Planting the seeds for the next crop of health care providers

Last summer, DMU osteopathic medical student Bill Bensen found many benefits during a preceptorship at Kossuth Regional Health Center (KRHC) in Algona, IA. The critical care hospital and multi-specialty clinic let him dive into a variety of patient-care cases, working alongside several DMU osteopathic and physician assistant graduates. Everyone bent over backward to make him feel welcome, from the movie tickets and popcorn vouchers he received from KRHC’s chief administrator to the 45-minute tour of the town he got from the front desk receptionist upon his arrival. The health center even provided him with comfortable living quarters.

And then there was the World’s Largest Chee-to, shellacked and poised on a velvet pillow under glass at Emeralds Restaurant. Algona acquired the orange blob in 2003 after a fierce online bidding war.

“My son told me on the phone he’d heard that Algona had it, so he wanted a photo,” Bensen recalls.

“We’ve been very fortunate with students chosen for the [Rural Medicine Educational Pathway] program. They’re so excited not just about medicine, but about rural medicine.”

Such are the perqs and quirks of rural life and practice – friendly people, sometimes-unusual attractions and opportunities to treat patients of all ages and conditions. For Bensen, his four-week immersion – which followed the intensive didactic first year of medical school – “re-energized and affirmed” his medical pursuits.

“The clinical aspect was so participatory. I had the opportunity to practice all the skills I’d been learning. I got to do procedures. I said I would love to see a surgery, so I got to assist with some,” he says. “My last week there, I got to catch a baby, and in Spanish. I got to work with physicians who are really into evidence-based medicine. I learned so much.”

Those physicians included Michael Lampe, D.O.’02, a family practitioner at KRHC since 2005. He and his colleagues are committed to mentoring students interested in rural medicine.
“It’s important to help students get to know what small-town life is like and give them a taste of what their future may hold,” Lampe says. “We’re also trying to promote their coming back.”

Preceptors like Lampe play an important role in recruiting a rural health care workforce. They’re especially important to DMU’s Rural Medicine Educational Pathway (RMEP). The program was created in 2009 to provide an elective course and full-tuition scholarship opportunities for osteopathic medical students who commit to practicing primary care in Iowa for at least four years after residency.

RMEP was designed in collaboration with the Iowa Area Health Education Center (AHEC) Program, a comprehensive statewide initiative to recruit and retain a strong primary care workforce in Iowa.

“Our staff assist in finding and facilitating summer preceptorship opportunities for participating students and help make the critical community connection above and beyond the clinical aspects of the experience,” says Wendy Gray, M.H.A.’97, director of the Iowa AHEC Program office, headquartered in the University of Iowa College of Nursing. “In doing so, the program strives to further solidify interest in rural practice and promote Iowa’s rural communities and lifestyle.”

As of this academic year, the Rural Pathway scholarship and elective are available to students in DMU’s osteopathic, podiatric and physician assistant programs; this fall, physical therapy students also may apply. Scholarship recipients must commit to practicing in rural Iowa for as many years as they receive the scholarship. Both scholarship and elective students attend periodic Saturday sessions on topics specific to rural medicine, from lifestyles and practice management to health/injury risks associated with farm equipment and animal drugs.

“We’ve been very fortunate with students chosen for the program,” says David Plundo, D.O.’85, M.P.H.’11, FACOFP, acting dean of the College of Osteopathic Medicine. “They’re so excited not just about medicine, but about rural medicine.”

Those are the people rural health care organizations want. One of the first six recipients of DMU’s Rural Pathway scholarship, Eric Neverman, D.O.’12, M.H.A.’12, spent two months of his third year in medical school at the Grundy County Memorial Hospital in Grundy Center, IA, one on a family medicine rotation and the other as part of his administrative internship in DMU’s master of health care administration program. Before he began his fourth year, he already had a contract to return to the hospital in 2016, after he completes his residency in internal medicine and pediatrics at the University of Missouri Hospitals and Clinics in Columbia.

Neverman praises RMEP for its Saturday sessions and required clinical experiences in rural areas. He gained insights he’s now using to develop his residency schedule.

“There are electives/topics that I need to know well since I will be expected to deal with them in rural practice,” he said in an e-mail message. “In addition, there are situations that arise now in residency where a course of treatment is chosen and I have to ask myself how might I deal with this in a rural setting where some of the resources are not available as readily.

“Perhaps the most important thing I have taken from the rural track experience is developing relationships with numerous physicians in rural practice,” he added.

Relationships across the community combined with skills to handle a broad scope of practice are critical in effective rural medicine. Dave Nystrom, D.O.’04, who practices in Car roll and Coon Rapids, IA, where he often takes students on rotation, says in many patient cases, he “might be the most qualified provider” in the vicinity.

“I’m not a doctor in a box. If I’m in the middle of Des Moines, I might have specialists around me, but here I don’t have that luxury as much,” he says. “I’m the director of our local ER. We don’t have ultrasound capabilities on weekends. We have the equipment but not the technicians. That changes how you practice.”

At the same time, those demands may broaden a provider’s partners in caring for patients.

“They could be a local minister, superintendent or social worker. The local physician assistant could be an extension of your practice,” says Roberta Baldus, D.H.Ed., PA-C, M.P.A.S., assistant professor in DMU’s physician assistant program and a member of the RMEP faculty. “We want students to understand they aren’t alone out there.”

Not alone, and likely loved, she adds: “I tell students, ‘You won’t get into a bigger heartfelt practice than in rural medicine.’ They are the most affectionate and appreciative patient populations I have ever had the privilege of providing medical care.”