Rockford Medical School: Rural Health Needs Challenge Doctors

Rockford RMED at http://www.rockford.uic.edu/rmed.htm

By way of an update, here at Rockford, the Rural Medical Education Program (RMED) program continues strong. The program began in 1993 with a pilot class of (4)four students and a full class (15 )+ (5 special consideration possible if admitted through other pathway- including traditional admission). We have an average class size around 16. We continue to believe selection for rural practice to be key in outcomes. In a sense, selecting the right students WILL yield rural physicians. Trying to convince students to "become rural interested" may be a much more difficult task. Students selected because of their "rurality" that receive "curricular booster shots" through a longitudinal rural curriculum has been improving our state work force concerns. The outcomes are:

1993-2005

132 Graduates
71 Doctors in practice (completed residency)
61 In Residency/ Fellowship training
58 Students in Medical School --(In RMED program)
53 Doctors in Illinois (not only rural)
70% of Graduates in Rural Illinois Primary Care Practice( Defined as General Pediatrics, General Internal Medicine and Family Medicine[ Largest percentage are F.M.]
We do not include OB/GYN in our reporting, but they represent an additional 4%
81% of Graduates are in Primary Care (In Illinois & other states)

We are continuing to expand our efforts within the National Center for Rural Health Professions which encompasses development efforts in rural tracts for; Dentistry, Public Health, Nursing, Social Work and Pharmacy. We continue to work with collaborating partners and new rural programs as they develop. The total class size here at Rockford averages around 50 students. As an interesting side note, despite pre-admission data (lower MCAT, GPA), at
graduation, the last 3 years, our 15 RMED students have taken a disproportionately large % of academic awards (50%). We are pleased with the accomplishments they have made.

Matthew L. Hunsaker MD
Director, RMED
National Center for Rural Health Professions
University of Illinois College of Medicine at Rockford
1601 Parkview Ave.
Rockford, IL 61107
(815)395-5780
matthewh@uic.edu

Rockford also has a graduate who  had 7s on his MCAT and finished at the top of U of Illinois. Rockford is a prime example of changing admissions to meet the needs of underserved areas. The academic folks make the judgment as to who can survive the academic rigors of medical school.  Rockford uses a rural community committee to make the final recommendations. These choices are often different than the usual choices, with some unusual results as seen below.

During my first contact with Rockford and Jeff Stearns years ago, Jeff was worried whether the students would actually make the choices that would allow the program to continue and thrive. In the first years of the program he drove some of the students across the state to a meeting. As he drove he heard the students engaged in a lively debate about the pros and cons of articulated tractors. He no longer worried about the outcome only 2 years into the program and 5 years before anyone had chosen any location. 

The following is my nomination for news story of the year about rural medical education:

As of 2001, two classes already have trained to practice medicine in underserved areas.

By ELIZABETH NENDICK, Rockford Register Star
http://cf.rrstar.com/stafflist/showprof.cfm?department=Business&ID=41


PRINCETON It's barely past daybreak when Dr. Kurt Crowe starts checking on patients at the only hospital in this mid-Illinois city. He's skipped the white lab coat and is dressed casually in a short-sleeved shirt. His shoes pad softly down the hospital's main wing before stopping near the end of the hall. Inside a room, an elderly man with congestive heart failure lies diagonally across his bed. Crowe checks on him before slipping to another room, where the morning news spills from a television.

"Hello, sweetie," he greets a baby girl with breathing problems. Turning to her parents, he asks, "Is she doing any better?" On he moves. Back and forth, from the elderly to the very young, Crowe continues about his day as a family doctor in a small town. 

It's up to the 35-year-old Crowe to be an expert on all ailments. He can't call upon a gerontologist for his elderly patient or a pediatrician for the infant. Crowe faces more challenges in this town of 7,500, about 94 miles southwest of Rockford. Some patients drive 40 miles to see a doctor, so many don't get follow-up care or come in until they're quite ill.

After two years in practice, Crowe works harder than he did as a paramedic or medical student in Rockford. He heads into his office each morning, expecting to see 20 patients. He usually sees 35 to 40 by day's end. Still, Crowe said he feels prepared for those challenges. He was among the first to complete training as a rural doctor from the University of Illinois College of Medicine at Rockford.

The largest of its kind in Illinois, the Rural Medical Education Program is designed to prepare students for work in the 80 percent of rural Illinois counties that don't have enough doctors. The first two classes have graduated and are heading to rural communities such as Princeton. The college soon will begin training nurses and pharmacists how to better serve rural patients.

State of rural care

Midmorning at Crowe's clinic brings a wave of babies for routine check-ups. A little boy receives a clean bill of health, then Crowe notices he can't give the child a routine shot. "We don't take (Medicaid) cards for that here," he tells the boy's mother. "But if you go down to the health department, they'll take care of it for you." 

Rural towns, including Princeton, bring such challenges to doctors: The elderly constitute more of the population in rural areas. In 1998, 18.4 percent of the rural population was elderly, compared with 15 percent in urban areas. Elderly people frequently require more medical care than younger people.

Poverty is especially high in rural areas. A greater share of rural residents are unemployed, and nearly half of the poor receive government health insurance. Many farm workers lack private health insurance. In 1999, 35 percent of rural residents did not have private insurance. Crowe routinely stashes away free drug samples for them. Some patients drive significant distances to visit a doctor and schedule appointments only when something is wrong.

That means Crowe often shuffles his busy schedule to fit such patients in. Several times each morning, a nurse replaces the list of patients on his office wall with an updated schedule. On average, he said he sees 10 to 15 more patients each day than he would as a family physician at Swedish American Health System in Rockford.

