Admissions process aims to boost rural doctors

Medical students in a Tulane University program are picked based on their likelihood to practice in rural Louisiana.

By Myrle Croasdale — Posted Feb. 7, 2005

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Margeaux Coleman Walker, MD, would like to return to her hometown of Church Point, La., when she finishes her family medicine residency in Baton Rouge.

"I have always had hopes of going back to a rural area," Dr. Walker said. "I know a lot of medical students are looking at dermatology, radiology, that rural areas are not too appealing, but I know there's a need."

If the Tulane Rural Medical Education program had been up and running when she was applying to medical school, Dr. Walker would have been an ideal candidate.

The program aims to increase the number of rural doctors the school produces. Next fall, program director Richard Streiffer, MD, chair of Tulane's family and community medicine department, will welcome the first students to the rural medical education track, based on a model that's proven to have one of the best success rates turning out rural physicians.

Only seven other medical schools have such a program, although there is a range of rural health options offered at other medical schools, an expert in the field said.

At first glance, Tulane's program may not seem that big of a deal, yet it holds great promise, according to Dr. Streiffer.

"We're targeting six to eight students at our peak," Dr. Streiffer said. "If we place just four or five students in rural practice year after year, that's a significant impact. We can make a difference."

The Assn. of American Medical Colleges reports that nationally, fewer than 3% of U.S. medical school graduates say they want to practice in rural areas. Those who do go to rural areas don't stay long -- just seven years on average.

If all goes as planned, Tulane expects to have results similar to those of the Physician Shortage Area Program at Jefferson Medical College in Pennsylvania. During its 30-year lifespan, Jefferson's program has produced 12% of the rural physicians currently practicing in Pennsylvania.

Jefferson's graduates have also proven to stay in rural medicine for the long haul.

After 11 to 16 years, 66% were still practicing in the rural area where they started, according to one study, while another 11% had left their first rural practice but were still working in a rural community.

Central to such results, according to Howard Rabinowitz, MD, director of Jefferson's rural program, is selecting students from rural communities who have a desire to practice primary care.

This is good news to family physician Wayne Gravois, MD, who sees medical students come through his office in Zachary, La., with little intention of choosing a rural career.

"The majority of them are not interested in rural medicine per se as a career, but they enjoy the rural medicine experience," Dr. Gravois said.

Walter Birdsall Jr., MD, a family physician in Cut Off, La., has had the same experience.

"Most of these kids are from California, Los Angeles, big cities," he said. "For a lot of them, this is their only exposure to rural medicine, and the likelihood of somebody like that staying is not too strong."

The critical factor to getting and keeping physicians in rural areas -- and what distinguishes rural programs like Tulane's -- is the focus on capturing potential rural doctors during the admissions process.

At Tulane, applicants to the rural program are looked at differently than the 8,000 others applying to the school.

"Often they don't look as competitive on paper, but they have other strengths," Dr. Streiffer said.

Filling the pipeline

To increase the likelihood of finding rural Louisiana students who want to practice primary care, Tulane has set up an early admissions pipeline with Xavier University of Louisiana, a historically black university; Loyola University of Louisiana; and most recently, Nicholls State University, a small, regional college in Thibodaux.

Committees from each of these schools may recommend students for early admission. If accepted, they will move directly into the medical school without having to take the Medical College Admission Test.

Whether they come through the early admissions process or apply to the rural program on their own, once admitted, the students will be assigned a rural physician mentor, participate in a rural medicine interest group with their peers, do clinical rotations in rural practices and get guidance on financial support and scholarships related to working in health professional shortage areas.

Building such a rural track isn't a matter of big bucks, Dr. Streiffer said. Some public schools get funding to address rural health issues, but Tulane and Jefferson are private medical schools that don't get such dollars. Tulane's main costs are managing the rural track office and running separate admissions for the program.

"It's more of an attitudinal program," according to Dr. Streiffer, that simply requires a medical school making the needs of rural citizens a priority.

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