One of the enduring commitments of the College of Medicine is to train physicians to meet the manpower needs of Nebraska. Since a large portion of the population of the state and its geography are rural in nature that commitment must include programs to meet the health care provider needs of rural Nebraska. However, that is easier said than done.
Statistically, physicians and other health care providers are more likely to decide to practice in rural areas if they are originally from those areas and/or train in those locations.
The creation of the Rural Health Opportunities Program (RHOP) in partnership with Chadron and Wayne State Colleges, as well as a similar program with the University of Nebraska at Kearney (KHOP), to identify and recruit talented students from rural Nebraska to the health professions has been a great success over the last two decades, with 60 percent or more of RHOP and KHOP students now practicing in rural locations, mostly in Nebraska.
Similarly the Rural Training Track residency program in family medicine has created the opportunity for residency training based in Grand Island, Kearney, Norfolk, North Platte, and Scottsbluff that in turn has resulted in the retention of program graduates in those and surrounding communities.
However, in spite of these successes, the need for medical and allied health students to have to move to Omaha for their training has disadvantages.
For a number of reasons some students are reluctant to relocate to Omaha from their rural locations. Others may come to Omaha but their plans to return to rural Nebraska get sidetracked as they lose their connections to their roots once they are in Omaha and develop personal connections with friends and future spouses with no connection to rural Nebraska.
Finally, in the absence of residency training opportunities in rural Nebraska, graduating medical students must remain in Omaha or leave Nebraska to complete their training. Residency training in an urban health care setting may not optimally prepare a resident for practice in smaller communities. As important, by remaining in Omaha or training out of the state, residents further lose their ties to rural Nebraska. This in turn decreases the likelihood that they will return to practice.
Last month, I joined two other UNMC deans – Kyle Meyer, Ph.D., School of Allied Health Professions, and Juliann Sebastian, Ph.D., College of Nursing, on a visit to central and western Nebraska. We met with people in several rural communities, including Kearney, Hastings, Grand Island, Scottsbluff, Broken Bow, Ogallala and Sidney.
Much of the discussion focused on UNMC’s plans to extend several allied health programs to UNK and expand the number of nursing students in the UNK program. Both of these expansions have as their primary goal to help address the shortages of these health care providers in central and western Nebraska by allowing students to train closer to home.
Obviously, many of the same factors that are driving the expansion of nursing and allied health programs on the UNK campus apply to the training of physicians.
The ability to expand the number of medical students at UNMC is limited by the constraints on the sites for clinical rotations in metro Omaha, which will likely only become more challenging as care increasingly moves to the ambulatory setting. However, expanding the number of medical students on our Omaha campus for the reasons noted above would not necessarily translate to increased physicians in rural Nebraska.
Thus, there has been growing discussion about the potential for developing a satellite campus of the UNMC College of Medicine at UNK, utilizing clinical sites throughout the Tri-cities area and beyond to make it easier to attract and train students for rural practice. As you can imagine, this was a concept that was met with great enthusiasm during the recent visits to central and western Nebraska.
Satellite campuses are not a new concept, as states such as Kansas have successfully established a number of them in past years. However, each state is different and any decision to move forward on this concept in Nebraska, which poses a number of unique challenges, will require an extensive assessment of feasibility.
To this end I have asked Dr. Jeff Harrison, assistant dean for admissions and student affairs, as well as director of the rural training track program, to lead the effort to define the advisability and feasibility of the extension of the UNMC College of Medicine to central Nebraska.
It is expected that this will take a minimum of 6-9 months. These discussions also will likely include the feasibility of residency programs in some of the communities involved.
I am very grateful to Dr. Harrison for his willingness to take on this task and for the Department of Family Medicine’s willingness to free up his time to take on this time-consuming activity.
There is much to learn and understand. We should know much more by this time next year, and we will keep you posted as this analysis comes together.