Despite an increasing oversupply of physicians in the United States, statistics show that rural areas of the country continue to suffer from a shortage of physicians, especially family physicians. In response to this national geographic maldistribution of physicians, Jefferson Medical College of Thomas Jefferson University, Philadelphia, initiated the Physician Shortage Area Program (PSAP) in 1974 to increase the number of family doctors in rural and underserved areas, especially in Pennsylvania.
Now 25 years old, the PSAP, which admits approximately 15 students per year, accounts for 12 percent of rural family doctors in Pennsylvania. A retrospective study demonstrating the impact of the PSAP on easing the shortage of rural physicians over the past two decades appears in the January 20 issue of the Journal of the American Medical Association (JAMA).
According to Howard K. Rabinowitz, M.D., professor of family medicine at Jefferson Medical College and director of the PSAP since 1976, the program recruits students who have grown up in a rural area and who are committed to practicing family medicine in the same or similar area.
"The recruitment and selection process of students for the PSAP has been key to the program's successful retention rates," explains Dr. Rabinowitz.
PSAP students follow a curriculum similar to their non-PSAP classmates, but take some courses that focus on practicing family medicine in a rural community, receive training in rural or small town areas and pair with an academic advisor from Jefferson's family medicine department.
The study used current data to compare a total of 206 PSAP graduates from the classes of 1978 to 1991 currently practicing family medicine in rural and underserved areas of Pennsylvania with all allopathic (M.D.) medical school graduates in the state, and with all U.S. and international graduates. All PSAP graduates were also compared with their non-PSAP peers at Jefferson Medical College regarding their U.S. practice location, medical specialty, and retention for the past five to 10 years.
Study results show that PSAP graduates, who represent only 1 percent of the graduates from Pennsylvania's seven allopathic medical schools, accounted for 21 percent of family physicians practicing in rural Pennsylvania coming from those schools. Among all national and international medical school graduates, PSAP graduates represented 12 percent of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in other underserved areas.
Overall, PSAP graduates were eight times more likely than their non-PSAP classmates at Jefferson to practice family medicine in a rural area of the U.S. Program retention was also found to be high, with the number of PSAP graduates currently practicing family medicine in rural and underserved areas of the U.S. equal to approximately 90 percent of the number practicing five to 10 years ago.
"The biggest impact of the PSAP program has been our ability to provide doctors to rural areas that have a limited number of physicians," explains Dr. Rabinowitz. "With more people living in rural Pennsylvania than in any other state in the nation, the medical needs of this population are great and this program has let us meet these needs to a large extent."
Family practice in rural areas truly represents care for the family as a whole with physicians treating each generation. "Family practitioners in rural areas provide general medical care, but also deliver babies and perform minor outpatient surgery," says Dr. Rabinowitz.
Dr. Rabinowitz views the PSAP as a public service program, providing family physicians to rural areas where the demand for good medical care is high and the availability is low.
"While there may be a glut of physicians nationally, there are still areas of the country that need doctors and we are addressing and successfully meeting this need through the PSAP," he says.
Since 1978, the PSAP has also been supported by the PSAP Cooperative Program, a joint program with six undergraduate institutions in Pennsylvania - Allegheny College, Bucknell University, Franklin and Marshall College, Indiana University of Pennsylvania, the Pennsylvania State University and the University of Scranton. All of these institutions assist in the recruitment and selection of PSAP applicants.
James Devlin, M.D.
1985 PSAP Graduate
Jefferson Medical College of Thomas Jefferson University
For James Devlin, M.D., of Brockway, Pa., medical training began as a child when he accompanied his father, a family physician, on house calls in his hometown of Brockway, Pa., a small rural community in western Pennsylvania. A 1985 graduate of the Physician Shortage Area Program (PSAP) at Jefferson Medical College of Thomas Jefferson University in Philadelphia, Dr. Devlin today practices family medicine in Brockway, located in West Central Pa., bringing his two children with him to observe house calls much the way his father did a generation ago.
"Growing up in Brockway, I watched my father practice medicine and get to know his patients as people by really getting the opportunity to share in their lives," said Dr. Devlin. "I knew that I wanted to return to this small town atmosphere and practice medicine in much the same way. The PSAP gave me the training I needed to return home and practice medicine."
Through the PSAP, Dr. Devlin was able to take his family medicine training during his junior and senior years of medical school in rural areas of Pennsylvania. This training exposed him to inpatient and outpatient settings, giving him hands-on understanding of the practice of family medicine in a rural area.
"Practicing family medicine in a rural area truly means providing a wide-range of comprehensive health care for the entire family," explains Dr. Devlin.
In private practice in Brockway, Dr. Devlin practices primary care in the sense most city dwellers know it, but also delivers babies, and assists with various surgeries, including gall bladder removal, hysterectomy, total joint replacement and cesarean sections.
"Practicing family medicine in the country differs greatly from providing primary care in the city in that there is a limited number of subspecialists, broadening the scope of the care I am able to provide," he says.
Dr. Devlin cares for entire families, treating grandparents for the general health problems of old age, while delivering their great-grandchildren.
"My training through the PSAP gave me excellent exposure to family practice medicine and strove to return me to the place I loved growing up," says Dr. Devlin. "I am able to care for patients who are also my friends, practicing family medicine in its purest form, in a time when the emphasis in medicine is on primary care."
Thane Turner, M.D.
1993 PSAP Graduate
Jefferson Medical College of Thomas Jefferson University
A 1993 graduate of the Physician Shortage Area Program (PSAP) at Jefferson Medical College of Thomas Jefferson University, in Philadelphia, Thane Turner, M.D., of Lock Haven, Pa., has experienced the benefits of the program both as student and teacher.
Enjoying the history and people of Lock Haven, Dr. Turner knew that he wanted to return there to practice medicine, caring for the friends and family he had known for a lifetime.
"The PSAP allowed me to complete training during my years of medical school in rural areas and also conduct some interesting academic research," says Dr. Turner. "In addition to the training, I was able to build solid relationships with my advisors and various members of the Jefferson faculty who helped teach me through their experience the scope of what you can do in family medicine."
Dr. Turner put his training to work in a group medical practice in Lock Haven, where he lives with his wife and two children. He provides comprehensive family medicine common to rural areas. This includes everything from treating patients for the cold and flu to delivering babies, performing minor outpatient surgeries (e.g. suturing, wart and mole removal), and casting minor fractures.
"Practicing medicine in the country allows me to provide a wide range of care to all family members in an area where the availability of general and specialty medical care is low," says Dr. Turner. "My practice gives me the opportunity to learn not only the patients' medical history, but also the history of their family and life experiences."
Like all PSAP participants, Dr. Turner studied under a physician preceptor for six weeks in a rural area of Pennsylvania in his fourth year of medical school. This experience solidified his relationship with his academic advisor and gave him support for his career goals. He found the experience so beneficial that he just finished serving as a preceptor for a current Jefferson Medical College student.
"Serving as a preceptor allowed me to experience the benefits and impact of the PSAP from the other side," says Dr. Turner. "I was able to keep my teaching skills sharp and bond with my student in much the same way as I did with my advisor. As a whole, the PSAP gives both students and teachers the opportunity to learn the dramatic and interesting differences between the practice of family medicine in Center City Philadelphia, and rural Pennsylvania."