Where Are They Now?

Until the relatively recent past, Virginia had 3 medical schools, UVA, EVMS, and VCU.

Then the Edward Via College of Osteopathic Medicine opened in Blacksburg, then Virginia Tech-Carilion in Roanoke, then the Liberty University College of Osteopathic Medicine in Lynchburg.  Other medical schools for Virginia are being discussed as well.

Often, the discussion about a potential new medical school will include comments about needing more doctors in Virginia; or needing to fill gaps in underserved areas.

But do more medical schools = more doctors?

Studies have shown that physicians are likely to stay in the area where they received their residency training.  And in Virginia, that’s not the same as where they went to medical school.

Data provided to us from Medical Society of Virginia demonstrates that of the 693 medical students who were matched with a residency program this spring, only 156 received a match in Virginia.

That’s just over 22%.  693 medical students and only 156 staying in Virginia.

Some states have decided to focus on developing residency programs instead of increasing the number of medical students.  Maybe Virginia needs to consider this as well.

“Choose Virginia” Scholarships

The Virginia Academy of Family Physicians (VAFP) Foundation is delighted to announce one new medical student scholarship and one new resident scholarship annually for assistance with education loan repayment.

Many medical students and family medicine residents in Virginia have expressed an interest in staying in Virginia after their graduation to complete a family medicine residency or to practice in a medically underserved area. Over the past two years the VAFP Foundation has received donations to support this effort to keep our own.

Annually the Foundation will offer one graduating Virginia medical student a $1,000 scholarship. The successful candidate will meet the following criteria:

  1. Graduating Virginia medical student in good academic standing
  2. Entering a Virginia family medicine residency program. A letter from the program director is required.
  3. Will have completed the PGY-1 year successfully and be entering into the PGY-2 year at that program. A letter from the program director is required in order to receive the scholarship check for loan repayment at that time.
  4. Must submit a 250-500 word letter explaining why he/she wants to practice family medicine in Virginia as a resident and as a family physician.

In addition, the Foundation will offer one $1,500 scholarship for a graduating PGY-3 Virginia family medicine resident who wishes to practice in an underserved area of Virginia. The requirements for this scholarship are as follows:

  1. Graduating as a PGY-3 Virginia family medicine resident
  2. Have an up-to-date Virginia medical license
  3. Practicing family medicine in an underserved medical area after graduation as designated by United States Human Resource Service Administration (HRSA) and/or Virginia Department of Health. A letter verifying this is required.
  4. Must submit a 250-500-word letter explaining why they he/she wants to practice in an underserved area of Virginia
  5. Practicing at the underserved site for one year. Documentation is necessary to receive the scholarship check for loan repayment after one year of practice in an underserved area.

Application letters may be sent to Mrs. Mary Lindsay White at mlwhite@vafp.org or to Dr. Roger Hofford atrahofford@carilionclinic.org.

The deadline for application letters is May 31, 2016.

If anyone is interested in making tax deductible donation in support or expansion of this effort, or is interested in learning more about the VAFP Foundation, please visit our website at http://www.vafpf.org.

Project PROMISE

The Rural Health Information Hub (RHIhub) has a section of their website dedicated to model programs.   They recently highlighted Project PROMISE, a North Carolina program designed to encourage rural youth to pursue medical careers.

Project PROMISE (Providing Rural Opportunities in Medicine through Inspiring Service and Education) is the brainchild of two medical students who started the program to give high school seniors medical academic training, mentor relationships, and hands-on experience in rural North Carolina facilities.

Project PROMISE launched in the Fall of 2014 with their first group of students.  Since then, it has graduated 10 high school students, 5 of whom are pursuing an undergraduate degree with an interest in studying medicine.

Read more about Project PROMISE.

Doc Burnout

What happens when an eager young doctor in a rural community with a passion to make a difference becomes the medical director for the nursing home, the overseer of the town’s emergency medical service, the football team’s sideline doctor, the clinic’s medical director, and the hospital’s trauma director and chief of staff?

And has two children?

