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Special Theme: Rural Health Care

The Special Theme issue on rural health care includes four separate articles approaching this issue from different perspectives. The Case for Growing Rural Physicians is the most general of the articles and provides an overview of the issues and people involved in rural health care. The two articles, The AHEC Program and Rural Medical Education- Idaho’s Incentives, describe special programs that support and encourage medical education for individuals interested in providing rural health care. The article “Importance of Rural Public Health” addresses some of the public health issues unique to the rural setting. Each of these articles is summarized below.

The Case for Growing Rural Physicians: Perennials vs Annuals

Robert C. Bowman, MD

Using the plant analogy of perennials and annuals, Bowman discusses the current maldistribution of physicians, describes the programs addressing this issue at several medical schools, and offers some ideas for rectifying the situation. There is a critical need for rural family physicians, and the people who are most likely to serve underserved communities are the ones least likely to be admitted to allopathic medical schools in the U.S. Osteopathic medical schools in general produce a larger number of physicians who settle in rural areas. The people most likely to choose to practice in a rural area tend to be older, interested in family medicine, and have grown up in a rural area. Several medical schools have successful programs. The Jefferson PSAP works with several small colleges and uses very selective criteria in admissions. Factors such as growing up in a rural setting are given significant weight in the admissions process. The medical schools (allopathic and osteopathic) in West Virginia are all leaders in rural medicine through almost exclusive preference given to (the largely rural) in-state applicants and substantial assistance with medical school tuition. Other schools, such as Duluth’s RPAP, provide intensive training in rural settings during the clinical years of medical education.

In short, perennial programs admit and support the types of people who will return to their rural roots and remain there in practice. Annuals, those serving rural communities to pay off loans through such programs as the National Health Service Corps, are unlikely to stay in an underserved area beyond the required time, resulting in high turnover and less than optimal medical care. An extensive bibliography is provided supporting this work.

The AHEC Program and One Advisor’s Experience

Chere Pereira

Ms. Pereira, the health professions advisor at Oregon State University, describes the Area Health Education Center (AHEC) Program and how it can assist advisors. With regional offices located across the country, the AHEC mission seeks to improve access to quality health care by improving the supply and distribution of health care professionals in typically underserved areas such as rural and minority communities. Their website and printed material serve as excellent resources of information on workforce issues, health care needs, and training programs. Some regional AHECs provide outreach programs such as camps and career fairs to spark interest and provide support for students interested in health care careers. Their staff and boards of directors are a good source of speakers. Having had very good experiences with the Oregon AHEC, Ms. Pereira urges others to investigate their regional AHECs.

Rural Medical Education- Idaho’s Incentives or
What Exactly is WWAMI?!

Glenda Hill

WWAMI is the acronym for a medical school partnership begun in 1972 which includes Wyoming, Washington, Alaska, Montana, and Idaho. Each of the participating states designates a specific number of seats in the University of Washington School of Medicine allowing for publicly supported medical education in states that do not have their own medical school. WWAMI has made a very successful commitment to training and retaining physicians in its many medically underserved areas. Idaho, ranking 49^th among states in physicians per capita, has made further commitments to “growing and keeping their own”. U-DOC is a program for high school students. Student Providers Aspiring to Rural/Underserved Experiences (SPARX) is directed to college level pre-health students. It provides shadow experiences, medical student mentors, field trips, and guest speakers. Rural/Underserved Opportunities Program (R/UOP) allows Idaho medical students to spend the summer between their first and second years of medical school with a rural primary care physician. All WWAMI students may complete their clinical years in the 5 state area through WRITE (WWAMI Rural Integrated Training Experience). Through the Idaho Track, Idaho residents may move back to Idaho for their clerkships. Finally, there are three primary care residency programs in Idaho. These programs have successfully retained an unusually large percentage of physicians to practice in rural, underserved areas.

Importance of Rural Public Health

Dan Boatright, Ph.D, FRSH, Allison Foster, MBA, CAE, and Michael B. Meit, MA, MPH

Although most public health concentrates on densely populated area, rural communities are in need of public health practitioners and programs. Rural public health deals with such unique issues as agriculture, mining, and logging health concerns as well as the more prevalent issues created by poverty and negative health behaviors. The geography of such regions often results in low availability of primary and preventive care, and poor use of the care that is available. Rural health practitioners typically enjoy the outdoors, don’t mind driving long distances, and are able to work alone or with little support. These people tend to be public health generalists, addressing a variety of issues at once. Interested parties are encouraged to visit the Association of Schools of Public Health website at: www.asph.org.

Crafting the Letter of Evaluation: Composing a Letter that Captures the Applicant as an Individual

Carol Elam, Ph.D., Thomas Oeltmann, Ph.D., Joe Workman, Ph.D.

The letters of evaluation written for pre-medical students are key components of their admissions application materials. Admissions committees use these letters to screen and select applicants. The most useful letters are candid and honest, offering insight and examples. The least useful letters repeat information found elsewhere in the application and offer vague and irrelevant information. The two aspects of letter writing addressed by this article are obtaining useful information and crafting the language of the letter.

Advisors obtain direct information about students in several ways: academic advising, teaching courses, and directing research. Advisors also review a student’s record of courses taken and grades earned. Some use standardized test scores (MCAT, SAT, ACT) to put grades in some context. Whether the advisor works alone or with a faculty advisory committee, the final letter that is written should synthesize all available data on a student including personal characteristics, and social skills. The most valuable letters address weaknesses as well as strengths.

A table is provided with key personal qualities, social skills and other relevant information that should be gathered and addressed for each applicant. These characteristics include: leadership, ability to work collaboratively, honestly and integrity, responsibility and dedication, motivation, empathy, communication skills, service to others, problem-solving ability, and exposure to the profession. An extensive collection of examples of student strengths and weaknesses in each of these areas is presented. These contrasting examples of writing about strengths and weaknesses would be especially helpful to a new advisor.