Bridging the Care Gap: New Residency Program Aims to Train More Rural Doctors

Pictured Above: Site director Dr. Thomas Huber with the PRFMRP’s first two residents, Gene Campbell, MD, and Abby Serpan, MD. “If it works, they will all have gone to places of need,” says Huber.

By Alex Strauss

Tom Huber, MD, is used to being something of a pioneer in South Dakota medicine. The long-time Pierre physician was among the first residents to graduate from the Sioux Falls Family Practice Residency program some 40 years ago. 

Now, the Pierre native is part of another pioneering effort to increase the number of primary care physicians in the state. He is site director for the newly-established Pierre Rural Family Medicine Residency Program (PRFMRP). 

“I was asked if I would be willing to ‘help’ get this established and I said, ‘Sure, I’d like to help’. Now I’m the director!” jokes Huber. Then he gets more serious about the potential impact on the future of healthcare in South Dakota. 

“Honestly, this is probably one of the best things that has happened to me in my career,” he says. 

The Same, But DIfferent

Like the residency training sites in Sioux Falls and Rapid City, the Pierre program is a joint effort of Avera and Sanford and is overseen by the Center for Family Medicine. But unlike Rapid City or Sioux Falls-based residents, PRFMRP doctors will learn to practice hundreds of miles away from many specialty services and facilities. 

“A fair number of people who come to the Sioux Falls program with the goal of practicing in a rural community end up changing their minds and staying in Sioux Falls,” observes Mark Huntington, MD, PhD, Director of the Center for Family Medicine and program director for both the Pierre and Sioux Falls programs. “Part of it is not having that comfort level of practicing in an area with more limited resources.”

With the next nearest non-critical access hospital more than 150 miles away in Mitchell, Pierre-based residents are likely to get very comfortable with limitation during the three-year program. PRFMRP residents will spend their first year in Sioux Falls to take advantage of higher volumes and advanced technology. Then they will relocate to the city of 14,000, for the remaining two years. 

“This part of the state is different from both Eastern and Western parts of the state,” says Huber. “We have bigger distances to deal with. You get used to driving distances, stocking up, thinking ahead, or doing without. You have to be ready for whatever comes at you.”

Pierre Sits in a ‘Care Gap’

The American Academy of Family Physicians predicts a national shortage of 44,000 primary care doctors by 2035. The PRFMRP is the result of a state task force charged with finding ways to address the worsening shortages in rural areas. As more older rural doctors near retirement, and fewer younger ones stand ready to take their place, a growing number of communities could be left with no access to primary care. 

Statistics suggest that graduates who train for more than six months in a rural area are 10 times more likely to practice in a rural setting (Can J Rural Med, 2005). GIven that most new family physicians settle within a hundred miles of their residency program, Pierre was seen as a perfect training ground for a new batch of rural-ready doctors. 

“If we look at a map of health professional shortage areas in our state, Pierre is pretty much in the middle of it,” says Dr. Huntington. “If you draw a 100 mile radius around the two programs we already have, there is a huge area of underserved counties between them.”

Rural Practice Training Ground

Although PRFMRP residents are not required to commit to practicing in a rural community after training, that is clearly the expectation. 

“I have told prospective residents that the entire aim of the program is to fix a problem that exists in this state,” says Huber. “I tell them ‘I want to see you in Ipswich or Winner or Gregory.  If you don’t think that is what you want, you may not be a good fit.’”

The first two residents include a woman whose hobby is trapping and harvesting furs and a veteran of the Special Forces. If they do choose to practice in a rural setting, these physicians will face unique challenges, such as being the only doctor for miles around, knowing how to leverage telemedicine, and caring for friends and neighbors.

“In a small town, you are taking care of people who are not anonymous to you,” says Dr. Huntington. “It is so important they learn how to balance professional and personal relationships before they are on their own. By training people in that environment, we hope they will be less intimidated to practice in a rural environment.”

Eighty percent of the three hundred and fifty graduates of the Sioux Falls Family Medicine Residency program practice in South Dakota or bordering states. But, with just two doctors entering the Pierre program each year, it will take many years to determine if the investment in the PRFMRP has paid off. 

“We need at least four or five sets of residents to graduate before we will know if this is successful,” says Dr Huber. “If it works, they will all have gone to places of need. That is our hope.”