- The Washington Times - Wednesday, December 29, 2004

NEW ORLEANS — Wanted: small-town students who want to become country doctors. Tulane University is mounting an effort to bring more doctors to underserved rural Louisiana.

The school is looking for students like Dr. Margeaux Coleman Walker, who has known she wanted to be a doctor since she was 11 or 12 and helped her grandmother clean the doctor’s office in Church Point, a town of 4,700.

But she wants much more than a medical practice. “Hopefully, when I want to retire, I’ll be able to say, ‘I worked hard and I made a difference in people’s lives.’”

She’s finishing her three postgraduate training years in the family-medicine residency at Baton Rouge General Medical Center and would like to wind up back in Church Point.

“She’s just the type of student we hope to identify,” said Dr. Richard Streiffer, head of Tulane Rural Medical Education, which is taking applications until Jan. 15 for its first class.

“She just happened,” he said. “Our program, we hope, will make that occur more regularly.”

Dr. Streiffer hopes to get six to eight students a year who want to stay in rural Louisiana, and perhaps surrounding areas. “It’s not been a point of emphasis for Tulane at all, to focus on keeping people in Louisiana, particularly in rural Louisiana. I can’t quantify it for you, but it would be the rare or occasional student who does this,” he said.

Lack of rural doctors is a problem nationwide, not just in Louisiana.

One-fifth of the U.S. population — about 60 million people — lives in rural areas, spread over four-fifths of the land. About 10 percent of the doctors live in rural areas, said Marcia Brand, head of the U.S. Office of Rural Health Policy.

Louisiana is more rural than most states. About one-quarter of its 4.5 million residents live outside metropolitan areas, along with fewer than one-eighth of its doctors.

Tulane’s new program is one of only a handful nationwide designed to train doctors for rural areas and inner cities where there’s a shortage.

One of the first — and the model for Tulane — was set up in 1974 by Jefferson Medical College at Thomas Jefferson University in Philadelphia. Graduates of that program are eight times more likely than other medical school graduates to become rural family doctors, said Dr. Howard K. Rabinowitz, its director since 1976.

Over 30 years, the program has graduated just 350 students, but most stay in rural medicine: A study of the first nine classes found that 80 percent were still country doctors. Most were in Pennsylvania; some in other states.

“Most of them are well-established with their families and their lives in these communities,” Dr. Rabinowitz said.

In contrast, almost half of all doctors who are lured to needy areas with medical school scholarships or help paying off their college loans leave such areas after their time is up.

Part of it is the culture shock illustrated in the TV show “Northern Exposure,” about a New Yorker sent to the tiny Alaskan town that paid his medical school tuition.

“I call our program the opposite of ‘Northern Exposure,’” Dr. Rabinowitz said. He looks for people who love the life to start with. “If they didn’t do rural family practice, they would probably go into another profession, like teaching or health care or something in a small town.”

But family practice is a dwindling choice among U.S. medical school graduates. Overall, the number taking family-practice internships has fallen by nearly half since 1996.

One reason, said Tulane’s Dr. Streiffer, is that city youths are more likely to get into medical schools. And, by and large, they want to work in or near cities.

“Private schools like Tulane and others are much more likely to look at students who come from certain universities. Those don’t usually include the smaller colleges where rural students tend to stay,” he said.

In addition, medical schools are in cities, and it’s often hard to resist the appeal of the large multispecialty urban setting, some experts say.

To help them, the Jefferson Medical program has mentors, special courses about rural family medicine, and several monthlong “rotations” working in rural areas.

Many doctors would rather work in cities or suburbs just because the hours are shorter. There are more doctors to talk to if you run into a problem, and far more specialists.

“If you’re looking for more of a 9-to-5 practice where you can sign out and someone’s going to cover for you,” rural medicine isn’t for you, said Dr. James E. Devlin, a graduate of the Jefferson Medical program.

He’s a solo practitioner in Brockway, Pa. (population 2,500), checking his hospitalized patients seven days a week. It’s hard to find someone to do that if he wants a vacation. But he knew growing up that he wanted to go into practice with his father, who has since retired.

He said he loves being a big fish in a little pond. But more, he loves knowing his patients as friends, as church members, as people. Being part of their community. “I wouldn’t trade that for anything,” he said.

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