Homegrown doctors key to staffing

Scholarships attempt to solve physician shortage in rural areas.

By Myrle Croasdale, amednews staff. Aug. 4, 2003.

Steve Spence, MD, is glad to be home.

Marianna, Fla., 66 miles from Tallahassee, may be the middle of nowhere for some, but it's where Dr. Spence and his wife grew up and where both his and his wife's parents live. And the townspeople hope he'll stay.

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Dr. Spence is the first physician to return after taking advantage of an offer from his hometown's local hospital to give him $6,000 each semester for medical school if he promised to come back and set up a practice.

Faced with a persistent shortage of physicians and growing difficulty recruiting and keeping them, Jackson Hospital decided to offer the scholarships to local students in an effort to get a return on the investment.

When they return as doctors, their loan is forgiven in three years. If the doctor reneges, the debt can be paid off at 10% interest.

Many rural hospitals are facing the same chronic physician shortages as Jackson Hospital, and at least a handful of them are using the scholarship approach to address the problem.

The National Rural Health Assn. says rural areas have about half as many physicians as urban areas serving the same size population base.

Nearly 90% of all specialists practice in urban areas, according to the NRHA, leaving rural areas largely unserved.

Ken McBain, CEO of the Community Health Center in Casper, Wyo., and a member of a National Rural Health Assn. task force on rural health policy, said it's no surprise hospitals are getting creative in their recruiting.

"I frequently hear stories of hospitals making financial resources available for students to pursue health care," he said. "This shortage is sustained and more serious than any cycle I've seen in 37 years."

By his estimate, the United States needs 2,400 more primary care doctors every year. In 2002, there was only a net gain of 300, he said.

Scholarships key to staffing hospital

In Perry, Fla., having good access to health care is so important the townspeople voted for a 1-cent increase in the sales tax to pay for a new hospital building. To keep the hospital staffed, they've started giving scholarships for doctors.

Joda Lynn, a third-year medical student at Florida State University College of Medicine in Tallahassee, will be the first doctor from Perry to return to the community to practice in 50 years, if he sticks with his plan, which includes a residency in family medicine. The hospital is providing scholarships to three medical students, and a fourth is possible this fall.

Lynn says he'll owe $16,000 to the hospital when he's done, which will be forgiven in four years. Jim McKnight, CEO of Doctors' Memorial Hospital, said the hospital is spending $65,000 to $75,000 this year to pay tuition for all the students.

"In the long run, it's more economical than what we did before," McKnight said. "Recruiting doctors, we'd pay to relocate them, give them income guarantees. We were spending $250,000 a doctor, who would leave after his commitment was done. What we're doing now is cheaper, but you have to be willing to wait."

The plan is not without risk. The medical students can opt to pay back the scholarship or leave once their debt is forgiven, but McKnight is betting his scholars will be back for good.

"We picked young people tied to the community by marriage, or they lived here all their lives. They want to come back," McKnight said.

For his part, Lynn is confident of his career choice and his commitment to rural medicine.

"It's really a wonderful feeling to know you have that kind of support behind you in your career," he said. "I want to repay that by coming back."

Perry is built around tree farms and a pulp mill. There's plenty of hunting and fishing. The town is a 15-minute drive from the Gulf of Mexico and just 52 miles from Tallahassee.

Raising up physicians who know what to expect from small town life is expected to help retention rates.

Loan forgiveness provides normalcy

Even Dr. Spence, who was considering returning prior to the scholarship offer, second-guessed his decision a couple of times.

After graduating from the University of Florida College of Medicine in Gainesville, he trained in internal medicine there. As his residency drew to a close, he was invited to apply for a fellowship by the cardiology, pulmonology and gastroenterology departments. When he said no, he was offered a job.

In the end heading home won out. Not only would he and his wife be close to family, they also would be getting out of debt.

"The loan forgiveness helps you live like a normal human being instead of a starving college student," he said. "It's nice. If you want to get married, have a place to live -- the extra money isn't there otherwise."

There also were unexpected benefits. "Practicing medicine here is a lot more interesting than I expected," he said. "I thought the little hospitals only did the simple stuff."

To Dr. Spence's surprise, he's been able to keep many critically ill patients in town, with only the occasional transfer.

He is the first of Jackson Hospital's scholars to return, with four to finish next year and three the year after that. Others in the pipeline bring the total to 13.

John West, CEO of Jackson Hospital, said another physician who finished with Dr. Spence opted to repay the loan and move to his wife's hometown to practice. If he gets one out of three doctors to return, West said he'll be pleased.