UA Medical Students and Rural Physicians Work Side-by-Side

June 8, 2007

A nationwide physician shortage is hitting Arizona particularly hard. Designated by the U.S. Census Bureau as the fastest-growing state in the nation, Arizona has a critical need for more physicians -- especially in rural areas. In 2005 Arizona had a ratio of 219 physicians per 100,000 people -- compared to the national average of 293 physicians per 100,000, according to "The Arizona Physician Workforce Study: Part II." And the data on Arizona's rural doctor-population ratio is even more distressing: 130 physicians per 100,000 people.

To help increase the number of physicians practicing in rural Arizona, every summer for the past 10 years a select group of physicians in rural communities throughout the state has mentored medical students from The University of Arizona College of Medicine.

For four to six weeks in May, June and July, the physicians volunteer as preceptors, or mentors, to UA medical students between the first and second years of medical school. The students work at the physicians' practice sites and reside in their communities.

The physicians are rural faculty members in the UA College of Medicine's Rural Health Professions Program, established in 1997 by the Arizona Legislature to encourage medical school graduates to practice medicine in rural communities.

The students are matched with rural physician-preceptors based on medical specialty interest and community preference. Physician specialties include family practice, pediatrics, internal medicine, obstetrics and gynecology, and surgery. Thirty-five rural communities are participating in the RHPP, and additional sites will be selected throughout the state. Communities hosting students this summer include:

  • Casa Grande: Dr. Jacqueline May, medicine/pediatrics, mentoring Nicholas Holtan, of Phoenix, May 29 - June 8 and July 23 – Aug. 3. (Dr. May, a 2000 UA College of Medicine graduate, participated in the RHPP as a medical student and completed her residency in medicine/pediatrics at Good Samaritan Regional Medical Center in Phoenix in 2004.)
  • Chinle: Dr. Scott McGarvey and Dr. Melissa Lee, both in family medicine, mentoring Kimberly Insel, of Tucson June 4 - 29
  • Douglas: Dr. Peggy Avina, family medicine, mentoring Mariposa Wolford, of Tucson, June 25 - July 27 (Dr. Avina is a 1994 UA College of Medicine graduate.)
  • Elfrida: Dr. Ramesh Karra, family medicine, mentoring Raquel Cisneros of El Mirage, May 29 - June 29. (Dr. Karra completed his residency in family medicine at the UA College of Medicine in 2001.)
  • Flagstaff: Dr. Lauren Stuart, pediatrics, mentoring Heather Spellman of Phoenix, June 11 - July 27
  • Lakeside: Dr. Daniel Neel, family medicine, mentoring Christine Poach, of Scottsdale June 4 - July 13. (Dr. Neel has been an RHPP mentor since 1998; he completed his residency in family medicine at St. Joseph's Hospital and Medical Center in Phoenix in 1972.)
  • Marana: Dr. Christina Weissauer-Condon, family medicine, mentoring Comfort Hines of Tucson, July 2 – Aug. 3
  • Pinetop: Dr. Edith Bailey, pediatrics, mentoring Melinda Valichnac, of Show Low June 12 - July 20. (Dr. Bailey is a 1989 UA College of Medicine graduate and completed her residency in pediatrics at University Medical Center in Tucson in 1992.)
  • Prescott: Dr. Jeffrey Osburn, obstetrics and gynecology, mentoring Lilia Pinedo, of Phoenix June 18 - July 13. (Dr. Osburn is a 1994 UA College of Medicine graduate.)
  • Prescott: Dr. Matthew Hinton, pediatrics, mentoring Angela Valdez, of Phoenix June 25 - July 20. (Dr. Hinton, a 2001 UA College of Medicine graduate, joined the practice where he was mentored as a medical student in the RHPP.)
  • Safford: Dr. Susan Jones, family medicine, mentoring Amanda Brown, of Tucson May 29 - June 22. (Dr. Jones, a 1979 UA College of Medicine graduate, is in practice with three other UA College of Medicine graduates: Dr. Cathy Romero, Class of 1997; Dr. Shirley Rheinfelder, Class of 2000; and Dr. Gail Guerrero-Tucker, Class of 2002. Drs. Rheinfelder and Guerrero-Tucker also participated in the RHPP as medical students.)
  • Show Low: Dr. A. Daniel Greco, general surgery, mentoring Andrew Hopper of Snowflake June 4 - July 13
  • Show Low: Dr. Becky Thompson, family medicine, mentoring Valerie Matthew of Tucson June 11 - July 20. (Dr. Thompson is a 1996 UA College of Medicine graduate.)
  • Sierra Vista: Dr. Ralph Mayberry, family medicine, mentoring Mike Kushner of Sierra Vista June 18 - July 27. (Dr. Mayberry has been an RHPP preceptor since 1998.)
  • Springerville: Dr. Cathy O'Rourke Taylor, medicine/pediatrics, mentoring Beth Clark of Mesa June 25 - July 25. (Dr. Taylor, a 2001 UA College of Medicine graduate, participated in RHPP as a medical student and completed her residency in medicine/pediatrics at Maricopa Medical Center in Phoenix in 2004.)
  • Tuba City: Dr. Diana Hu, pediatrics, mentoring Celeste Rodriguez of Tucson May 29 - June 22. (Dr. Hu has been an RHPP preceptor since 1998.)

