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UC Denver Voices

Keeping Doctors in Rural Areas


 

By Mark Deutchman, MD

The Denver Post's Sunday article about the town of Wellington losing its only doctor serves as a reminder of Colorado's increasing crisis in rural health care. This is an important issue that the state must address.

The University of Colorado Denver School of Medicine tries to do its part through its Rural Track and Rural Scholars programs. Both programs aim to supply physicians to underserved areas.

The numbers demonstrate the need. With Baby Boomers aging, demographers and health care policy researchers acknowledge a serious national shortage of physicians everywhere in the country.

But the workforce shortage is worst in rural America, where patients must routinely drive dozens of miles to find even basic health care.

According to the Colorado Health Institute, Colorado will need 50 new primary care doctors and 20 new obstetricians each year for the next decade to keep up with health care demands and an aging physician population.

This doctor shortage will dramatically hurt places such as Wellington, which already suffer a lack of doctors, nurses and health care support services. These areas include Colorado's rural eastern plains and Western Slope.

For instance, the Colorado Health Institute reports that in 2007, no active licensed physicians lived in Bent County or Washington County. San Juan, Mineral and Costilla counties had one active licensed physician each.

Fewer than five active licensed physicians lived in each of 10 other rural counties. The lack of rural health care causes some people to forgo preventive care and often the immediate treatment of serious conditions.

Specialty care is even more difficult to obtain. No oncologists presently work in the San Luis Valley. So the University of Colorado Cancer Center must send a cancer doctor to the area four days a month the see patients.

The Rural Track program admits medical students based on their background and interest in establishing a future practice in a rural area.

The program keeps these students grouped together in an academic and cultural curriculum that emphasizes the opportunities and challenges of rural practice.

It supports their interests in rural healthcare throughout the four years of medical school and provides financial incentives when it can.

Rural Track students spend time with rural physician role models during the very first year of school. They also get extra early learning opportunities for many of the varied skills that they will need in later training and practice, as well as the special relationship that a rural physician establishes with patients and the community. The process of producing physicians is long and expensive.

The Rural Track will graduate its first class in a few months, but the students must still go on to an additional three to four years of residency training - mostly in primary care specialties such as family medicine, internal medicine, pediatrics and in emergency medicine.

These are the most practical specialties for rural practice because they can take care of the widest variety of medical problems.

The Rural Track will boost the number of rural physicians by producing at least a dozen new physicians each year who seek further training to handle the unique responsibilities and rewards of rural medical practice.

Many of these new physicians will graduate with an educational debt of more than $150,000 each because of the costs of attending medical school.

One reason for the debt load is that Colorado ranks last in the nation in per student public support for medical students.

To really address rural health care delivery problems like those facing Wellington and other remote areas of Colorado, the state must increase medical student funding.

In addition, greater scholarship aid and expanded loan forgiveness programs can attract more physicians to practice in rural areas.

While Rural Track trains physicians, the medical school's Rural Scholars program provides a pipeline that directs rural high school students toward health care careers.

Each summer, the Rural Scholars program brings to the medical school high school juniors and seniors interested in becoming physicians.

Their three-week, expenses-paid experience includes lectures from school of medicine professors and visits to clinical facilities.

The Rural Track and Rural Scholars programs target students from rural areas because statistics show that people who grow up in rural areas understand the lifestyle and health care challenges of those areas and are more likely to practice medicine in rural settings for extended periods of time. This adds continuity of treatment to the availability of rural health care.

Colorado's state and federal leaders must hear from constituents that better rural health care benefits everyone in the state, no matter where they live.

Mark Deutchman, MD, a professor of family medicine, directs the University of Colorado Denver School of Medicine Rural Track program.

The University of Colorado Denver School of Medicine faculty work to advance science and improve care as the physicians, educators and scientists at University of Colorado Hospital, The Children’s Hospital, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. Degrees offered by the UC Denver School of Medicine include doctor of medicine, doctor of physical therapy, and masters of physician assistant studies. The School is part of the University of Colorado Denver, one of three campuses in the University of Colorado system. For additional news and information, please visit the UC Denver newsroom online.

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