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October 26, 2004   Email to Friend 

White Coats & Pickup Trucks
Beth Farnsworth

The Rural Medical Scholars Program at the University of Alabama is increasing the number of rural doctors like recent graduate Dr. Drake Lavender.
Children cough and squirm as adults flip through magazines in the waiting room of Dr. Garry Magouirk's family medical practice in Fayette, Ala. The small town of less than 5,000 people isn't exactly famous as a population center, but rural practices like Magouirk's have more than enough illnesses and injuries to keep them busy.

The decline in the number of rural family physicians is a major problem in Alabama. In fact, 62 of the state's 67 counties are currently experiencing a physician shortage. That's why, in 1996, Dr. John Wheat decided to try and reverse the trend with the inception of the Rural Medical Scholars Program (RMSP). The program is structured to increase the number of rural physicians produced by state medical schools.

"We started this program because it was clear that not enough students from rural Alabama were getting into medical school," said Wheat, a professor in the College of Community Health Science at the University of Alabama. "The program stemmed from my own personal interest and background (in a rural setting), and at the urging of doctors and people in the rural communities....They all said we needed more rural farm doctors, more rural physicians."

The RMSP works to produce more rural doctors by "finding and nurturing capable rural students" and enrolling them in a five-year medical school track at the University of Alabama School of Medicine. The selective program chooses 10 rural students each year who have shown a desire to serve the rural population of Alabama as general practice physicians. The program guarantees them a slot in the highly competitive 160-member medical school class at The University of Alabama at Birmingham (UAB). The students spend their first year in Tuscaloosa, continue on for two years of basic medicine at UAB, and finally return to Tuscaloosa for two more years of clinical studies.

Last month, Alfa Insurance Co. and the Alabama Farmers Federation donated $1.8 million--which will be awarded over the next six years--to create an endowed scholarship fund for the RMSP.

Doctors say that just having spaces held for these 10 students makes a huge difference.

"We were given the ability to choose for different strong points in a medical student (for the RMSP) versus what the typical student that was trying to get in on the UAB campus was chosen from," said Magouirk, a talkative doctor who sports a Mickey Mouse tie that makes his younger patients smile. "Which kids would you think are most likely to not be admitted? It's the kids that are going to have a more marginal MCAT (the medical school entrance exam), a more marginal GPA, that are from rural Alabama, not the kids from Mountain Brook."

The emphasis on choosing students from rural areas is so great, say experts, because studies show that doctors who are originally from the countryside are seven to 10 times more likely to practice in rural areas than students originally from urban communities.

Dr. Drake Lavender, a recent graduate of the RMSP's first class, is a prime example of this statistic.

Growing up in Eutaw, Ala., Lavender was diagnosed with asthma when he was only 3 years old. Weekly visits to his family doctor, Rucker Staggers, gave Lavender the desire to grow up and be a physician just like his hero.

"He gave me my shot every week, and every six weeks he expected to see my report card," Lavender said. "He was my buddy more than anything else. I associated going to the doctor with feeling better, and I said, 'That's what I want to do, I want to make people feel better.'"

And that's just what he's doing. Lavender recently joined the practice of Dr. John Brandon at the Pickens County Medical Center in Carrollton. He's excited about the chance to be part of a small-town environment again and the opportunities that practicing medicine in a rural setting can bring.

"One of the main things I enjoy about family medicine is the relationships that you form with people who are your patients," he said. "Especially in a rural community, you're not just going to see them in the office and never see them again--you're going to see them in church, you're going to see them at the ball field, you're going to see them at the grocery store--and you really do become an integral part of the community, not just the doctor. It's really special."

Dr. Fred Yerby, a family physician who, like Magouirk, practices in Fayette, agrees.

"I think I enjoy it most of all because of the variety," he said. "You see everything from a 2-week-old baby to 100-year-old grandmas and grandpas. It's just a little bit different every day, and you never know what you're going to see."

A small-town medical practice is rewarding for everyone, not just doctors. According to recent studies, a rural physician generates almost $3 million a year, making them one of the biggest employers in their area and a commodity that already-struggling rural towns can't afford to do without.

Unfortunately for those living in rural communities, trends show they stand a good chance of losing the few physicians they currently have, as older doctors begin to retire and younger doctors are lured into big-city specialties instead of general family medicine. But the RMSP and its sister programs--the Rural Health Scholars (RHS) and the Minority Rural Health Pipeline (MRHP) programs--are working hard to reverse that movement. While the RMSP concentrates on providing curriculum and encouragement for rural students currently in med school, RHS and MRHP are designed to get more high school students headed in the direction of medical school in the first place.

RHS began in 1993 and works by encouraging rural high school students to consider a career in the medical field, enrolling them in a five-week summer program for college credit at UA and giving them a first-hand taste of a doctor's life as they visit hospitals and labs. MRHP is a more recent development that kicked off in 2001. It is designed to generate an increase in the number of minority rural students eligible for acceptance to medical schools. While MRHP uses many of the same methods as RHS, it is tailored specifically toward minorities.

Amit Sharma, a young doctor and researcher from India who has been heavily involved with the rural health programs during his time at UA, thinks the need for more rural and minority physicians is urgent in Alabama. Sharma has a love for both medicine and agriculture: after finishing his residency, he plans to return to India and work with rural health initiatives in his home country.

"The need is enormous, especially in Black Belt communities," he said, his voice accented but clear. "Statistics in those communities are matching with Sri Lanka and Cuba--the key factor is that they don't have good health care, they don't have doctors. If you train a minority student they're more likely to serve minority patients."

Although only time will show how successful the RMSP is in helping more rural students return to their communities to serve as physicians, early results are encouraging. Five out of eight from the RMSP's first class of medical students are returning to rural settings, a much higher percentage than their classmates who were not involved with the RMSP. While it's still too early to tally results from other programs like RHS and MRHP, Wheat and Sharma say they already are seeing improvements as these young students move through college and start medical school.

"The bottom line is, are we producing the kind of doctors that rural Alabama needs?" asked Wheat. "And after the first year (of graduates) we can say 'yes,' we're turning them out."

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