Dr. Jean Sumner likes to tell the story of how she once raised a woman “from the dead.” It happened years ago on a Thanksgiving Day when she was still working as a rural physician in the central Georgia town of Sandersville.
“I was already dressed for dinner at my mother’s” when the call came in, says Sumner, now dean of Mercer University’s School of Medicine in Macon. The sheriff drove her to the woman’s house so that as a doctor she could make the official declaration of death. Neighbors had gathered in the woman’s front yard.
Sumner found the stricken lady lying in a recliner, and quickly determined that despite appearances, she was not dead.
“I asked for some sugar, made a syrup, and put it under the woman’s tongue.”
A few minutes later, the woman rose up out of the recliner. She was a diabetic, and her blood sugar level had dropped after she’d skipped a meal in anticipation of the Thanksgiving feast.
“When we left the house, the crowd parted,” Sumner recalls, laughing. Everyone was in awe of the “miracle” that had just occurred. “And the lady went on to be my patient for many years.”
Of course, life as a rural physician isn’t always so dramatic or idyllic, admits Sumner, who worked as a country doctor for almost 30 years. Today’s young physicians seem to know about the downside of such a career, and most shy away from practicing primary care in rural or other underserved or inner-city areas. There’s a looming physician shortage in these places.
It’s trend that’s only going to get worse, according to a study by the Association of American Medical Colleges. The report predicts a shortage of up to 120,000 physicians by 2030. The South’s rural and other underserved areas could be especially hard hit, the study suggests.
“Unfortunately, we’re getting exactly what our health care system is designed to produce,” says Dr. Mark Deutchman, director of the rural track program at the University of Colorado’s School of Medicine. The system dictates where physicians locate because it rewards high-tech medical services, expensive surgeries and sub-specialty care, says Deutchman.
Mercer School of Medicine, founded in 1982, is trying to help reverse the trend, at least in Georgia.
“I think it’s really important to give every medical school student the opportunity to see quality medicine in a rural community at work,” Sumner says, “just the experience to practice alongside rural physicians as positive role models.” Mercer’s medical students also take courses in the business of medicine, where they learn how to run an independent practice.
Mercer focuses on recruiting and training future physicians in Georgia — especially for rural and underserved areas and in the fields of internal and family medicine. It is one of about 30 medical schools in the nation that offer some type of dedicated rural health track.
Nearly 1,840 physicians have graduated from Mercer Medical since its founding. Currently, about 400 medical students are enrolled on campuses in Macon and Savannah
Mercer tries to cultivate future generations of rural doctors with the Accelerated Track Program. The ACT program gives students studying family medicine and general internal medicine the opportunity to complete their training in three years, instead of the usual four. There’s a scholarship available that lets students pay for their first year, while state funds cover their second and third years.
Also targeting rural health needs is the Nathan Deal Scholarship, named for the current Georgia governor. Funded by the state, it allows Mercer, a private school, to support eight to 10 medical students each year. The students receive a stipend that pays for 85 to 100 percent of their tuition.
Both programs help graduates start their careers with little or no debt. After their residency, though, the young physicians are obligated to practice for three to four years in a rural or underserved community in Georgia.
Applicants for these programs must also be Georgia residents with “deep roots in the state,” as Sumner puts it.
The majority of Mercer’s medical students — 70 percent of the new class, according to the school’s website — are white. Fifteen percent are African-American, Hispanic or Native American, and 15 percent are Asian. This does not strictly reflect Georgia’s current ethnic makeup, which is 30.5 percent black, for instance.
One thing is clear, though: Most of Mercer’s med students are not urban.
Take, for example, Wesley Durrence, who just finished his first year. Durrence, 24, with a soft drawl and a gentle demeanor, is from Glennville in the southeastern part of the state. “I’m a sixth-generation Glennville resident,” he says proudly.
Durrence, who has a degree in engineering from Georgia Tech, always knew that he wanted to go into medicine. “Medicine really found me,” he says, as he sits with his parents in camping chairs on the lake dock on the family’s 80-acre farm.
He remembers the journey starting when he was 4 or 5 years old and having a severe asthma attack. His parents rushed him to the nearest emergency room — over 30 minutes away. It was the longest 30 minutes of his life, he says.
As a 10-year-old, he assisted his mother, Sandra, an advanced practice registered nurse, when she helped provide basic primary care to migrant workers on the nearby onion farms. Wesley tagged along, learned how to take blood pressure and basic metrics, and watched closely as his mom treated a wide variety of conditions, from foot fungus to dehydration.
