Rural Medical Training Spurs Economies

[imgbelt img=rural-physicians-seal320.jpg]Minnesota’s legislature has put in place a model for medical training
that has improved rural health outcomes AND boosted rural economies. Why
aren’t federal health administrators taking note — and taking action?


Rural Physician Associates Program (RPAP) was created with 60 medical students a year spending 9 months in Greater Minnesota as members of health care teams. This structure remains one of the best ways for a low-cost boost in health care delivery where it’s most needed.

RPAP sites deliver $40,000 to $70,000 more care when they have a medical student on the team as compared to years without, as Jack Verby long ago noted. Studies in Australia support this value of long-term continuity in rural rotations. RPAP has been a key part of medical school graduates’ remaining in family medicine, instate, and where they’re needed.

Diagnosis-Related Groups  to “shared savings” for areas with the least health spending already. The Institutes of Medicine have recommended lower reimbursement for smaller and rural practices, a continuation of flawed indices, biased reports, and lack of awareness of most Americans’ health care needs.

[imgcontainer left] [img:Sarah-Eisenschenk225.jpg] [source]ACMC

Sarah Eisenschenk, medical student, trained through RPAP in western Minnesota. “I wanted to try on the ‘life of a rural physician’ because that’s what I’ve always seen myself doing… It’s hard to know what’s right for you until you get an opportunity to try it out.”

The Health Resources and Services Administration fails to comprehend that RPAP-type year-long experiences could deliver care to millions more people, involving thousands of health care students trained where care delivery is needed most. This design would do far more to train health care professionals to work with other health professionals, as the experience involves many months of continuous team work.

RPAP also has been effective in identifying problem future-physicians and problem current-physicians; current methods of health care training fail to do so.

RPAP provides an experience far beyond the usual few weeks or months of rural or of primary care exposure (which is about enough time to drive graduates away from choosing primary care as a specialty or opting to work in a rural area). Complex health care delivery and rural relationships -– as well as the literature on rural primary care — take time to understand and appreciate.

Instead of expanding the Rural Physician Associates Program, we have invested over $600 million over the past three decades to create too few health care professionals, placing them in the wrong careers and wrong locations. RPAP, especially combined with the Duluth Medical School, was specifically designed to turn out permanent family practitioners and yield more professionals in rural general surgery, rural obstetrics, and rural primary care.

Our nation supports generic primary care training, but in 70% of cases, these graduates do not continue working in primary care. The often promoted physicians assistant, nurse practitioners  or advanced nurse interventions are low yield, with less than 25% of those so trained ultimately  employed in family practice.