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Medical students tap into rural life

UA program takes on doctor shortage

 Concerns about low pay, isolation and limited technological and social amenities make it hard to attract and retain health-care professionals in rural communities.
 
"There's a shortage of doctors in the state, but it's accentuated in the rural areas," said Carol Galper, assistant dean for medical student education at the University of Arizona College of Medicine. "It's easier to get someone to practice in Scottsdale than Springerville."
 
About 36 percent of Arizona residents lived in an area designated as a Health Professional Shortage Area in 2003, according to a 2008 report by the Arizona Healthcare Workforce Data Center.
 
This summer, 22 students from the university's Phoenix and Tucson colleges of medicine will spend up to six weeks practicing in communities such as Yuma, Springerville, Show Low, Tuba City, Chinle and White River.Since 1997, UA has been engaged in efforts to encourage more medical students and physicians to practice in rural areas. The university's Rural Health Professions Program matches medical students with rural physicians who volunteer as mentors to the students.
 
Brenna Derksen, a second-year student, says she has always been interested in "full spectrum" family medicine and has already spent three of her six weeks with North County Health Care, a community clinic in Show Low.
 
"I knew the best way to get that experience was in a rural area," she said.
 
Under the supervision of Dr. Melody Jordahl-Iafrato, a 2005graduate of the UA medical school and a former Rural Health Professions Program fellow, Derksen sits in during patient visits but also has also been able to do things such as well-woman exams. She said it is an opportunity to learn and grow that she wouldn't have in a city hospital.
 
The students are immersed in the underserved communities and experience the lifestyle, challenges and unique medical needs of a rural community.
 
Galper said, "We want to make sure our students understand the plusses and minuses so that they make informed decisions."
 
She said working in a rural community puts a lot more stress and a bigger workload on doctors as they have to manage patients who would be managed by specialists in the city. Rural hospitals depend on fewer physicians, which translates into longer days for the doctors and longer waiting times for the patients.
 
"You are the big fish in a small pond," Galper said. "Everyone knows what your car looks like. There's a lot less anonymity. You have to be the doctor all the time."
 
In 2000, there were 119 physicians per 100,000 people in rural areas nationwide compared with 225 physicians per 100,000 in urban areas, according to a 2005 report on the future of rural health care by the National Academies Press.
 
According to a 2005 Arizona Physician Workforce Study by Arizona State University and University of Arizona, the state's accelerated population-growth rate and limited number of medical-training facilities could lead to a dependence on physicians from out of state. The shortage of primary-care doctors in the state comes at a time of a nationwide shortage in the field.
 
A 2008 Association of American Medical Colleges report projected a nationwide shortage of 124,000 full-time physicians by 2025.
 
As the only physician at the clinic and with one nurse practitioner and a physician's assistant, Jordahl-Iafrato does anything from basic exams to baby deliveries. The nurse practitioner and physician's assistant also perform some procedures.
 
"There's really a shortage here," said Jordahl-Iafrato, who is also president-elect of the Arizona Academy of Family Physicians. "Doctors sometimes get spread pretty thin. We could do with another doctor or two."
 
As a student, Jordahl-Iafrato spent weeks in Ganado on the Navajo Reservation and in Safford under the Rural Health Professions Program. She also worked in a rural hospital near Arusha, Tanzania.
 
"You see your patients at the store and they say hi," Jordahl-Iafrato said. "You get to know your patients better. A lot of times there are social factors that affect their health."
 
For her, pay is not the issue, but the challenge brought on by the lack of specialists. Patients in need of special care have to go to Phoenix, Flagstaff or Tucson, which is expensive and a burden for many families.
While Derksen plans to return to Show Low in her third and forth years for rotations, she recognizes that working in a rural community is "different."
 
"It would be beneficial for everybody, but it wouldn't be everybody's cup of tea," Derksen said.

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Photo couresty of University of Arizona
 

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