Incentives offered to practice in small towns

Saturday, August 3rd 2002, 12:00 am

By: News On 6

FREDERICK, Okla. (AP) _ After spending four years in medical school, another year as an intern, then several more in residency, what would entice a medical student to complete schooling and then move to a small town to practice medicine?

People in southwest Oklahoma towns have implemented programs to encourage doctors to give small-town life a chance.

These include a partnership with a larger hospital, job security, loan repayments, scholarships and pay incentives.

Randy Segler, chief executive officer of Comanche County Memorial Hospital, said the hospital has been working on physician recruitment for more than 15 years.

``We have opened 11 clinics in several of the area towns which had no health care clinic before we moved into their community,'' Segler said.

The hospital also has supplied specialists for ``telemedicine'' in area towns.

``Telemedicine is a transfer of medical data from one hospital to another that allows the patients to stay in their community instead of traveling to a larger facility,'' Segler said.

Segler says he is also recruiting doctors in conjunction with the rural communities.

Doctors are attracted to the idea of going to small towns for different reasons.

For example, after spending years working through medical school, some doctors find that job security is the most important issue.

Comanche County Memorial Hospital has found a solution that is being used by hospitals all over the country _ partnering with rural hospitals to provide stability and job security to physicians willing to try the atmosphere.

``For one thing, a physician coming to a rural town doesn't have to worry about the everyday business; we take care of that when we partner with the facility,'' Segler said.

``Some of these physicians go to the small town and it just isn't the right environment for them,'' Segler said. ``It is very difficult to be in a small community by themselves _ they don't have the typical network of specialists.''

Dr. Francois du Toit has been in Frederick for eight years. When asked why he chose a rural community he said, ``the weather.''

``The truth is that I came from a small town in Canada and I decided to come here to Frederick because of its partnership with Comanche (County Memorial),'' du Toit said. ``This association gives me job security. And it can get lonely out here, and having people at Comanche to communicate with makes it much easier. Additionally, I really like the relationship between patients and staff. It is a lot more personal.''

Du Toit also said the variety of disease he sees is much more than he saw in the cities.

``When you work in a large hospital with specialists of all parts of medicine, you don't get to see as many diseases as you do in a small hospital void of most specialists,'' he said.

Although most people enjoy the luxury of a larger facility to fall back on, Tom Rine, chief executive officer of Southwestern Medical Center, said his hospital has never had clinics and partnering as part of its strategy.

``One-third of our patients come from outside Comanche County. While we realize that there is a need for doctors in these towns, it is very expensive to get into these types of deals and we offer the services here,'' Rine said.

``And the care most people will get in these small towns is not something that we would compete with,'' Rine said. ``They go to these facilities for day-to-day needs and they come to us for their primary care needs. Most of these patients come to us for their specialty situations.''

Rine said Southwestern, a private hospital, gives its assistance to rural communities through donations to a foundation.

``Southwest Oklahoma has the Medical Education Foundation. We support it financially and give money to the program, which is connected to OU,'' Rine said. ``We understand that the population is growing and there is an increased need for physicians everywhere.''

Dr. Kenneth Evans, the outgoing director of the Southwest Oklahoma Family Practice Residency Program, said the program works with the staff at the University of Oklahoma to try to recruit doctors.

``What we do is take young physicians that have completed medical school and their internship. Once they complete this they can go to specialty residency programs of their choice,'' Evans said.

``Our role is to work with family practice physicians. We train four residents a year for three years. Then about 50 percent set up their practice within 75 miles of where they were trained.''

People in Frederick have been banking on this idea for more than two decades, and the community has played a part in recruiting physicians.

Back in May 1974, community leaders recognized the need for qualified practitioners and combined their efforts into a scholarship program and formed a physician recruitment committee.

Frederick resident Bill Crawford said Frederick had only six active physicians; three of them died and one retired.

``So we began by soliciting funds from residents of Grandfield, Tipton, Davidson, Chattanooga and Frederick,'' Crawford said.

``We received donations ranging from $5 to $500. We raised $100,000.''

The idea was simple, that the community would pay the medical school bill for area students if they agreed to come back to the community to practice medicine.

``We recruited five physicians, none of which are currently practicing in our town today. Most of them worked for three years and then chose to move on,'' Crawford said. ``However, all the physicians repaid their loans to us because they left. We recruited eight nurses and two of them still remain in our hospital. We currently have one young man on scholarship and we continue to actively recruit.''

Crawford said several things account for these physicians leaving Frederick.

``Normally, the doctor left here and either went back to school to specialize or just decided that they did not want to practice in a rural community,'' Crawford said.

``I believe that in order for this or any recruitment to Southwest Oklahoma is recruiting people who can develop or already have ties to the area. We have funds for those who need it and we will continue to work at it.''

Frederick isn't the only place having this problem.

Evans says hospitals and health care facilities all over the country are having difficulties retaining physicians in rural communities.