The students will continue to work with their preceptors over the course of their three remaining years of medical training, returning to the rural communities in their third and fourth years.

"This program helps nurture students' interest in a rural practice," says Carol Galper, EdD and assistant dean for medical student education in the UA College of Medicine.

"Many of the students grew up in rural towns in Arizona and have a desire to practice in small communities, perhaps even returning to their hometowns. Their RHPP experiences help them understand the unique health care needs of rural populations as well as strategies to address these needs, and help them decide about where they want to practice in the future."

By working side-by-side with a physician - consulting with patients, discussing lab results, helping to diagnose childhood ailments, observing surgeries - students learn about the unique health care needs of rural populations and how to meet them. By returning to the same community during each year of medical school, students learn to appreciate the area's culture and community character and begin to experience the lifestyle of rural residents.

Each year, 15 first-year UA medical students are selected for RHPP and given intensive preparation, including a course covering managed-care issues, referral needs, the impact of poverty and lack of health care, environmental health concerns, the influence of culture and the role of physicians in rural communities.

RHPP students learn to use telemedicine technology in communities that are linked to the Arizona Telemedicine Program (ATP) -- a health care telecommunications network that allows rural physicians and patients to have real-time online medical consultations with specialists at the UA College of Medicine in Tucson. The system also allows rural physician-preceptors and their students to "virtually" attend grand rounds lectures at the UA College of Medicine.

Rural physician-preceptors enhance their teaching skills by attending faculty development and continuing medical education programs conducted by the UA College of Medicine. To minimize disruption of the physicians' medical practices, the programs are offered regionally as well as by video links provided by ATP to the UA College of Medicine and the Regional Behavioral Health Authorities of the Arizona Department of Health Services/Division of Behavioral Health Service Services.

RHPP students develop long-term relationships with their rural physician-preceptors, who act as medical and career counselors, helping the students make informed choices when they decide where they will practice medicine.

Upon graduation, RHPP students are more likely to select primary care specialties than their classmates: 75 percent vs. 56 percent of UA College of Medicine graduates. Of the 107 RHPP graduates to date, 45 have completed residencies and, of those, 31 percent are practicing in rural Arizona, eight percent are practicing in rural areas in other states and 17 percent are practicing in urban underserved areas in Arizona.

"We now have other graduates throughout the state, in places like San Luis, Yuma, Pinetop, Fort Mohave, Camp Verde, Flagstaff, Safford and Prescott, with more graduates returning each year," says Dr. Galper. "It is exciting to see these physicians return to Arizona and to have them teach our RHPP students. RHPP has come full circle."