Med students see physicians’ crisis first-hand

Third-year medical students learn about family medicine, primary care in rural settings.

Labour dispute

Stephen Maturen

Labour dispute

Peter Olsen started Thursday morning off unusually: he delivered a baby. While most of OlsenâÄôs classmates, third-year medical students at the University of Minnesota, may observe or assist on deliveries, OlsenâÄôs preceptor at the Owatonna Clinic lets him fly solo. According to a report made to the Legislature in January, 37 percent of MinnesotaâÄôs rural population lives in federally designated âÄúHealth Professional ShortageâÄù or âÄúMedically UnderservedâÄù areas. The Rural Physician Associate Program originated in the 1970s in an attempt to meet that need by recruiting students like Olsen from urban campuses and placing them in rural clinics and hospitals for a nine-month rotation. âÄúMedical students can get lost in the fray,âÄù Olsen said of the traditional teaching hospital, where groups of third and fourth-year medical students learn alongside residents. âÄúI donâÄôt compare myself to students, because IâÄôm always surrounded by physicians.âÄù Olsen is one of two medical students at the Owatonna Clinic. Most RPAP sites only host one student. Unlike major urban hospitals, the clinics in the rural areas often donâÄôt have specialists on staff, said Laura Ford-Nathan, a fourth-year medical student who finished RPAP last year. Instead, visiting specialists such as urologists and cardiologists came to her site in Glencoe, Minn. on a rotating basis. Patients in those areas could âÄústill have that care,âÄù she said, but âÄú(the physicians) just wouldnâÄôt be based there.âÄù Dr. Kathleen Brooks, director of RPAP and associate dean for primary care in the Medical School, said as medical students emerge from school carrying increasingly more debt, lower paying specialties like primary care become harder for students to choose. Olsen said the average debt is $150,000 or more for most medical students, and many choose their specialties while worrying about how long it will take to pay those debts back. But his experience in Owatonna has been, âÄúa chance to get away from that,âÄù he said. Watching his preceptor, Dr. Jason Wray-Raabolle, Olsen said he has seen why Wray-Raabolle practices medicine, and has a better understanding for the lifestyle of a rural physician. âÄúIâÄôm going to have these debts for a long time,âÄù Olsen said. âÄúBut IâÄôm going to be happy.âÄù Though Olsen is not yet a licensed medical doctor, it was hardly noticeable in his âÄúwell-child check-upâÄù with a mother and her two-year-old son Thursday. Olsen reviewed literature with the mother about safety and development and examined the child, talking softly in a childâÄôs voice to comfort him. Preceptor Wray-Raabolle is an alumnus of both the Medical School and RPAP. His role varies, Olsen said, from observing Olsen perform procedures and exams to taking a primary role to teach. âÄúYou want to give back,âÄù said Wray-Raabolle, who usually goes by Dr. Jason, âÄúand contribute to another physicianâÄôs career.âÄù In Owatonna, the physiciansâÄô shortage is less obvious. The clinic has 62 physicians, about 20 of whom specialize in family medicine. The clinic is part of the Mayo health system, and is connected to a wealth of resources just 40 minutes away. But other small communities arenâÄôt as lucky, Wray-Raabolle said. âÄúPeople have to go farther to receive primary care. ItâÄôs strain on families, time off from work,âÄù he said. âÄúThereâÄôs a sense of pride in a community. If it canâÄôt keep a clinic open, it can be a huge blow.âÄù The clinic, which sees 250,000 patient visits a year, serves not only the 22,000 or so Owatonnians, but often times patients from smaller, neighboring communities as well. According to the Minnesota Department of Health report, 8 percent of the stateâÄôs physicians practice in rural areas. Mary Bassing, a third-year medical and RPAP student based in Grand Rapids, Minn., said although her clinic primarily serves the community of about 8,000, the surrounding area makes up as many as 40,000. They too have about 20 family physicians, and also host visiting specialists such as oncologists or dermatologists who see patients about two days a month. But when her clinic is unable to provide those specialty services or the need for an appointment is urgent, some patients find themselves driving 90 miles to Duluth. âÄúItâÄôs reinforced my vision about medicine,âÄù she said. âÄúAnd the fact that I really do want to go into this field.âÄù Bassing said she has performed procedures she hadnâÄôt expected to learn in her third year, such as thoracentesis, which drains fluids from the lungs, and pericardiocentesis, which drains fluids from the area around the heart. Her patients know sheâÄôs a student, but âÄúmost of them are really fulfilling and happy to have students there,âÄù she said, âÄúbecause I think they see it as the continued future of medical care in their area.âÄù Ford-Nathan said, during her rotations in RPAP, she too learned procedures other third-year medical students might have only observed, such as intubation (inserting a breathing tube), working with IVs and removing moles. One unique aspect of the program students on the Twin Cities campus might not experience is the continuity of care âÄî or seeing patients more than once. âÄúI would see my patients at primary care, and then if they needed a surgery, IâÄôd do their pre-op, and then see them in surgery, and then see them later on in recovery,âÄù Ford-Nathan said. Sometimes, the seeing of patients extended beyond the walls of the clinic to places like the library and the grocery store. Brooks said RPAP is one of the oldest programs of its kind and has been used as a model to create others around the country and the world âÄî and with good reason, the program works. About 75 percent of the students stay with primary care. Olsen says nationally that number is in the single digits. The RPAP website lists the programâÄôs success statistics: âÄ¢ More than half the students go on to practice medicine in rural settings. âÄ¢ About 60 percent stay in Minnesota. âÄ¢ Thirty-eight percent of the alumni have stayed in Minnesota, in a rural community. Brooks says they donâÄôt have trouble finding preceptors either âÄî a common question from budding program leaders around the country. âÄúOne of our resources is to go into our alumni database, look at whoâÄôs where and see if they are interested in teaching in our program,âÄù she said. Wray-Raabolle said working with Olsen, âÄúhelps keep me fresh, and on top of my information.âÄù âÄî Emma L. Carew is a senior staff reporter