Burnout

This wasn’t a scenario we made up.  This is a real story highlighted in a recent article by the Rural Health Information Hub:

Randall Longenecker, MD, FAAFP, serves as assistant dean for rural and underserved programs at the Ohio University Heritage College of Osteopathic Medicine and is the Executive Director of the national RTT Collaborative. He is an advocate of teaching medical students and residents skills to build their resilience and help them deal with the stresses of rural practice.

In Longenecker’s experience, rural settings can actually encourage providers to admit they have a problem. “One of the advantages of living in a ‘glass house’ where everyone knows each other’s business is that (burnout) quickly becomes apparent to others,” said Longenecker.

Providers who build strong relationships within their community also have an advantage when dealing with burnout. “Resilience, or the ability to persist and thrive through hardship, is a competency for a rural practice,” commented Longenecker. “Hardship itself is not the most important contributing factor (to physician burnout), the lack of healthy relationships is.”

Read the full article here.

Affording Medical School

There’s no doubt about it — medical school is expensive. But U.S. News & World Report has compiled a list of 10 private medical schools with the lowest tuition and fees for the 2015-16 academic year.

Here are the 10 most affordable private medical schools and their 2015-16 out-of-state tuition rates, according to U.S. News & World Report:

  1. Baylor College of Medicine (Houston) — $31,663
  2. Lake Erie College of Osteopathic Medicine (Erie, Pa.) — $32,985
  3. University of Pikeville–Kentucky College of Osteopathic Medicine — $41,320
  4. University of Miami Miller School of Medicine — $42,626
  5. Edward Via College of Osteopathic Medicine–Virginia campus (Blacksburg, Va.), Carolinas campus (Spartanburg, S.C.) and Auburn (Ala.) campus — $43,250
  6. Kansas City (Mo.) University of Medicine and Biosciences — $43,513
  7. Lincoln Memorial University DeBusk College of Osteopathic Medicine (Cumberland Gap, Tenn.) — $46,528
  8. Touro College of Osteopathic Medicine (New York City) — $48,340
  9. Hofstra Northwell School of Medicine (Hempstead, N.Y.) — $48,500
  10. Mayo Medical School (Rochester, Minn.) — $49,900

See those three schools in bold type?  That’s right – three out of the top ten are in our region!

Emergency Residency

Tom Morris – HRSA’s Associate Administrator for Rural Health Policy – has a stump speech about rural healthcare vs. urban healthcare entitled; “Rural is NOT Mini Urban.”

To underline his point, he puts a picture on the screen of a huge tractor next to a lawn mower.  Guess which one is intended for use in rural areas?

By the same token, emergency medicine is different in rural communities.  A hospital in Idaho has recognized that difference in creating a rural emergency medicine program.

St. Luke’s Hospital and the University of Washington created the program after the university decided its students should be exposed more to rural medicine.  The students are overseen by emergency physicians and the students are able to help out in the ER during busy times.

Read more about this unique program.

Preparing for Rural

The Rural Health Research & Policy Centers recently published, Outcomes of Rural-Centric Residency Training to Prepare Family Medicine Physicians for Rural Practice.  This policy brief identified family medicine residencies providing rural training and the practice locations of their graduates.

KEY FINDINGS

  • Family medicine physicians who graduated from rural-centric residency programs—those that actively recruit medical students with an interest in rural practice and require at least eight weeks of rural training—practiced in rural areas during the first five years after graduation at much higher rates than the entire population of family physicians.
  • No single program characteristic or model offered sustained advantages over any other type in producing high yields to rural practice.
  • Graduates of rural-centric family medicine residencies also chose to practice in Primary Care Health Professional Shortage Areas (both rural and urban) at high rates, up to 54% three years post-graduation, declining by five years post-graduation to 42%.
  • The combination of a program mission to produce rural physicians with required rural training experiences may help to account for similar outcomes among a diverse group of residency programs that produce family physicians who choose rural practice.
  • More research is needed to determine whether rural practice choices are sustained beyond five years post-graduation, the time period of this study.

The last point is of particular interest as the paper notes:

It is not known the extent to which these high rates of practice in shortage areas are the result of incentive programs, such as the National Health Service Corps, or Conrad 30 Waiver Program, or other factors. If incentives are driving this trend, we do not know whether these physicians will remain in shortage areas once incentive obligations are fulfilled, since incentive programs typically involve two to six years of service in underserved locations.

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