2/14/2000
We accept 6 high school seniors into the Rural Health Opportunity Program.
The focus is getting people from the smallest towns so that they can return
after graduation from residency. This dictated the choice of two small
colleges as starting points. People in the state anxiously await the
results of the first location decisions of the graduates. Of course they
are missing the real success of the program.
The program has had major changes. Jealousy by other colleges and internal
politics at UNMC reduced the class size to 6 instead of 10 per year.
Attrition reduces it further. Initial students were a bit weak in the
sciences so the med school required 4 years instead of 3. In a typical
fashion, the med school did the right thing for the wrong reason. Since the
point of the program is small town doctors, the 4th year increased the
probability of a small town mate instead of one met in Omaha. The impact of
the weak academics is a moot point because the program has changed the
small colleges so much. Chadron and Wayne State have attracted and trained
a much higher quality student since the program began. Micro classes now
have 14 well deserved A grades per semester instead of 2 weak ones. Now
RHOP students are much more prepared for medical school due to increased
competition at the college level. Another impact has been increases in
interest, admissions, and science majors at Chadron and Wayne State. The
Rural High School Career Day at Chadron attracts over 220 students from up
to 4 states.
The big challenge for the students is adapting to urban culture when they
move to Omaha for 4 years of med school, as most are from small towns.
The success of the program with minimal effort points out one of the major
components of the maldistribution problem. Over the years states have
allowed centralized professional training further into urban colleges. With
an urban college location, there is increased probability of an urban
spouse and a spouse with a more specialized career. These are less likely
to return rural, even when the rural background candidate wants to do so.
For more on centralization see
http://www.ruralfamilymedicine.org/JoRMMEno1winter99.htm#continued
(under review, please critique).
Given the past three decades of changes in rural schools and small
colleges, it is no surprise that small towns lack population in the 25 - 44
age category.
Given that these are professionals and potential community leaders in many
walks of life, it is no surprise that small towns lack direction.
Given that medical leaders still blame the maldistribution on the poor
rural economy, this is unlikely to change. See example from AAMC at
http://www.aamc.org/findinfo/aamcpubs/acadmed/dec1998/ftp.htm .
This is sad because even a small program with minimal cost can have a major
impact on the college location of graduates by leveling the playing field.
Even a governor interested in accountability could build this awareness by
executive order.
This is not just a rural issue. It is also true for rural minorities and
various under-represented or unrepresented cultures, etc. If we really want
to correct the maldistribution then we must integrate some schools into
culture at their location. Programs such as the Rural Medical School in
Japan, the new medical school at Hazard KY, and similar programs in other
countries are a step in the right direction.
We must build awareness at the institution and state level so that we can
work with rural and underserved communities and peoples.
Education - the entire pipeline