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UA program aims to place doctors in rural areas

Dr. Gail Guerrero-Tucker (left) and Dr. Shirley Rheinfelder have worked at Safford's Gila Valley Clinic since participating in the University of Arizona College of Medicine's Rural Health Professions Program.

Dr. Gail Guerrero-Tucker (left) and Dr. Shirley Rheinfelder have worked at Safford's Gila Valley Clinic since participating in the University of Arizona College of Medicine's Rural Health Professions Program.

SAFFORD – Dr. Gail Guerrero-Tucker said there have been no “normal” days since she started practicing three years ago at The Gila Valley Clinic.

One day she can be treating hangnails and tonsillitis. Just recently, however, a woman who didn’t know she was pregnant walked in ready to give birth.

Because she specializes in obstetrics in addition to her other duties, the clinic called Guerrero-Tucker in from home. She wound up delivering a healthy baby at the hospital next door.

Hectic as it is, this is what Guerrero-Tucker has wanted since she studied at the University of Arizona College of Medicine. In a community like Safford, a general-practice physician does pretty much everything.

“I wanted to do rural medical because I wanted to do the country doctor thing,” she said.

The demands can be a shock, but Guerrero-Tucker said she came here well-prepared by going through the Rural Health Professions Program, which sends UA medical students to communities such as Safford while they study.

Dr. Carol Galper, who directs the program as the college’s assistant dean for medical student education, said it helps create doctors who want to work in rural communities.

“There is a huge shortage of physicians in rural Arizona, and it can be hard to keep them there when they do get them,” she said.

The program, funded by the state, accepts at least 15 beginning medical students each year. Dozens of medical students have participated since the program was founded in 1997, with Guerrero-Tucker among the first class of graduates in 2000.

Students attend sessions in which visiting clinicians discuss what it’s like to practice in rural areas. Participants select a town from a list provided by the school, then study that community’s health challenges and work there at several points during their four years of medical school.

Guerrero-Tucker chose Safford and worked at The Gila Valley Clinic as a student. Now she helps others taking part in the program.

“It’s hard to adjust if you haven’t had residency out here,” she said. “People who don’t have that small-community experience fail.”

One the challenges she helps aspiring doctors deal with is a loss of anonymity in rural areas. As Guerrero-Tucker knows well, patients often approach doctors while they are shopping or at dinner and often have no qualms seeking medical advice, test results and more.

“You see a fishbowl effect,” she said. “It’s difficult to have a personal life.”

Dr. Shirley Rheinfelder, who went through the program in Springerville and now works with Guerrero-Tucker, said her biggest challenge was learning to deal with not having specialists nearby. But the program allowed her to learn from rural doctors who are used to dealing with pretty much everything.

“You have to be comfortable practicing without specialist backup,” Rheinfelder said. “There are not the knee-jerk referrals out here.”

Galper said the ability for medical students to shadow rural doctors makes the program work.

“They know a lot about a lot,” she said. “A good family doc like them, you need someone like that in a small community.”

It also exposes students to the doctor’s larger role as a leader in a smaller community and the challenges of having that responsibility, Galper said. Part of participants’ learning in the classroom, seminars and the field involves preparing for community leadership.

“Oftentimes they’re involved in many other positions: local health board, doctor, school board member,” Galper said. “They’re under a microscope and held to higher standard because people know who they are.” Beyond educating students about a rural doctor’s role, the program helps break through stereotypes that medical students might have about moving to a smaller community, Galper said. Students who have a chance to work in rural communities discover the allure of life there.

“In a smaller community, where the people you sit next to in church are your patients, neighbors and kid’s soccer coach, there’s a deeper connection,” she said. “And the insurance paperwork doesn’t have to be there standing between things.”

David Kincaid, Safford’s interim city manager, said he sees great value in connecting aspiring doctors with communities such as his.

“Anytime we can get people here at an early stage and get them emotionally involved with the community, they tend to stay longer,” he said.

That pays dividends, Kincaid said, because having doctors who stay and are committed to the community helps Safford attract businesses.

“A revolving door creates a hole in the health care program in that you’re not having a practitioner stay with you for a long period of time,” he said.

Guerrero-Tucker said it didn’t take much to sell her on the idea of committing to Safford.

“There are a lot of people who don’t know how much more fun it is in the boonies,” she said.



Quick facts about the University of Arizona College of Medicine’s Rural Health Professions Program:

Objective: Placing more doctors in rural Arizona.

Method: Offers specialized training and hands-on experience for students interested in practicing in rural communities.

Origins: Launched in 1997.

Participants: At least 15 beginning medical students join the program each year.

Funding: State funds make the program possible.

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