Regional partnership tackles health care disparities in rural areas
Rural America is facing a shortage of primary care physicians and health care providers. While almost a fourth of the U.S. population lives in rural America, only about 10 percent of U.S. physicians practice in rural communities, according to the National Rural Health Association.
However, the rural community surrounding Wright State University—Lake Campus in Celina, Ohio, is determined to find a solution.
Led by Robert P. Gill, M.D., a family physician with the Grand Lake Health System, physicians are teaming up with educators from the Boonshoft School of Medicine, Wright State University and Miami Valley College of Nursing and Health, Wright State University–Lake Campus, Cedarville University School of Pharmacy, and local foundations to introduce medical, nursing, and pharmacy students to the possibility of practicing in a rural area.
“In some of the rural practices, our physician population is aging, including myself,” Gill said. “We realize we have to replace ourselves.”
While Grand Lake Physicians Practices actively recruits doctors, Gill thought about other ways to attract clinicians to practice in the area. In the summer of 2013, Gill spoke with Dean Parmelee, M.D., associate dean for academic affairs at the Boonshoft School of Medicine. That conversation resulted in a collaborative effort now called the Wright Rural Health Initiative.
Opportunity to learn in a rural setting
Through the Wright Rural Health Initiative, medical students have the opportunity to learn the practice of medicine in a rural health setting. The initiative provides a means of collaboration among educators, communities, health care providers, and interprofessional students to increase the number of primary care and primary care clinicians in Ohio’s rural areas.
The Wright Rural Health Initiative advisory group, which includes representatives from Wright State’s medical school, nursing college, and Lake Campus, along with the Grand Lake Health System, Mercer Health, Health Partners of Western Ohio, Cedarville University School of Pharmacy, HealthPath Foundation of Ohio, Western Ohio Educational Foundation, and other community partners, has been meeting throughout the past year to develop and implement the initiative. A regional summit was held at WSU—Lake Campus last February.
Parmelee explained that part of the Boonshoft School of Medicine’s social mission is to prepare medical students for careers in primary care in underserved areas. “We also want to provide our students opportunities to learn medicine in hospitals, clinics, and practices that provide quality care outside of the more customary academic medical centers and urban systems,” he said. “Our hope for the Wright Rural Health Initiative is to have another very special set of experiences in a very different setting from our urban and suburban health care domains in the Dayton area.”
The rural setting of the five counties that include the Lake Campus and its neighboring health systems is representative of much of Ohio where there is a great shortage of health professionals, including primary care physicians. “So for the Boonshoft School of Medicine, our students will have this additional learning environment that is both special and is very much a part of our social mission,” Parmelee said. “For the health care systems of the five counties, a program like this will help with the recruitment and retention of physicians, an expectation being that students who have the experience there would consider practicing there after residency.”
Therese Zink, M.D., M.P.H., chair of the Boonshoft School of Medicine Department of Family Medicine, is an advocate of the Wright Rural Health Initiative. Before she became chair in January 2014, she served as a professor in the Department of Family and Community Medicine and the Rural Physician Associate Program at the University of Minnesota in Minneapolis.
“We have huge needs for health care providers in rural areas,” Zink said. “The Affordable Care Act underlines the need for more family medicine physicians, especially in rural America.”
Exposure to rural areas in medical school key
From her experience at the University of Minnesota, Zink learned that exposure to rural areas during medical school is one of the keys to attracting future doctors to consider practicing in small communities. In addition, offering a rural health care residency makes a difference. She and others are developing relationships with health partners, hospitals, and physicians.
In June, The HealthPath Foundation of Ohio gave a $73,663 planning grant to the Boonshoft School of Medicine to help develop the rural health-training track. The goals of the Wright Rural Health Initiative fit with the foundation’s strategic initiative, Strengthening Ohio’s Safety Net (SOSNet), which seeks to improve health care access for underserved populations, with a primary focus on rural areas, and to enhance the distribution and diversity of the health care workforce.
“The partnership between the Boonshoft School of Medicine, the WSU-Lake Campus and surrounding communities holds great promise for success in providing an excellent experience for medical students in learning about the practice of medicine in a rural environment and the quality of life that this kind of community can provide,” said Theresa Wukusick, executive director of the HealthPath Foundation of Ohio. “In addition, the focus on inclusion of an interprofessional learning component to the project is in alignment with the foundation’s goals and emphasis on the provision of patient-centered, team-based care.”
John Pascoe, M.D., M.P.H., professor of pediatrics at the Boonshoft School of Medicine, is the principal investigator for the grant. He runs the meetings and harvests and coordinates the ideas. “Everyone involved in this initiative is committed to medical education, helping families, and recruiting physicians into the area,” Pascoe said. “There is a lot of synergy.”
Pascoe and others are working on an implementation grant and will submit it to the HealthPath Foundation in February. If approved, this would be a $300,000 grant spread over two or three years.
Strengthening ties with regional health partners
In the meantime, the various members of the initiative are working with health partners in the region. “Moving forward, we’ll be strengthening those ties with our health partners north of Dayton, including Grand Lake Health System, Mercer Health, and Health Partners of Western Ohio,” Pascoe said. “Medical, nursing, and pharmacy students will be included in the interprofessional curriculum being developed for the Wright Rural Health Initiative.”
