Credit: Sofi Gratas/GPB News
How rural residency programs for doctors can help solve the health care shortage
The city of Moultrie sits in the middle of Colquitt County. It’s emblematic of most small Southern towns, with a historic square, one Piggly Wiggly supermarket, and miles of farmland on the periphery.
Moultrie also has the only hospital in the county of about 45,000 people, Colquitt Regional Medical Center. It offers the only specialty care options within an hour’s drive. Without the hospital, things like obstetrics and cancer treatment would be nonexistent in the area.
Through a new residency program, Colquitt County has three new psychiatrists, the first to be trained in Moultrie. Anthony Cimino is happy to be one of them.
“You'll be the first picture on the wall, you know, for all the next generations of residents to come and see,” Cimino said. “And I loved that aspect of it.”
The psychiatry residency launched this year with $750,000 in funding from the U.S. Department of Health and Human Services, under a “rural residency” designation.
Although doctors can practice straight out of medical school, graduating from a residency program is required for accreditation. A medical student’s final year in school is typically spent applying to residency programs at different hospitals. Once a student matches with a facility, they become a resident who spends three to seven years training in their desired specialty.
In 2016, Colquitt Regional transitioned into a teaching hospital and launched Georgia South, the internal medicine residency program hosted at the hospital. Until the psychiatry program started this year, the hospital had hosted only family medicine residents, bringing in three residents a year.
Jessica Rothaker, who oversees the medical education partnership, credits the success of that first residency for new opportunities at the hospital.
“We've seen an increase in research and development and clinical trials, all of that,” Rothaker said. “I think it may have happened without a residency, but I know for sure that having a residency has benefited all of those things.”
Dire need for rural doctors
Colquitt County is officially a medically underserved area. That’s a federal designation based on death rates, poverty, and doctor-to-patient ratios. Over half of Georgia counties fall below state averages for per capita access to primary care, and 141 counties, both urban and rural, are medically underserved.
Public health data shows that areas without easy access to health care have poorer health outcomes. Jessica Mitchum, a family medicine doctor at Colquitt Regional, says she has patients from neighboring counties who have never received care besides visits to the emergency room.
“If people don't have access to care, they're more likely to forgo care altogether,” Mitchum said. “You're basically starting from scratch with them. And they may have underlying health conditions that have been present for years.”
In a 2020 survey of students from five Georgia medical schools conducted by the Georgia Board of Healthcare Workers, only about a quarter of students wanted to practice in a rural hospital in an underserved community. Far more expressed interest in what the survey called “inner-city” practice.
But Colquitt Regional has managed to keep seven doctors on full time after they graduated from residency at the hospital. Over half of the other Georgia South medical graduates work within 100 miles of the hospital.
That’s because some people just like it here.
Jermaine Robinson graduated from the family medicine residency this year and is staying on as a hospitalist.
“Everyone was just welcoming,” Robinson said. “And I loved that feeling and I wanted to keep that feeling.”
Second-year family medicine resident Rickey Patel said if he doesn’t stay at Colquitt, he’s likely to continue his practice in North Georgia, another area that's lacking doctors.
“I like the community, and it's good to be able to see some of your patients just out and about in the town,” Patel said. “And then they come in and it just helps build a better patient relationship.”
Plus, rural residency programs typically aren’t as competitive. Residents don’t have to fight for slots in medical rotations, where they work with attending physicians on surgeries, deliveries and other forms of primary care.
“We have a lot more autonomy and we get better training as far as procedures go because there's no one else,” Patel said. “You know, we are it.”
Rural challenges in medicine
But there are challenges to being a rural doctor, too.
For one, doctors can be overrun with patients.
Sheena Favors is an OB/GYN in Albany. While Dougherty County isn’t really “rural” — government agencies define “rural” as 50,000 people or less — the major hospital where Favors works serves six neighboring counties that don’t have access to emergency and specialty care.
“Oh, it's intense," Favors said. "It's insanity. It's almost like you have more patients than you have docs so you're constantly overbooked.”
Smaller cities might also not offer as many amenities or job opportunities for spouses. Some programs offer financial incentives in exchange for a stint in rural, underserved areas for these reasons. In fact, Favors is a member of the National Health Service Corp, a federal program that helps health care workers find jobs in underserved areas and offers loan repayment and scholarship programs.
Over 22,000 people are involved in NHSC nationwide, though the majority serve in urban areas.
State-funded incentives can fill that rural need. Mercer University’s Nathan Deal Scholarship offers to reimburse 85% to 100% of eligible students’ medical school tuition for those who commit to four years in a rural, underserved primary care setting after residency.
Maria Westerfield graduated from Mercer’s School of Medicine last year and is in her second year of a family medicine residency at Self Regional Hospital in Greenwood, S.C.
“I would have chosen to do rural health either way, but sometimes it's not feasible because of the amount of debt that school causes,” Westerfield said. “Most of my colleagues here have over $400,000 of debt. Like, it's unreal.”
Westerfield estimates that in the long run, she will have saved about $200,000 with the scholarship.
But Favors said small cities, like Albany, need to do their part in keeping doctors around even after those program incentives are gone.
“What can they do to bring people to the city, to see the city, to explore, to come here to visit, to see if they like it and be like, ‘Oh, maybe this is a place I could live,’” Favors said.
Both Favors and Westerfield have something in common — they want to work in rural medicine. For them, the benefits outweigh the challenges. It’s a common thread among those who decide to practice in rural hospitals.
Back at Colquitt Regional Medical Center, psychiatry resident Cimino says the town of Moultrie is growing on him.
“I've lived in urban areas my whole life — New York City, for a while," Cimino said. "So I was used to that fast pace: Go, go, go, rat race mentality. But honestly, I'd had enough of it.”
So odds are, after his residency, he’ll stay.
Earlier versions of this story read:
State-funded incentives can fill that rural need. Mercer University’s Nathan Deal Scholarship offers to reimburse 85% to 100% of eligible students’ medical school tuition for those who commit to three years in a rural, underserved hospital after residency.
The scholarship requires four years of service, not three, but may be in primary care settings, not only hospitals.
Dugan estimates that in the long run, she will have saved about $200,000 with the scholarship.
Both Favors and Dugan have something in common — they want to work in rural medicine. For them, the benefits outweigh the challenges. It’s a common thread among those who decide to practice in rural hospitals.
"Dugan" should be "Westerfield" in both cases. GPB News regrets the errors.