Help wanted: Rural physicians

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“Now Hiring” signs are everywhere, often accompanied by promises of sign-on bonuses. 

But difficulty in attracting doctors to rural areas is an age-old story that remains a challenge in North Carolina.

This month, according to North Carolina Health News, more than 550 graduates will begin residency training across the state — but only one in four will pursue training in family medicine, and most won’t do it in rural areas.

That family medicine estimate may be high, says Molly Benedum, a family medicine and pediatrics specialist at AppFamily Medicine in Boone, part of Appalachian Regional Medical Associates. “If a medical school says 15% of our graduates are doing internal medicine, they count that as primary care. Maybe 10% will go into primary care, but the rest will go into being a hospitalist, or into cardiology, so sometimes those numbers are inflated,” she says.

Benedum is director of the new rural family medicine residency program at the Mountain Area Health Education Center, which operates in Asheville, Boone and Hendersonville. She grew up in Winston-Salem and graduated from Furman University and UNC Chapel Hill’s medical school. She moved to Boone two years ago to help start AppFamily Medicine. 

“I had been on the faculty with family residency in Greenville, S.C., and I was inspired by the training of rural doctors for western N.C. and getting to build something from the ground up,” she says. “Family medicine has the broadest content of any specialty. We take care of patients from the cradle to the grave, the whole family, in the hospital and in the clinic. So when you think about developing physicians for the future, you think about what the community is going to need.

“You have doctors who wear a lot of different hats: They do home visits, go into intensive care units, into nursing homes. And they’ve done a lot more recently in dealing with substance abuse, with the opioid crisis. And we’re training doctors for that.”

Salaries for residents in Boone start at about $52,300 and increase to about $56,000 in the third, final year, according to the Mountain Area center. But drawing residency participants and physicians to remote areas goes beyond money. 

“I get dozens of emails every day from physician recruiters asking me to go to remote areas like parts of Kansas or Minnesota,” Benedum says. “What do rural communities have that can get recruits to come to them? Do they want to live in a town with only one Walmart, or are they bringing their families with them to a place that has more to offer as far as schools and cultural events? So what we’re seeing across the country is a split between urban and rural.”

The Mountain Area center’s facilities include AppFamily Medicine and Watauga Medical Center in Boone, Mission Children’s Hospital in Asheville and Charles A. Cannon Jr. Memorial Hospital in Linville. 

The key, Benedum says, is finding people with the desire and commitment to invest in a small community. “Part of my vision for the residency program, and part of the reason MAHEC is investing in Boone is to create family physicians who have a heart for rural medicine,” she says. “One of our metrics for success 10 years from now will be how many of our graduates will stay in rural North Carolina. We’re trying to be very intentional about giving them a window into all the amazing things in a rural community, and to become part of the community. You don’t miss the big city as much as you think you would.”

The National Resident Matching Program, a private not-for-profit corporation that places graduating medical school seniors and post-graduate candidates in clinical training, started in 1952 with 6,000 applicants nationwide and has grown to 48,700 in 2021. The program covers nearly 50 specialties, from anesthesiology to vascular surgery.

North Carolina institutions participating in the residency match include Atrium Health Cabarrus (Concord), Campbell University (Lillington), Carolinas HealthCare System Blue Ridge (Morganton), Carolinas Medical Center (Charlotte), Cone Health (Greensboro), Duke University Medical Center (Durham), Mountain Area Health Education Center (Asheville/Boone/Hendersonville), New Hanover Regional Medical Center (Wilmington), Novant Health (Cornelius), Southern Regional AHEC (Fayetteville), UNC Hospitals (Chapel Hill), Vidant Medical/East Carolina University (Greenville), Wake Forest Baptist Medical Center (Winston-Salem) and WakeMed Health (Raleigh).

The Health Resources & Service Administration program in Washington, D.C., awarded $200 million over three years to 27 organizations to focus on rural health, according to North Carolina Health News. MAHEC and Duke’s primary care residencies will receive about $23 million to expand rural grant programs.

“Despite the challenges, it’s rewarding to practice in a rural area,” Benedum says. “Our goal is to find physicians who are passionate about that, and will be excellent physicians in their rural communities.”

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