NC trend: Rural RX
By Edward Martin
With its modern façade of gleaming glass and brick, Southeastern Regional Medical Center covers several blocks in a Lumberton neighborhood of retail centers and bank branches. Its impressive presence masks an unsettling reality: Robeson, its home county, has a fraction as many doctors, per capita, as the state’s largest counties.
Now, three years after Campbell University in Buies Creek launched North Carolina’s first new medical school in more than four decades, 40 students are at Southeastern. Their presence offers hope in a state where underserved communities beg for doctors, while some urban centers have four times the state average of about 27 per 10,000 residents. Robeson County, with the fourth-lowest median income among North Carolina’s 100 counties, has about 13 docs per 10,000. Neighboring Hoke County’s ratio is less than three.
Under a partnership with Southeastern, which has an active medical staff of 117 doctors, Campbell students are spending two years in Lumberton in clinical rotation. After graduation — for the first class, that’s May 2017 — most will spend another three or more years there as residents. Then, they’ll face a big choice: stay local or head for the big cities?
Southeastern is one of a half-dozen N.C. hospitals collaborating with Campbell’s Jerry Wallace School of Osteopathic Medicine, hoping to boost the rural doctor count. “All of the data indicate between 65% and 70% of physicians in America practice within a 50-mile radius of where they did their residency,” says Britt Davis, vice president for institutional advancement. “If you travel in a 50-mile radius of those hospitals, you’ll see every need known to man.”
Campbell might demonstrate one way North Carolina can ease its uneven distribution of doctors. The ninth-largest state by population, North Carolina is 34th in primary-care doctors.The medical school opened in 2013 and has become the core of the university’s blossoming health-sciences campus, which former President Jerry Wallace championed during his tenure from 2003-15. Campbell’s pharmacy school dates to 1986, but in the last five years, the university added a physician assistant school, a master’s degree program in public health, a physical-therapy doctoral program and a school of nursing. With 150 slots, the medical school received 3,300 applications the first year, before it opened. For those slots this fall, it has more than 6,000.
Davis estimates Campbell has invested as much as $100 million in bricks and mortar, faculty and other costs associated with the health-sciences schools, which have been financed through the university’s private investments and donors, including Leon Levine, founder of the Family Dollar discount store chain.
“They amaze me,” says Bob Seligson, executive vice president of the 12,000-member North Carolina Medical Society in Raleigh. “When they first told me they were going to create a medical school, I didn’t believe they could do it. I’m glad to say that several years later, they were back, able to say, ‘We told you so.’”
Campbell’s motivations are humanitarian and financial. The medical school’s students are trained in osteopathic medicine and will become DOs, rather than MDs, a faint distinction. Both get four years of medical school followed by residency, and they are licensed by the N.C. Medical Board and all other states. Osteopathic physicians emphasize holistic medicine, prevention and primary care, basics often most needed in rural counties. UNC Chapel Hill’s Cecil G. Sheps Center for Health Services Research identifies 14 N.C. counties as having persistent physician shortages, or less than one doctor per 3,500 residents. Tyrrell has no doctors, while several, including Warren, Hyde and Gates, have one per 10,000.
Without a track record, it’s hard to say how the Campbell school will help meet those needs. Surprisingly, its location in Harnett County’s tiny, rural Buies Creek could be in its favor. “We have great medical schools in our state, but most of the students at the other schools do their rotations in hospitals on campus,” Davis says. When they follow up with residencies at those medical centers or other urban hospitals, most tend to practice in those areas.
Since 1980, the numbers of doctors per 10,000 citizens in the home and surrounding counties of the state’s big medical schools have nearly doubled, according to a Sheps study. Orange County, home of the UNC School of Medicine in Chapel Hill, has 105.4 doctors per 10,000 people and Durham, with the Duke University School of Medicine, has 74.5.
By the time a Campbell student completes residency, he or she may have been in the community for as long as six years, be approaching age 30 and have a family, ready to put down roots. It is rarely easy to keep doctors in the smaller markets, but Davis and Seligson say the best retention strategy is to attract more students from underserved areas.
Campbell competes for a limited pool of top students from the region with East Carolina’s Brody School of Medicine. Founded in 1969 after a bitter fight with Charlotte and other cities that wanted a med school, Brody is required to recruit solely from North Carolina. “They receive only about 800 applications a year for 80 positions,” Davis says, while the bulk of Campbell’s applications come from out of state. “One of the major differences between us and ECU is we’re twice the size.”
Cultural and financial factors make it hard to lure doctors to remote counties. The medical society’s Community Practitioner Program has helped place more than 400 doctors, physician assistants and nurses in rural practices since 1989 and provided more than $15 million to help set up practices. But cuts in Medicare, Medicaid and other funding sources have made it more difficult in the last five years.
“Personal and economic factors influence where a lot of doctors go, but you have a better chance of keeping them there if you can help them deal with the challenges and put them in a position where they can thrive and become part of the fabric of the community,” Seligson says. “It motivates them to say, ‘Hey, this is the life I want.’ But it takes unique people.”
In that regard, Campbell’s gradual introduction to rural medicine may prove significant. “Exposing these students to that environment and these communities, the chances of keeping them there are far greater than bringing in someone who has been in an urban community and trying to keep them there.”