical exams, and preventive medicine of a family physician, plus a dash of obstetrics care and other specialty procedures, let set in a traditionally underserved area, and youÂ’d end up with a rural physician.

America is not the primary agricultural nation that it used to be, but there are still many places across the country that need physicians who are dedicated to being a primary care physician–and a lot more.

The UNT Health Science Center has long had a focus on rural medicine, starting with a track for students to follow through medical school at the Texas College of Osteopathic Medicine about 15 or 16 years ago, said Dr. John Bowling, assistant dean for rural medicine and an associate professor in the department of family medicine. Several years ago Bowling and others at the school started researching what was needed to develop a full curriculum specifically to help educate rural physicians.

Dr. Bruce Dubin, vice dean of TCOM, said many medical schools consider students trained for rural medicine if the school itself is located in a rural area or if the students do a brief rotation through a rural area, but the full-scale rural curriculum in Fort Worth immerses students in rural medicine topics from the time theyÂ’re accepted into the program.

“Rural areas are underserved areas of health care, and very often the rural physician, rural doctor, is a psychiatrist, the obstetrician, the sports medicine physician for the Friday night football teams and even a veterinarian and the emergency dentist at times,” Dubin said.

Not only does being a rural physician require more knowledge about some areas–students are accepted to TCOM and then have to apply to the Rural Osteopathic Medical Education program, and they take the traditional medical school classes and extra classes and clinical hours to learn more about rural topics–but it requires a lifestyle commitment, Bowling said.

Bowling served as a rural physician in southeastern Ohio on the edge of Appalachia, and students need to commit to the area that theyÂ’re living in, he said. Students are required to spend time throughout their medical school experience at rural sites for several days and are encouraged to take their spouse, significant other or family with them. The trips include weekends.

“They’re not spending the whole time in the doctor’s office, but so they’re doing whatever the doctor is doing in the community, whether it’s going fishing, going to a Fourth of July parade, going hunting,” Bowling said.

ROME, which accepted 15 to 20 students per year, also attracts some students who have international inclinations, Dubin said. Some may want to join an international medical organization, like Doctors Without Borders, or a medical missionary group. Bowling said many of the incoming students already have international volunteer experience, but he said the vast majority of the students have some kind of domestic rural experience (such as living in a small town for a period of time) and want to return to that.

The first class of students in ROME are now third-year medical students, and Bowling said the students usually go into residency program that emphasizes rural health once they graduate.

“We’re not pretending to be producing a finished product,” he said.

Even with a broader medical base than most, rural physicians canÂ’t be everything to every patient. Dubin said ROME incorporates telemedicine into its curriculum so students know how to get a specialistÂ’s long-distance input when faced with a patient who has difficult medical needs. Students are taught how to present patients by video conferencing, for example, and also go more in-depth about how to find data on diseases and treatments through databases, medical libraries and other resources.

Rural patients are often older and use Medicare, Bowling said, and many medical students may not consider rural medicine because they don’t think they’ll make enough money to pay off school debts. However, those rural physicians who learn to perform procedures–like a colonoscopy to screen for colon cancer–can make a decent living just because insurance reimbursement focuses on procedures rather than preventive care, he said. However, most of the students who go into rural medicine don’t do despite the money, but rather because they truly want to fill that medical gap.

“They are altruistic kids that really are in medicine for the right reasons, and I love that,” he said. “I love to see students that are really not thinking about how they are going to negotiate a contract six years down the road.”