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 Advocate for the Unlettered, by Dale Smith.

 

Third-year MU medical student Laura Morris grew up in Holts Summit, Mo., a dot on the map between Jefferson City and Fulton. For Morris, big-city medicine may have its attractions, but she's aiming to settle in a small town.

"My husband and I definitely don't feel comfortable in a big city," she says. "And I don't think big cities are conducive to the kind of family practice I want to do."

That's just what administrators at MU's School of Medicine want to hear. Ever since Morris was an undergraduate they've been grooming her to become a rural doctor by providing her with an array of academic enticements and training experiences designed to make small-town medicine appealing.

She's one of dozens of students who've been getting this treatment. Over the past 15 years, the medical school has put together one of the most ambitious programs in the nation for attracting students interested in rural medicine and guiding them toward that goal throughout their academic careers.

While St. Louis, Kansas City and much of the i-70 corridor are well-stocked with doctors, in rural areas of northern and southern Missouri doctors are in chronic short supply. The problem is a critical one in rural areas across the nation. Rural residents tend to be older, poorer and less likely to be insured than their urban cousins. And the smaller and more isolated the place where they live, the harder it is to recruit and retain physicians.

The shortage of rural health care providers has been a problem ever since the nation's population began to migrate to cities a century ago, says Harold Williamson, chair of the Department of Family and Community Medicine and one of the creators of MU's "rural track program" for medical students.

"Doctors have just been following the demographic trends and the greater opportunities offered by hospitals in urban areas. People want to live in cities. And most people who make it into medical schools are from cities," Williamson says.

When the state authorized the creation of MU's medical school in 1948, it was deliberately situated in Columbia, rather than St. Louis or Kansas City, in order to help meet the need for rural physicians, Williamson says. While the school never lost sight of that mission -- it had long been the No. 1 provider of rural doctors in the state -- University administrators decided in the late 1980s that not enough was being done. "We were doing OK, but we could have been doing a lot better," says Weldon Webb, the medical school's director of rural health programs.

When Lester R. Bryant was appointed dean of the medical school in 1989, Webb says, Bryant made the school's rural mission a priority. Webb and Williamson were among those given the task of coming up with effective ways to encourage the school's graduates to make their careers in small towns. They investigated programs at medical schools across the country, looking for ideas. "We were able to steal the best of these programs and put them into a mix," Williamson says.

They realized early on that trying to persuade big-city students that they would enjoy rural medicine wasn't likely to work. Less than five percent of such students abandon cities for the country after they graduate.

       
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