Welcome back!  Wow, last week’s blog really hit home for many of you.  Almost 1000 readers tuned in to read about our friend MAP’s journey with chronic illness…and from the responses I received, many of you have been in his position.  Keep living!  The world needs you.  Thank you for teaching us about your world, MAP…it was a fascinating look inside your day-to-day reality, and you were very brave to write to us.  You should write your own blog!
So, as we wind down the month, the question remains…what can we do to help those who suffer with chronic illness?  This week’s contributor is a student doctor, and he has some really good insight into this problem.  The United States is suffering from a serious shortage of Family Doctors.  People who can’t get in to see their doctor in a timely manner, often end up being seen after they have been sick for a long time, rather than early on, to catch the illness before it becomes chronic.  You may be asking yourself, “And so?  What can I do about that?”  Let’s see what this week’s contributor has to say, and don’t forget to come back next week as this writer wraps up the month with “A Cup of Coffee”.  

Please welcome Student Doctor Jacob Thatcher!

Chronic Illness: Lack of Physicians

I consider my childhood perfect. My commitment to rural America took root growing up on a small potato farm. I have fond memories of summer swims in the nearby river, large family gatherings after church and home visits from our family doctor. As times have changed, the doctors in my town have too. My town is faced with fewer and fewer doctors, and consequently fewer babies being born locally. We have learned that babies without roots don’t stay. As a result, the town is slowly wilting away.

I guess things could be worse. If it weren’t for DO’s, maybe my town would have already shriveled up. During the last 30 years, a miracle has occurred. I like to call it the saving grace of rural—Doctors of Osteopathic Medicine to the rescue! In 1990 there were 30,990 practicing DO’s in the United States. Now there are over 109,000. That’s a 300% increase to the ranks of healthcare—and many have chosen to serve in the traditionally sicker and older rural America. In fact, a recent study found that Osteopathic Physicians are 2.3 times more likely to practice medicine in rural America. It’s not that Allopathic Physicians haven’t been pulling their weight. In fact, together we are quite the team. It is through our collaboration and unique, yet similar, training that allows us to touch the hearts of our patients.

Currently the patient to primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. Put another way, about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there. Within the next decade, AAMC projects a shortage of 95,000 doctors, and 43,000 of those vacancies are projected to be in primary care—the lifeblood of rural healthcare. Traditionally primary care has been internal medicine, family medicine, and pediatrics. Less often are obstetrics and gynecology and general surgery included. In my opinion, these services are of “primary importance” to rural communities. Additionally, they are usually the main revenue source for rural hospitals; but that is a story for another time.

Much research has been done to find ways to recruit and retain rural physicians. We are learning what works and what doesn’t.

When searching for a town to lay down roots, new physician graduates have been shown to search for a town that has culturally diverse opportunities and quality of education. They are more likely to work rural if they, or their spouse, have a rural background. If their significant other is from a rural town—game over. But what can we do short of encouraging arranged marriages? First let’s examine what doesn’t work.

Here is what yields a poor return on investment (ROI):

  1. The state subsidized medical school model: many states subsidize students to attend medical school in that state with the hope of retaining them, then exiling them to their outermost rural borders. Just 20% of those students stick around. For some states, this poor investment comes to 2.5 million dollars per retained student (the average cost for the state to subsidize each medical student is $500,000).
  2. Federal and State loan repayment models: (AKA indentured servant model). Nowadays it’s a given. Medical students have two choices. They can either sell their soul to 300k+ in student loans (at 6.5% interest) or become an indentured servant to primary care at a specific HPSA training site. Beware. If you choose option two, your pre-medical experience better have given you sufficient exposure to be confident in committing to primary care, because if you change your mind, you return three times plus interest what was loaned to you.

What works? spoiler alert: community based residency programs and rural medical schools. If you train rural, you stay rural. Prove it? Stats are showing us that 60-80% of physicians who completed their training in a rural residency continued to stay rural. A little higher than the 20% ROI for the state medical school “sponsorships, eh?” And you don’t even have to fiddle your way down to Georgia to meet the devil with the National Health Service Core. Osteopathic rural medical schools and community-based residencies programs  have kept rural America afloat—and this is why 643 rural hospitals  “at risk of closing,” probably won’t close. DO POWER.

But really, it’s no secret. Allied health and Allopathic Physicians have jumped on the bandwagon. Congress is even listening (surprised?). Well a few representatives have at least…Bill #S.455, Restoring Rural Residencies Act was proposed by Senator Jon Tester (D-MT) February of 2017. It was read twice, then referred to the Committee of Finance. No other action has been taken

So what can be done now? Show your #DOpride. #Ruralrocks. Support GME rural expansion.

So what about my town? Idaho College of Osteopathic Medicine is now officially Idaho’s first ever medical school. Idaho Medical Association took the initiative and recommended to our state legislature, through a public private venture, the creation of 12 new residencies in Idaho, graduating 357 residents. Each resident would have a $1.9 million indirect and direct impact on the community. We asked the state for 5.239 million. Our governor appropriated, but didn’t allocate 1.1 million.   We have a way to go to move up from 49/50.


S.455 – Restoring Rural Residencies Act of 2017. (2017, February 1). Retrieved February 8, 2018, from Congress: https://www.congress.gov/bill/115th-congress/senate-bill/455/all-actions?overview=closed#tabs

Mann, S. (2017, March 14). American Association of Medical Colleges. Retrieved February 9, 2018, from https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/

McCarthy, O. o. (2017, August 24). Washington State office of Auditor. Retrieved 1 2018, February, from http://portal.sao.wa.gov/ReportSearch/Home/ViewReportFile?arn=1019636&isFinding=false&sp=false

Pouliot, S. (2018, January 10). Rural Graduate Medical Education. Retrieved from Idaho Medical Association: https://www.idmed.org/IDAHO/Idaho_Public/ActionCenter.aspx?vvsrc=%2fcampaigns%2f55449%2frespond

Slabach, B. (2017, September 10). About Rural Health Care. Retrieved February 2, 2018, from https://www.ruralhealthweb.org/about-nrha/about-rural-health-care

Thaddeus Miller, M. R. (2006). Characteristics of Osteopathic Physicians Choosing to Practice Rural Primary Care. (2.-2. Vol. 106, Ed.) Journal of the American Osteopathic Assocation, 106, 274-279.


  1. The author states: “What works? spoiler alert: community based residency programs and rural medical schools. If you train rural, you stay rural. Prove it? Stats are showing us that 60-80% of physicians who completed their training in a rural residency continued to stay rural. ”
    The “prove it” evidence does not fully support the assertion. Yes, stats do show that physicians often stay in the area/region where they completed residency, but it would be different evidence that would show that rural medical schools are associated with an increase in rural practicing physicians. I am not aware of such evidence, and would have wished the author would present such evidence for this assertion. Furthermore, it seems that the rural medical school that the author asserts would result in more rural primary care physicians is eerily similar to the “poor return on investment” state-funded medical schools: simply having a medical school in a certain location has not been shown (I wish it did) to increase rural primary care physicians in practice.
    The author also states that Federal and State loan repayment models (indentured servitude models) don’t work, but doesn’t support this claim with actual evidence. Instead, the author points out that it is apparently a poor financial choice for students. While this is absolutely an important factor, that is not what the article is about. The article is about effective methods to increase rural primary care (and perhaps specialty care) physicians. Let’s discuss the indentured servitude model with measures of it’s efficacy in terms of primary care physician production, not dismiss it because of another reason that has probably benefited rural primary care overall (these programs make financial sense for some students).

  2. Thanks. I have long believed that #2 actually worked.

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