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Summer internship allows Morris native to live and learn rural medicine

By Tom Larson

Sun Tribune

Rural areas in the U.S. are clamoring for their kids to come back home, new doctors especially.

And physicians in training with rural backgrounds, like Morris native Jake Eiler, are exploring that possibility very seriously.

Eiler, a 2001 Morris Area graduate, will be entering his second year of medical school at the University of Minnesota Duluth this fall.

Much of this summer he's been working and learning at the Stevens Community Medical Center, under the guidance of SCMC family practice physician Patrick Burke, and through the auspices of UMD's Summer Internships in Medicine Program.

"I'd like to end up in a rural facility," said Eiler, the son of William and Debbie Eiler. "(The internship) has been a great experience and I've seen a lot of different options. I'd like to end up in a place like Morris, where it's a community rather than just a place to live."

Need is there

Rural communities welcome that attitude.

According to the American Academy of Family Physicians, 21 percent of the U.S. population lives in rural areas but only 10 percent of physicians practice there.

The U.S. is short 8,755 primary care physicians, and rural areas are short about 3,200 of that total. A 15 percent increase in total medical school applicants would total almost 25,000 new physicians in 10 years. If 15 percent of graduates are readied for rural practice, there could be about 3,700 new rural physicians in 10 years, according to the AAFP.

UMD's mission is to prepare physicians for family medicine practices and other primary care specialties in rural Minnesota and American Indian communities. The internship program is one of several programs designed to complement the academic rigors of medical school with practical experience.

However, University of Minnesota medical students spend only their first two years at UMD; they complete their studies in the Twin Cities. And it's at that point that the tug of war begins, Burke said.

"Unfortunately, when someone like Jake goes to the U of M, he'll have instructors who will tell him that if he goes to a rural setting he won't be paid enough, he'll work too much, there will be too much 'call' work -- nobody will respect him," Burke said. "You hear a lot of negatives about rural practice."

Disseminating that kind of propaganda in a medical school leaves Burke at a loss.

"We should all be part of a big team whose goal is to spread health care across the nation, to anyone who's out there," he said.

And he adds, with a laugh, "What does a physician at Fairview Hospitals know about how I spend my day?"

Rural experience remains

Burke has had numerous students join him -- before and during medical school -- to live and learn in a rural community's medical center and clinic. He noted that statistics indicate that there are accurate predictors of which students will end up in rural practices: students who come into training with a rural background; students who's interests or hobbies pertain to rural areas; and those who've had a positive experience in primary care in a rural community early in their training.

Eiler fits that bill.

Eiler graduated from the College of St. Scholastica, in Duluth, with a biology degree in 2005. He then spent a year working at St. Mary's Duluth Clinic Health Systems before enrolling in UMD's medical school.

The internship experience has helped ease the grind of long hours of classroom lectures and late-night studying. It helps to see patients as a reminder of why he chose his professional path.

Eiler's time at SCMC -- he'll also spend time in Benson's hospital and clinic before returning to school -- was long enough that he was able to be involved in follow-ups on patients, and to observe how long-term relationships are developed between physicians and patients.

"It's a great way to see all different sides of medicine and to see how it all interacts," Eiler said. "One thing that is a benefit to working in a rural community is that, in a city, people can become just another chart -- just another patient and you don't know if you'll ever see them again. In rural communities, you develop personal relationships with your patients."

More than money

Eiler knows what he would be sacrificing if he chose rural practice.

Jobs and populations in many regions are declining, and youths are leaving to seek greater opportunities and larger paychecks in urban areas. The same problems arise for physicians. The difference is that there are jobs available in rural areas for doctors who want them.

Burke said that, nationwide, the highest-paid rural physicians are paid on par with the lowest-earning medical specialists in urban areas. Rural physicians can expect to work longer hours, too.

However, he said, "money never makes a bad job a good job."

Eiler agreed that often the misconceptions about rural life come from a lack of exposure.

"(Some physicians) are trained in cities and work in cities, and they think that you would want to have a lifestyle like they have," Eiler said.

Patients are key

While Eiler would like his future patients to be more than just charts to him, he also understands the fine line he'll tread as a physician in a small community. Already at SCMC, he's been working with people he knew during his high school years in Morris.

While there's a closer bond among people in rural communities, there's a distinct professional-personal boundary in those relationships, he said.

But those past, present and future patients are critical to making programs such as the one Eiler is in successful, Burke said.

Perhaps those patients sense the need just as acutely as the health care system trying to encourage an upswing in the number of rural physicians.

"These programs don't work if you don't have patients receptive to having an intern involved with them," Burke said. "This community has been very accepting of the students I've had here."