Rural Medicine Gaining Traction In Montana

Sep 5, 2019


Rural areas across the United States struggle to find and keep doctors. In Montana, rural residency programs aim to fix that problem by training new doctors away from city centers. Hospitals will be able to access federal funding for rural physician training starting in October.

While about 20 percent of Americans live in rural areas, rural doctors made up only 10 percent of the total number of working physicians in the country in 2006. That’s according to the American Academy of Family Physicians website.

While AAFP says there’s still a hiring gap in rural America, it suggests that training residents in rural settings could contribute to a solution.

It also finds that doctors who grew up in rural areas are more likely to return to work there.

That’s true for Billings Clinic third-year internal medicine resident, Amy Consson, from Colstrip.

“I think it’s a mindset. So, I was born and raised in a small community, and that’s where my passion lies, and I think a lot of people come to the Billings Clinic program because we’re interested in rural medicine, and that’s one of the driving factors for us to come,” Consson says.

Consson is part of the second round of internal medicine residents at Billings Clinic.

A few years ago, Billings Clinic started sending those residents to Lewiston, Montana and Sheridan, Wyoming.

There, they do month-long rotations at Critical Access Hospitals, rural hospitals with fewer than 25 in-patient beds. There are 48 of these hospitals in Montana.

Consson says while smaller medical centers have fewer resources, that also forces residents to be resourceful.

“We are learning how to be self reliant if you will. And so, learning to deal with these problems that we don’t learn so much here at Billings Clinic because we do have so much access to specialists,” Consson says.

Family doctor and professor, Mark Deutchman, runs the rural track at the University of Colorado’s School of Medicine and agrees with that perspective.

“You have to be interested and even excited about seeing patients who come in with anything and everything,” Deutchman says.

Deutchman identifies medical students who want this type of rural practice and supports them through their training. And he says those who DO choose a rural residency are more likely to return.

“Not every town is gonna absorb every one of their graduates. That’s not the idea. The idea is that you train them and they go onto other rural sites,” Deutchman says.

A 2012 analysis from the federally-funded Rural Health Information Hub found that somewhere between 50 and 70 percent of rural program residents return to a rural area soon after graduation. They report that’s two to three times higher than rural placements following family medicine residencies.

So, rural residency programs are filling an ongoing need to attract and keep physicians. Deutchman says not all these programs use Medicare funding, but most do.

Now, that includes Billings Clinic.

A recent rule change will allow Medicare to subsidize physician training in Critical Access Hospitals.

That’s funding Montana Democratic Senator Jon Tester has advocated for.

“The rural residencies issue is not just a Montana issue, although Montana’s a very rural state. It’s an issue across the state, so I think this is gonna get doctors into rural America across the board,” Tester says.

Billings Clinic previously relied on multi-year, multi-million-dollar funding from the Helmsley Charitable Trust to send residents like Consson out to these different communities.

Other Montana-based medical programs that offer rural training include Riverstone Health and the Family Medicine Residency of Western Montana.

The rule change goes into effect October 1.