New Residency Program Aims to Keep Doctors in the Rural Southeast

Southeastern Health is looking to train physicians in North Carolina’s Robeson County with the hope that they will stick around and work locally.

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Boris Calderon was not your typical medical student. At 45 years old, the Army veteran lived in Fayetteville and worked as a paramedic when he applied for only one medical school: a college of osteopathic medicine in Virginia.

And when Calderon finished medical school and was looking for a post-graduate residency program in 2015, Southeastern Regional Medical Center in Lumberton was beginning its program for medical residents. He signed up and was part of the first graduating class earlier this year.

Lumberton-based Southeastern Health has had challenges finding staff to work in it’s system, which consists of a 292 bed flagship hospital which also includes psychiatric beds, a long-term care facility, 19 primary care clinics and 12 specialty clinics. (Photo by Taylor Knopf)

Because the program is in its infancy, Calderon said there was a lot of flexibility and ability to personalize the classes and experiences to the individual.

“It’s a new program, so there is a little bit of chaos, but with chaos comes opportunity,” he said. “I tell people now, you have to find a program that matches you and your personality. It isn’t always about the name.”

Calderon found the residency at Southeastern to be extremely hands on. He said by the time the syllabus indicated that his class should start doing admissions, they had already done 500. So the students requested more learning time in the ICU and staff granted their request.

And when it came time for graduation this spring, Calderon knew where he wanted to be. He already lived locally and decided to remain at Southeastern Regional as a hospitalist.

Recruiting rural physicians

One of the goals behind the health system’s residency program, in partnership with Campbell University, is to train medical professionals with the hope that some will stay and practice in the region, such as Calderon.

One of the goals behind Southeastern Health’s residency program, in partnership with Campbell University, is to train medical professionals with the hope that some will stay and practice in the region. (Photo by Taylor Knopf)

Of the 26 people who graduated in June, four are now practicing in Lumberton.

Southeastern Health has four residency programs: internal medicine, emergency medicine, family medicine and a traditional rotating internship, a one-year program to prepare students for residency.

“We are training competent and compassionate physicians to practice in rural communities, where, of course, there is a physician shortage,” said Patricia Matto, vice president of medical education at Southeastern Health.

She said many North Carolina counties lack primary care physicians, but rural areas are actually a great place to train new doctors.

In general, the rural population is sicker. They have higher rates of drug and alcohol use, suicide, years in productive life lost, injury, teen births, uninsured patients and preventable hospitalizations.

“In a lot of ways, this residency over-prepared us. We are so use to seeing people with seven major diseases,” Calderon said.

He said he often saw patients with hypertension, diabetes, tobacco abuse and obesity.

“It’s not a shadowing experience. It’s hands on patient care,” Matto said. “They will be more independent when they leave.”

Mission work in your backyard

Matto added that a lot of patients in rural areas haven’t taken very good care of themselves. So when her residents see them, they need a lot of help.

“They may only be able to see a doctor a few times a year. It’s multiple medical problems dealt with at the same time.”

When recruiting residents, Matto said she lets them know that Southeastern Regional is a community hospital, where “everyone is part of the patient care team.”

“It’s expected that they perform up to their level of training, providing education to patients and dealing with social issues,” she said. “It’s a holistic approach.”

Matto grew up in a rural town in Pennsylvania and she said she knows what great places they can be. But she’s also familiar with the needs.

Rural medicine is a type of missionary work, she said.

“You don’t have to go to a foreign country to find people in need. There is need right in your backyard,” she said.

Family feel

And the smaller communities can yield more personal satisfaction, she said, because everyone knows one another.

“I’ve only been here two years, but you would think I grew up here. They treat me like I’m from here,” Matto said. “The community is welcoming and inclusive and the whole staff embraces the residents who are here and tries to make them feel like it’s a second home.”

Calderon felt that way too. Despite completing the residency program, he’s stayed involved with it.

“I think if you don’t give back, you’re being selfish. And like to teach,” he said. “I didn’t get here on my own. I relied on mentors.”

“I feel fortunate to be around physicians that are exemplary human beings,” he added.

That showed through during Hurricane Florence. Calderon said he worked through the storm and no one left the hospital.

Southeastern Regional learned many lessons from Hurricane Matthew in 2016, for which they weren’t as prepared. This time, Calderon said there were multiple generators to ensure they never lost power.

“I thought the storm was a great learning experience as well,” he said. “The crew that I had were phenomenal. They advocated for patients and worked hard. I had two patients that looked on the verge of death, but they left and were fine. The nurses literally hand fed one of them. If there are any heroes, it’s them.”
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A Pricey Proposition

When Southeastern Health wanted to start a residency program, it was clear they would have to spend money. According to CEO Joann Anderson, it took a total of about $11 million to cover salaries for educators, staff, equipment, furniture, the works. One big price tag was the cost to revamp part of the hospital to create a medical education wing.So Samantha Bennett, Southeastern’s grants and governmental affairs specialist, researched grants. She found support from the Lumberton city manager and together the hospital and city applied for a rural reuse grant from the state department of commerce.

Southeastern Health’s Regional Medical Center revamped a wing of the hospital for its new medical education residency program with the help of a rural reuse grant from the state Department of Commerce. (Photo by Taylor Knopf)

“The program is designed to assist rural places in attracting, growing local medical, health facilities,” said Melody Adams, director of rural grants program.

“We can assist with renovation of the building you are in,” she said. “If you want to retool a space that is storage, maybe you want to make an exam room, we can help as long as you will create new, full-time jobs.”

The program started in 2013 as a way to help rural businesses. Health care facilities were added in a little later. By the end of 2017, the program included 14 rural health care projects from Dare to Catawba County.

“It’s a win-win: expanding access to health and dental care while creating new jobs,” Adams said.

The $500,000 rural reuse grant helped fund about a quarter of the renovation project at Southeastern Health, Bennett said. But it was instrumental in getting other grantors on board.

“When they realize you have a grant from some entity, it compels them to want to help,” she said. “And for a medical education program, that was a no brainer. Most grantors we use are pro-rural health care, education and job creation.”

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Taylor Knopf covers rural and mental health news. She previously wrote for The News & Observer as a politics and general assignment reporter. Before that, she worked at a small daily newspaper in southern California.

This story was originally published at North Carolina Health News and is republished here with permission.

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