Durrence says he enjoys the hands-on approach that rural medicine requires. This summer, he had the opportunity to return home for his first community medicine rotation. He shadowed Glennville’s town doctor for three weeks, watching him diagnose and treat patients.
One man came in with shortness of breath and some congestion. “To the untrained eye, mine, it seemed pretty straightforward,” perhaps a sinus infection, Durrence says. But the doctor suspected something more serious. Today the patient is being treated for cardiovascular disease.
“Learning to approach problems with a healthy sense of concern and knowing what questions to ask was a very powerful lesson for me,” Durrence says.
Academically, Sumner says, Mercer understands that students from rural Georgia may not have had the same opportunities as some Atlanta students.
“They may come in with a slightly lower grade point average,” she continues. “But that doesn’t mean they’re not academically qualified, and that doesn’t mean they won’t be as good or even a better doctor.”
Are Rural Doctors’ Hardships Exaggerated?
Dr. Daniel Gordon applied three times to different medical schools before he was accepted at Mercer, where he graduated in three years from the accelerated track program. Today, he is a family physician in his hometown of Hartwell in northeast Georgia, near sprawling Lake Hartwell, which straddles part of the state’s boundary with South Carolina. He’s 33 and the father of three.
Gordon works for MedLink Georgia, which operates 15 federally supported community health centers and serves patients in more than 20 North Georgia counties. He joined the office in Hartwell about a year ago, his first job after residency.
“There are patients who know me just as Daniel, and they will never know me as Dr. Gordon,” he says. “And that’s special.”
Gordon is convinced that primary care is the key to making more people live longer, especially in rural settings. This includes encouraging people to schedule preventive visits, helping patients quit smoking, getting them to eat healthier and making sure they take their medication correctly. The majority of medical problems — heart disease, diabetes, COPD, arthritis — can be prevented with primary care.
Gordon says he understands that students aim for specialty medicine because they have a “next-level mentality.” But he becomes troubled when they do it solely for the money.
“It doesn’t matter if I have the lowest-paying physician salary in the world, it’s still a lot more than what just about any of my patients make,” he says.
Also, he insists it’s a myth that rural physicians work longer hours than their specialist peers. All doctors work hard, he says. “I’ve seen a highly specialized cardiologist pulled away from his 30th-anniversary dinner for an emergency catheterization.”
Personally, he says, he gets to spend plenty of time with his family. “I’m not worked to the bone here,” he says.
Mercer just added another opportunity for students and graduates to train and practice in a rural community. Last month, Mercer opened a primary care clinic in Plains, the hometown of former President Jimmy Carter in the state’s rural heartland. The clinic offers comprehensive on-site primary care, including internal medicine, OB/GYN, family counseling, lab and X-ray. Also, state-of-the-art telemedicine technology provides access to multiple specialists at Mercer Medicine in Macon.
The New Mercer Clinic In Plains
Like Gordon, most Mercer graduates become strong advocates of rural medicine and embrace the lifestyle of a country doctor, says Sumner. “But we’re not so naive as to think that 100 percent of our students will end up in rural communities.”
More than 60 percent of all Mercer graduates practice in Georgia, and of those, 80 percent work in rural or underserved communities
But even those who end up as specialists in an urban area, “usually have a better understanding of how rural medicine works,” says Sumner, “and they’ve developed relationships with rural providers.”
Deutchman, the Colorado-based physician and academic, is less optimistic. The number of doctors produced by rural track programs “are inadequate to reverse the problem,” he says.
He notes that only 30 out of 160 U.S. medical schools offer rural tracks, and many of those operate on a small scale. Add to that the average age of rural physicians.
“Their retirement rates are exceeding the new graduates,” says Deutchman.
In this scenario, people like Durrence and Gordon are certainly exceptions rather than the norm. They’re all aware of it, and they don’t care.
Gordon thinks the variety of experience he gets by practicing medicine in a rural community is priceless. “I see everything from a 9-month-old baby with a little rash to a 95-year-old patient who’s admitted to the hospital with heart failure.”
As Durrence enters his second year of medical school he says it’s too early to commit to a specific path. “But I can tell you, whatever the setup may be, I am ready,” he says with a broad smile. He’s ready to be a country doctor in his hometown — and if necessary, even raise a patient “from the dead.”
Katja Ridderbusch is an Atlanta-based journalist who reports about health care for newspapers and public radio stations in the United States and Germany.