In April 2015, interprofessional students from the WSU Boonshoft School of Medicine, the WSU College of Nursing and Health, and Cedarville University School of Pharmacy will begin an interdisciplinary curriculum, recognizing the team approach to patient care to achieve optimal health outcomes for patients in a rural setting. In May 2015, Pharm.D. students will begin rotations into the area.
“The WSU College of Nursing and Health is working with the Boonshoft School of Medicine on developing a more structured experience for those nursing students who are focused on working in a rural area,” said Donna Curry, associate dean for graduate programs and professor at the College of Nursing and Health.
Grand Lake Health System is thrilled about the initiative and the possibility of medical students returning after residency. “We’re really excited to work with Wright State to give the medical students exposure to rural medicine,” said Michelle Wasmund, executive director of physician practices. “We have a good health care system. This is a good place to live and work.”
Wasmund said it is challenging to recruit physicians to rural areas. “The majority of physicians prefer to stay in urban or suburban areas,” she said. “It’s really difficult to get them to consider a rural setting.”
Angela Hale, director of physician services for Mercer Health, another health care services provider in the region, agreed with Wasmund about the challenge of recruiting physicians to a rural area.
“With an aging population of family practice providers in our community, the real issue of having providers to care for our community is becoming critical,” Hale said. “Even though we have local medical schools, the students are not staying here. We hope to change future providers’ understanding of rural health care by providing them with a firsthand look at family practice in a rural community.”
Gill and several of his colleagues have volunteered to be preceptors for the medical students. Under the rural clerkship, students follow physicians on their rounds and interact with the patients. They take time to discuss patient’s cases with the medical students. “We take teaching the students very seriously,” Gill said. “We want them to have the best educational experience.”
Training the next generation of doctors
Gill views this opportunity as a privilege. “We want to give something back to medicine,” he said. “We’re helping to train the next generation of doctors.”
The medical students experience working with a different population of people, who have concerns or illnesses the students might not have been exposed to in an urban or suburban setting.
Jordan Brunswick, a fourth-year medical student, has done rural health clerkships in pediatrics and family medicine. Gill was one of his preceptors. “It was a great learning experience for me to see what the day-to-day life is like for a rural physician,” said Brunswick, who is from Maria Stein, a rural farming community in Mercer County, Ohio. “I was already interested in rural health before doing these rotations. However, the experience confirmed that I would be very comfortable practicing rural medicine.”
During Cody Adkinson’s rural health clerkship, he was introduced to patients who were farmers or factory workers. Under the direction of his family medicine preceptor, Adkinson was able to assist with various family medicine procedures, including local anesthetic injections, removing skin lesions, and intramuscular and bursa injections. In his pediatric clerkship, he helped with newborn screenings and learned about circumcisions on infants. “I definitely see myself in a rural setting,” he said. “I grew up in Bellevue, Ohio, a small town. I like knowing everyone I see and the friendly environment of a small town.”
Erica Taylor, M.D., director of medical student education for the Boonshoft School of Medicine Department of Pediatrics, described the initiative as an introduction to a population that the medical students might not have seen and considered. “We talk about disparities in health care,” Taylor said. “Rural health is an untapped community we need to serve.”
She explained that this is an opportunity for medical students to determine whether rural health is for them. “It has to be the right fit for the medical doctor and the community,” she said.
A sense of community
Many students report a sense of community, which has embraced them during their experience. “It is obvious that a need is there,” Taylor said. “Our students are too early in their medical careers to be considered for an immediate position, but we are planting a seed. Our goal is to foster a passion to serve all communities, including this one.”
To help with living expenses, medical, nursing and pharmacy students can stay for free in a four-bedroom townhouse-style apartment at the Lake Campus.
“The Western Ohio Educational Foundation provided a townhouse-style apartment to the medical, nursing, and pharmacy students rent-free because this is a way to help attract those students to the area,” said Julie Miller, development officer of the Western Ohio Educational Foundation. “This eases the students’ burden of finding housing.”
The medical school is also paying for part of the cost of the student housing.
The foundation, which has been committed to the success of the Lake Campus and its students for more than 50 years, offers scholarships to undergraduate students who want to pursue careers in nursing, medicine, and pharmacy.
Recently, the Lake Campus, in conjunction with the Wright State’s nursing college, announced that WSU-Lake Campus will offer a Bachelor of Science in Nursing four-year degree program in the fall of 2015, pending approval.
Foundations in the community, including the Mercer Health Care Foundation Fund of the Mercer County Civic Foundation, also are excited about the possibilities that the Wright Rural Health Initiative and the four-year nursing program will bring to the region.
John Irmscher, chair of the advisory committee of the Mercer Health Care Foundation Fund, explained that part of the mission of the foundation is to improve health care in Mercer County. The fund is committed to assisting the local hospitals in various ways, including recruitment of physicians and other health care professionals.
“The Mercer Health Care Foundation Fund, under the umbrella of the Mercer County Civic Foundation, is excited about the Wright Rural Health Initiative and the four-year nursing program at Wright State University- Lake Campus,” Irmscher said. “These developments will help us improve health care in Mercer County as more medical, nursing, and pharmacy students are introduced to providing health care in a rural area or small town. This is an investment in our future.”