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The Flavor of Rural Medicine: Geisinger residency program focusing on the needs of less-populous communities is about to expand to Centre County

by on September 30, 2019 3:27 PM

Americans living in rural communities are seven times as likely as those in urban areas to report that they are unable to get the health care they need, according to a 2017 article from the American Society on Aging. Likewise, 20 percent of the U.S. population is considered rural, but only 12 percent of primary-care physicians work in rural areas, according to the Census Bureau.

Acknowledging this shortfall several years ago, Geisinger Commonwealth School of Medicine decided to do something about it, at least for the rural communities of Pennsylvania, and soon Geisinger’s efforts will be making an appearance in Centre County.

Dr. Sireesha Vemuri-Reddy is the founding program director of the Geisinger Family Medicine Residency Program, which currently places residents throughout central Pennsylvania. Residents work under physicians in family practices, with their own panel of patients. Residents rotate through Geisinger subspecialty offices to gain a full range of experiences, while also participating in community-based research projects.

The rural residency program also presents residents with more of an urban residency experience as their rotation will include serving patients in the State College area, with plans to extend resident posts to Scenery Park and Grays Woods in December.

At the completion of the program, each resident has the opportunity to serve within Geisinger and will not be limited to Lewistown. This attracts more talents to local communities – rural and otherwise, Geisinger says.

Residents will participate in the following practices in Centre County: dermatology, inpatient pediatrics, nephrology, family medicine, obstetrics, and gynecology.

“Part of the reason why this program came about was Geisinger wanted to do something collaboratively with family practice centers, with a rural focus, to help fill the needs and gaps in care for the community in the Mifflintown-Juniata area,” says Vemuri-Reddy, who was recruited to lead the project in 2017. “Overall, nationwide there is a huge shortage for primary-care providers in the rural setting; even if primary-care physicians are being recruited to these areas, it’s becoming difficult to retain them. So our hope and goal is, if we can train someone in this setting and … have them experience the flavor of rural medicine, [we will] be able to recruit them to the area and retain them here, because they are now trained in this setting [and] they understand the population.”

In some instances, according to Vemuri-Reddy, residents might even specifically apply to serve in a rural Pennsylvania community, to gain the unique opportunities serving rural populations provides.

Dr. Lionel Varela is one such resident. Raised in a small town in Arizona – much like Lewistown, he says, where he is currently working as a resident – Varela obtained his undergraduate degree at the University of Arizona before attending medical school in Guadalajara, Mexico, and interning in New York.

“I always had an interest in medicine, especially community medicine, especially during episodes where I had to take my grandmother to doctor appointments,” he says, noting his observance of how primary-care physicians were able to help his grandmother significantly. “I wanted to do the same for a small community such as the one I was in.”

The residency is a three-year program, with four new residents added each year. A wealth of learning opportunities await the residents.

“Rural medicine is a lot more extensive. It requires a lot more hands-on understanding of resources and how to be able to function and maximize the care you can provide to patients with very limited resources, limited access to specialty care,” says Vemuri-Reddy. “At the same time, it also requires a wide variety of procedural skills – dermatological procedures, gynecological procedures … things like that. So the role itself of primary care in rural areas is a little wider. It’s more vast.”

This necessity for a number of skill sets and an ability to make use of limited resources is something that Varela has seen firsthand. He calls himself “a jack of all trades,” and says, “I thought my ability to adapt to situations, to be creative, to be innovative with what I have available, would match right in with a rural community.”

On an average day, Varela might see a wide range of patient types, with an equally wide range of ailments.

“For us, the specialty is from the cradle to the grave,” he explains. “We see brand-new babies. We deliver pregnant women in the hospital. We have a clinic where we see the newborns that we actually delivered sometimes. We see their mothers, their grandparents, and any child or person in-between. Our residency program trains us to deal with all ages.”

With these patients, he explains he’s able “to be creative with the objects and utilities [available],” more so than he might in a more traditional residency setting. “You know, [we might not] have the appropriate set up for a certain procedure, so you grab what you have available,” he says.

Varela references one instance wherein a patient required a chest tube, which is a flexible, plastic tube that is inserted into the chest wall to allow air or fluid to seep out. “We don’t do those too often,” he notes and, because of this, he and his team had limited supplies to work with. “[The patients] often go to a higher level of care before that intervention is needed, but we did have resources and partial kits available from the surgery department. … Most of the items that are required for chest-tube placement were improvised on the spot. The items weren’t necessarily part of the chest-tube kit, but we created our own kit to help the patient.”

Beyond learning to improvise, residents in the program also learn to work with the very unique needs of a rural population. In many instances, a certain level of extra education is required to create the best patient outcomes. For Varela, a lack of health education in rural populations can lead to what he calls a “failure to comply.”

“That’s the most difficult aspect of primary care,” he says. "You have the plan or goals for a patient and sometimes they fall short of the recommendations.”

Some of the most common complaints that Varela deals with when working with his patients are those related to metabolic syndrome – conditions such as high blood sugar, obesity, and high blood pressure that can often be addressed with proper education.

However, it’s not just education regarding treatments and healthy lifestyles that those involved with the Geisinger rural residency program have on their hands. Education regarding the residents and the resident program itself has also been crucial.

“It was a 360-degree effort in educating the community and getting them to be a little bit more accepting of the residents,” says Vemuri-Reddy. “To most people, residents are students and that’s not really the case [here]. … When the nurses tell the patient, ‘Oh, this is a doctor-in-training,’ and if you by any chance use the word ‘student,’ there will be refusal on the part of the patient. … The nurses are now having to think … and treat their introduction [of the resident] to the patient differently … [as] that’s a potential loss of an opportunity for the resident.”

“The community at first might’ve had the thought of, ‘Oh, these are students,’” says Stephanie M. Bilger, administrator for the family medicine residency program. “But they’re not students, they’re physicians in training. The community has done a great job of accepting [the residents] and allowing them to care for them.”

“It required a lot of education, [but] I think the community has embraced the whole concept of, ‘OK, I will be cared for by more than just my physician,’” adds Vemuri-Reddy. “I think staff did a great job, administration put themselves out there, the physicians themselves do a great job, even in introducing [themselves]. … I think most are in the practice now of saying, ‘Oh, this is Dr. Such-and-Such. We both work together as a team; they’ll be seeing you first and then I’ll be co-managing the care with them.’ That’s how we practice it, when we introduce our residents to the patients. I think that’s made quite a bit of difference in the [patients’] acceptance of the residents.”

As to the future of the program, Vemuri-Reddy has her eye on further expansion and possibly even adding a complementary medical fellowship program to Geisinger’s educational offerings.

For Varela, it seems the residency program has accomplished at least one part of its goal. Varela hints toward potentially sticking around and serving the community further. “I wouldn’t be surprised if I stayed in the area and worked in a primary-care setting.”

 

Holly Riddle is a freelance writer in State College.

 

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