Nurturing rural health

What does the University of Minnesota Medical School have in common with rural health care?

Readers of the Star Tribune of Minneapolis may have noticed a front-page story this past weekend about a financial crunch afflicting the U of M Medical School. Although the situation is improving, there’s been severe belt-tightening, and the medical school could get hit again with cutbacks in state funding.

What really caught my attention, though, was three paragraphs near the end of the news story:

Dean Aaron Friedman said the Med School could probably withstand a 5 or 6 percent cut in state funding without losing programs. But if Senate discussions of an 18 or 19 percent cut materialize, the school will have to drop operations that aren’t essential for accreditation, he said. He would aim first at nonessential programs that help deliver health care and physicians to outstate Minnesota.

“We’d have to reduce those services in the next fiscal year,” Friedman said.

Another potential hit could come from a state-funded program that pays hospitals, clinics and other health care providers to train medical students. A potential trickledown effect would be a shrinking of Med School enrollment for lack of training positions.

There are few details at this point for what might happen, but I think it’s safe to say that if some of these cutbacks come to pass, rural Minnesota will feel the effects.

Although there are many strategies for building up the rural health care workforce, providing training opportunities in rural settings is an essential one. Research has consistently shown that when students in the health professions have the opportunity to do a clinical rotation during their training, they’re more likely to consider rural practice as a career choice.

Here’s one successful example: the U of M Medical School’s Rural Physician Associate Program, an elective program that allows third-year medical students to spend nine months living and working in rural communities.

From 1971 through 2008, there have been 953 students who have participated in the program. More than three-fourths chose specialties in family medicine, internal medicine or pediatrics. The majority also stayed in Minnesota when they finished their training. Overall, more than half opted for rural practice.

It takes money and resources, of course, to offer programs like this. The rural clinics and hospitals who agree to be training sites do so because they believe in the value: What they do today can help create health care professionals for tomorrow. At some point, however, it can become unsustainable for them if they don’t receive at least a small amount of funding to offset the cost.

If you combine this with less educational outreach for rural health and a reduction in medical school admissions, some form of blowback is probably inevitable.

It’s obviously too soon to know how the U of M Medical School’s situation will play out in the months ahead. Considerable discussion and funding decisions still need to happen, and nothing is a done deal at this point. But if some of these training initiatives are indeed cut back, especially in rural health, it’s bound to hurt. The effects might not be felt right away, but they would eventually become apparent as doctors begin to retire and can’t be replaced.

Issues at the U of M Medical School and the state Capitol might seem abstract and far away. In reality, this is one issue that hits pretty close to home.

Photo: Wikimedia Commons

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