There are twice as many people living in rural areas of Kentucky as there are physicians sufficient to care for them. That sobering statistic is the impetus behind a new program at the University of Kentucky Medical School. Known as the Rural Physician Leadership Track, the program gives participants additional exposure to rural medicine and leadership training in the hope they will choose to practice in underserved areas in the state.
The need for the program is clear, according to Dr. Jay Perman, dean of the UK College of Medicine and vice president of clinical affairs. Perman said a 2007 study conducted by the Kentucky Institute of Medicine concluded that Kentucky needs 2,298 more active physicians to meet the national average. In 2007, Kentucky had 8,981 doctors serving a population of 4 million.
Beyond the absolute numbers, the other issue is the distribution of physicians, according to Perman.
“Kentucky is the sixth most rural state in the nation; 43 percent of our population lives in rural areas,” Perman noted. “However, only 23 percent of Kentucky physicians live and practice in rural areas. Like other parts of the country, physicians in Kentucky tend to want to work more in urban areas. It’s not all about lifestyle either. Physicians in specialties need to be in an infrastructure where they can practice their specialty. Often that is not available in a small community hospital.”
Perman said other factors, including the aging out of physicians now in their 50s and 60s, an influx of women into the profession, and generational changes have “conspired to reduce the number of physicians available.” According to Perman, some younger physicians and some women do not want to work the 60-80 hours each week that physicians now in their 50s and 60s expect to work, again reducing the availability of physicians.
The Rural Scholars Leadership Program is designed to address the need for more physicians by adding 10 new slots each year at the UK Medical School. But the program is not just about adding more doctors; it is about adding physicians who are schooled specifically in rural medicine.
Students who join the program go through the same admission process and follow the same curriculum as other med students during their first two years of medical school. However, they receive additional training in rural aspects of public health, biostatistics, epidemiology and community medicine. During the first two years, they visit with community leaders and agencies and are matched with a community physician who serves as their mentor during clinical training.
In their third year of medical school, their training is based at St. Claire Regional Medical Center in Morehead. There the scholars follow patients throughout their course of care. The students also receive core clerkships in internal medicine, family and community medicine, surgery, obstetrics and gynecology, pediatrics and psychiatry.
“When we are talking about a shortage of physicians, the problem is not just limited to primary care,” Perman said. “It is hard to find a general surgeon or an obstetrician or an orthopedic surgeon in some rural areas as well.”
In their fourth and final year of medical school, the scholars attend the same clerkships as fourth-year medical students at UK Medical Center, but return to Lexington for clinical pharmacology, inpatient pediatrics and dean’s colloquium. They also conduct a community health research project in the Morehead area and evaluate a real-life medical practice. Students also receive community leadership training at Morehead State University.
For now, the program is limited to Morehead, but Perman said they hope to expand the program to Murray State University and involve the Murray and Paducah communities in the western commonwealth.
“That’s our vision,” he said, “but there are no funds to do the program in two sites right now. As soon as the funds are cobbled together, we will replicate what we are doing in Morehead. We feel our medical school has a statewide mission.”
Perman said the program, now in its first year, is expected to cost $500,000 for the one site, $1 million for two. The money is for one-time renovation costs to add new laboratory space and for additional personnel. Funds currently come from UK, he said.
One of the new personnel is Dr. Tony Weaver, an internist in Morehead who is now assistant dean of the Morehead Regional site for the UK Medical School. He will oversee the program in Morehead.
Weaver is “the real deal,” according to Perman. Weaver graduated from medical school at Vanderbilt, received additional training at the Medical College of Virginia, and then came back to Kentucky to practice in Morehead, where he has been an internist since 1986, giving him some 22 years of experience and perspective with rural medicine.
Weaver has seen bright young people from Morehead leave, complete medical school and move to urban areas. He has also seen bright students not go on to college or medical school because they can’t or don’t want to leave the Morehead area for four or more years.
“There is a constant drumbeat in medical school of ‘you should be like us in the city,’ ” Weaver said. “I experienced the same thing. People couldn’t believe that I actually wanted to live and work in a rural area.”
This program, Weaver hopes, will be a start toward ending that mentality and will help keep some of the talent from rural areas in rural areas.
He tells students there are three reasons they should consider the program: “One, they will be making history because this program is very different from any other in the country. Two, this is an opportunity to learn not only to care for patients but to care for a community. Three, they will learn to get things done when there is little or no support staff and few specialists around.”
Still, like Perman, Weaver acknowledges that the program is not for every student. Even so, both hope this program will be a start toward ending the perennial shortage of physicians in rural Kentucky.