Crowe tries to remember each patient's special needs before he walks into an examination room.

"The underlying question for everybody is, what kind of insurance do they have?" he said. "Every time I walk in, those things are running through my mind."

He also knows that smoking-related illnesses are a big issue in small towns. Crowe thinks his best bet is to address that problem one-on-one with patients.

"I think we need to do a better job just talking to people about their health," he said. "Too often, doctors just assume they'll be upset if we talk about them quitting smoking."

Crowe finds that working as a rural physician requires confidence and self-sufficiency. "You can't always rely on other people for help," he said. "Other people won't be there."

As one of about 10 full-time physicians in Princeton, Crowe sees an extraordinary number of children and pregnant women. That's because there are no pediatricians and only one obstetrician in town.

"You never know what you'll find yourself dealing with," he said. "I don't have a cardiologist. If someone is having a heart attack and comes here, I have to take care of it."

Life as a rural doctor

A boy and his mother are waiting in one of three exam rooms in Crowe's office. After a quick conversation with his nurse, Crowe greets them with a smile. The boy's eye is red and sore. His mother strikes up a conversation as Crowe examines the boy. 

"So have you met the new family that moved into the neighborhood?" she asked.

Large cities might have newer technologies and higher salaries, but rural towns offer community connections. Crowe prefers rural life to his years as a Rockford paramedic, rushing to emergency scenes and barely making relationships with patients. 

In Princeton, life moves more slowly. A small girl recognizes him in the hospital cafeteria. And home where he eats lunch with his family every day is minutes from the hospital.

"I've always liked small towns where you know everybody," said Crowe, who grew up in a 1,000-resident Wisconsin town. "I could work somewhere else and make more money, but do I want the lifestyle?"

Dr. Mary Simmons, also a graduate of the Rockford medical college's rural doctor program, also appreciates that closeness. "I have that sense of community," said Simmons, who practices in Belvidere with SwedishAmerican Health System. "We've all had a similar experience living in Belvidere and Boone County."

Still, working as a small-town physician can be frustrating. Crowe wishes he could spend more time on community education. He wants to take a few extra minutes to chat with patients about other problems in their lives. But there often isn't time.

"I'm already working 80 hours a week seeing people," he said. "Really what I'm doing is keeping my head above water day to day."

Rural medical education

A shortage of technicians, pharmacists and nurses has hospitals everywhere struggling to recruit workers. That problem is exacerbated in small towns. Crowe regularly sees nurses at Princeton's Perry Memorial Hospital carry heavier workloads as a result of understaffing. 

"This hospital in particular is getting killed by it," he said. "Nurses can go somewhere like St. Francis in Peoria, make twice as much and not be on call every other night."

The Rockford medical college is creating a center to teach doctors, nurses, social workers, pharmacists and dentists about cooperation in small towns.

"If they are out there, they need to learn to work with other disciplines and be able to look at it from other perspectives," said Cheryl Carlson, who heads the Rural Health Professions Education, Evaluation and Research Center.

So far, most of the applicants for the rural program are white. Although there have been a handful of Asian and Hispanic students, the program hasn't pushed to racially diversify its classes. "If there are rural communities with large concentrations of minorities, we would love to have them," said Michael Glasser, assistant dean for rural health professions. The true evaluation of the rural medical program's success is yet to come. The real measure will be whether graduates stay committed to rural medicine.

"The story isn't done yet," said Crowe. "Four to five years down the road, (the college) will be able to see who went on to work in rural communities, and then they'll be able to see if they're successful."

Rockford Trains Physicians for Underserved Areas



By ELIZABETH NENDICK, Rockford Register Star http://cf.rrstar.com/stafflist/showprof.cfm?department=Business&ID=41

ROCKFORD The Rural Medical Education Program began at the
University of Illinois College of Medicine at Rockford in 1993 to train
physicians for underserved rural areas.

The largest of its kind in Illinois, the program has graduated 21 students.

Medical students take extra courses and assignments to prepare for the
variety of cases they'll see. They also work in a rural community for 16
weeks during their final year at the school, completing a community project
that addresses that area's medical needs.

"One of the major things the RMED program does is focus your goal," said
Dr. Kurt Crowe, who was in the program's first graduating class in 1997.
"Like when you're working with a surgeon who says you're too smart to be a
family doctor or you see the dermatologist going in at 10 and leaving at 4."

The program recruits most of its students from rural areas on the premise
they'll be more likely to return to those communities. 

The need for doctors in some of these areas is great: Illinois ranks No. 8 in
the country for health professional shortages.

"It began because 90 percent of rural communities in Illinois were considered
underserved in primary care" in the early 1990s, said Michael Glasser, the
medical college's assistant dean for rural health professions.

"Their needs differ by size and place in Illinois. We try to look at the median,
and we have to tailor some of the curriculum."

So far, 47 percent of graduates have returned to rural Illinois communities.
The rest end up in larger cities or out of state.

"People are most likely to end up practicing within 50 miles of their
residency," Glasser said. "We have a number of students leave the state for
their residencies, and they end up practicing there."

Dr. Mary Simmons graduated from the second class. She works for
SwedishAmerican Health System in Belvidere, a borderline rural community.
She thinks a higher percentage of students will stick with rural medicine.

"This is a good program that really fills a need," she said.

"As they fine-tuned the program, it's helped students really understand what
they're getting into.

"Now I think they're doing a better job of fitting students with the program."

Copyright 2001Rockford Register Star.

 

KSB, U of I College of Medicine expand partnership

BY DIANE MARKEL  STAFF WRITER
Published: Wednesday, February 26, 2003   http://ww2.saukvalley.com/news/277117240806109.bsp