Combating doctor shortage by training in rural areas

A woman and man doctor with masks on sit at a computer

Some Creighton University internal medicine doctors and psychiatrists will split their training between rural and urban areas. Courtesy of Creighton University.

OMAHA, Neb. (NewsNation) — A first-of-its-kind residency program is training doctors to combat a shortage of physicians in rural areas.

Starting in 2023, some Creighton University internal medicine doctors and psychiatrists will do half of their training in Omaha, Nebraska, where the main College of Medicine is located. Their last two years will be located at CHI Health Good Samaritan in Kearney, a town of just over 33,000 people about three hours away.

Rural residency programs are not new, but a hybrid approach is. Creighton University in Nebraska says it is the first such program accredited by the Accreditation Council for Graduate Medical Education in the country.

“The first few years are very, very formative, very, very critical for (a resident),” said Dr. Jyotsna Ranga, the program director of the psychiatry residency. 

“Having the foundational years of the residency program (in Omaha) will give them that sort of boost in foundational knowledge so that they can then continue, with enough supervision, to grow as a psychiatrist (in a rural setting),” she continued.

And that knowledge will likely be tested. More than 30% of the population in Nebraska live in rural areas, and there is a shortage of both physicians and mental health professionals in 90 of the state’s 93 counties, according to the Rural Health Information Hub. 

The result: Nebraska’s rural residents are at higher risks of death from cancer, heart disease, stroke and diabetes. One in five Nebraska residents are suffering from a serious mental illness or substance abuse disorder, Ranga said. 

Train and remain

Nebraska is not unique — as many as 80% of counties across the U.S. lack proper access to health care, according to a 2021 report from GoodRX Health, with people sometimes driving for hours even in an emergency. 

Further exacerbating the issue, rural towns are losing specialists needed for consistent care or pharmacists to prescribe meds — it’s expected 25% fewer rural doctors will be practicing by 2030. And while telehealth can bridge some of these gaps, a lack of infrastructure for fast internet keeps the technology from many.

“What’s really worrisome is more than half of the workforce is over the age of 50, so looking at retirement in the next 15 years,” Ranga said. “It is critical for us to bring in the new workforce.”

Multiple studies have shown that doctors who choose a rural-focused training program are more likely to serve rural areas, with similar academic outcomes and retention rates as students in urban programs. 

“People, if they’re trained in a rural area, many times they stay there,” former U.S. Health and Human Services Director Eric Hargan told Illinois Public Media. “But if you end up … sending them to a city to have them trained, they may start out in that city and they’re kind of lost to the rural system.”

As many as 40 medical schools have created what’s known as “rural tracks,” often incentivizing applications and lowering tuition for students from rural areas (currently just 4.3% of incoming students). 

For example, Oregon Health & Science University actively recruits from rural community colleges, helping students interested in science understand what federal aid is available. A University of Kansas program allows students to sidestep the competitive medical school application to guarantee entry to programs after graduation.

These programs are attempting to overcome what is still a major hurdle: Graduating doctors — especially specialists — are likely to be swayed to urban areas that can offer better pay, resources and benefits. 

That may be why these programs remain small, despite the demand.

Experts point out it’s not just about getting medical staff into rural communities — they also have to be ready to fill in the gaps in care, said Dr. Jennifer Rose, a program director of a rural clinic program in Illinois. 

And training programs need to be prepared to support rural doctors who may feel isolated, overworked, and like they’re missing out on training opportunities.

Ranga said she hopes the hybrid approach will better prepare residents for a career where they may be the only psychiatrist in a geographic area. 

“By virtue of a resident being (in a rural hospital), many more patients can be seen,” Ranga said. “We hope that the residents there continue to then build up their practice … and, by virtue of that, we hope to increase the workforce to those areas.”


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