This month’s issue of The American Medical Association’s Journal of Ethics is entirely focused on rural medicine. With that said, it is time for me to make a confession: I belong to a physician shortage program. There – I said it. Contrary to what many may think, I didn’t initially plan on applying to the program, and didn’t apply as an attempt to circumvent the regular admission process either. I grew up in a rural Pennsylvania town with a father who ran (and continues to run) a private primary care practice. I worked there on weekends and during the summers while in high school. In fact, I was one of those go-getters who “always wanted to be a doctor,” and didn’t really see the need for a rural medicine program to help me practice the type of medicine I had grown to love.
I was drawn to my program after I learned about its specifics. There is no commitment involved; that is, there is no penalty if I do not choose a career in rural medicine one day, and there is also no restriction on the types of specialties or subspecialties I can choose to pursue. Inclusion in such a program also helps when applying for scholarship through The National Health Service Corps, which provides federal funding for tuition and education expenses, to those medical students who are committed to rural health. However, in my opinion, the greatest advantage to my physician shortage program is its creation of an environment for students to sit down and talk about their interest in rural health without receiving the scorn of peers or other members of the medical community.
While I think of Polish food, coal breakers, the native slang, church picnics, and a high school class of 64 students as a rough definition of my home town, when I sat down to write this entry, I thought I should probably have some iota of a clue as how to define a rural area. The US Department of Agriculture Economic Research Service does an excellent job. The next step was to find some statistics about the state of rural medicine in the US, but before I could find any real numbers, I made a few qualitative observations. While my search turned up the websites for a number of medical institutions touting their rural programs (and their rankings, according to US News and World Report), I found few sites, blogs, interest groups, or even Twitter accounts geared to supporting the few adventurers who choose to take the path less traveled. The sites I did find were downright dismal. There was Rural Family Medicine, last updated in 2004, and Rural Medicine, which asked me to sign a petition to reactivate the site. I did find a Twitter account dedicated to the topic – @ruralmed, whose archives contained a whopping 7 tweets, the last of which is from May of 2009. I found only one blog dedicated to policy- related rural issues, Legal Ruralism,which contained 58 posts about healthcare amidst a sea of other topics. Mind you, I most definitely did not scour Google to the fullest extent; but the idea that the few sites I did find were located within Google’s top results – that is, the ones most frequently viewed – is disheartening. Interestingly, my own go-to rural health policy blog, Rural Health Voices, was not among any of these results. What would a young pre-medical student, not unlike myself a few years ago, think of physician shortage programs given these online search results?! Like my physician shortage program has a place at my medical school, so too should physician shortage interest groups find a prominent place amidst the vast expanse of the World Wide Web.
The truth is many medical professionals, pride themselves on selfless care of the underserved – uninsured, homeless, refugee, you name it – but very few stop and take the time to consider those patients living in areas like my quiet PA hometown to have limited access to healthcare. Unfortunately, while rural hospitals and clinics are not short of underserved patients, they are lacking in funds, a substantial workforce, research opportunities, and career advancement possibilities that so many type-A, goal-oriented physicians seek. I fully understand that there are a variety of reasons for not pursuing a career in rural health (I hear them repeatedly from some of my peers), and as a second year student, I’m not even entirely sure where I’ll end up one day. However, I’m certainly not ruling out rural primary care as an option, so I’d love to hear some from those out there who feel the same way to identify some reputable online resources for rural medicine. Who’s with me!?