Creating New Rural Residency Programs: Three Grantees Share Their Stories

by Allee Mead

Since 2019, the Health Resources & Services Administration (HRSA) has awarded grant funding to 46 programs through the Rural Residency Planning and Development (RRPD) Program. The RRPD program supports organizations developing new rural residency programs in the following medical specialty areas: family medicine, general surgery, internal medicine, obstetrics and gynecology, public health and general preventive medicine, and psychiatry. In June 2021, HRSA forecasted a new RRPD funding opportunity for FY22 (HRSA-22-094), which is scheduled to post in October 2021.

HRSA also funds an RRPD – Technical Assistance Center to provide support to RRPD award recipients throughout the duration of their grant. Resources and tools are available at the RRPD-TAC's RuralGME.org portal for other organizations interested in developing new rural residency programs.

We asked three RRPD grantees:

What has the RRPD funding allowed you to accomplish?

Building a Psychiatry Rural Training Track Residency Program in Eastern Pennsylvania

by James Dalkiewicz, MBA, MHA, Project Director, Rural Residency Planning and Development Grant (RRPD), St. Luke's University Health Network

St. Luke's University Health Network (Bethlehem, PA) is a nonprofit, regional, fully integrated, nationally recognized health network providing services at 12 hospitals and over 300 outpatient sites. St. Luke's mission is to care for the sick and injured regardless of their ability to pay, improve our communities' overall health, and educate our healthcare professionals.

St. Luke's Miners Campus, a small 49-bed rural hospital in Coaldale, will be the primary teaching site of a new Psychiatry-Rural Training Track Residency program. The new program will start in July 2022 with a class of 2 residents per year (8 total). St. Luke's has committed to build a new rural outpatient clinic in Schuylkill County to expand access to care for the community and to train residents for their outpatient continuity experience.

The RRPD funding has helped offset the startup costs in starting a psychiatry rural training track program. The RRPD funding defrayed a portion of the costs, such as physician time needed to pull together resources for the Accreditation Council for Graduate Medical Education (ACGME) application, hiring and recruiting program staff, and paying for accreditation fees. In addition, it helped to spark discussion between education and service line leaders about a shared vision for expanding behavioral healthcare to our rural communities.

In designing the residency program, St. Luke's assembled a group of leaders from the department of graduate medical education and the behavioral health service line to sit down and assess the following: Where will the residents train? How will the program integrate into the behavioral health service line? Which rural psychiatrists are interested in teaching residents? How much protected time do we need for program faculty to teach? How will the program help to build a physician workforce pipeline for the rural communities?

I think that the overall structure of the RRPD program has been excellent. It has been great having an RRPD-TAC advisor, who has been phenomenal. In addition, the webinars and virtual conferences are super beneficial. It's great to connect with other health systems who are going through similar challenges of starting a rural residency program.

Since 2018, St. Luke's has operated a Rural Family Medicine Residency program based at St. Luke's Miners Campus. The Family Medicine program has already established a culture of education at the hospital and built sustainable community partnerships in the region. The new psychiatry rural training track will have the opportunity to collaborate with the family medicine residency program and build on the community relationships established by the existing program's leaders. This will provide a unique opportunity for the rural residents training in both programs.

St. Luke's objective is to build a pipeline of physicians to take care of patients in our rural communities. The rural psychiatry residency program will help expand access to care, train new physicians, and recruit academic physicians who are interested in teaching. The program will be a high-quality training experience where the residents are embedded in the rural community.

There has been generous support from St. Luke's executive leadership team in expanding education to rural communities. There is a need for new doctors across our rural communities, and recently we have gained momentum in establishing new residency programs, so we expect to keep growing education across our western rural campuses over the next 5-10 years.

Shoring Up a Primary Care Deficit in Mississippi

by Seger Morris, DO, Program Director, Baptist Memorial Hospital

Baptist Memorial Hospital-North Mississippi is part of a 22-hospital system. The strongest driving force in starting our internal medicine residency program was the shortage of primary care physicians in this area. As we analyzed healthcare access in north Mississippi, we found that, by federal methodology, we have a shortage of more than 60 primary care physicians. We started this residency as an effort to shore up that deficit.

Lafayette County is home to the University of Mississippi, so it's a very culturally diverse community with a high level of education and a pretty good income demographic, but then it drops off sharply at the edge of town. We are a short drive from the Mississippi Delta, which is one of the poorest, most underserved, and rural areas in the United States. That makes for a very dynamic environment here in terms of the haves and have-nots. Our hospital serves a wide spectrum of socioeconomic and racial demographics.

The grant funding provided us with resources to support putting our faculty in place and to work as a team prior to the arrival of our first class of resident physicians. Being able to pay people as part of their job to commit their time and energy to laying the foundation of this program made an incredible difference. The most significant portion of the funds went to our faculty, compensation, and faculty development efforts, and we feel that that's served us very well. After bringing our first class in, we have a very cohesive team, a well-laid plan, and lots of structure that you oftentimes wouldn't expect for a first-year program.

It's a relatively large program for being community-based, with 12 residents per year. We matched our 12 residents in the primary Match. We didn't have to participate in the supplemental program. So we were very, very proud of that effort.

Seamlessly Transitioning Primary Care Residents into Rural California

by Dineen Greer, MD, Program Director; Robert Hartmann, MD, core faculty; and Jennifer Shoemaker, MD, Rural Track Director, Sutter Health

Greer: For the rural track training, residents spend the first year here with us in Sacramento before going out to Jackson in Amador County for the second two years of their training. For a few years, we have had interest in developing a Sutter Amador Rural Training Track. The RRPD grant gave us the resources to get accredited. And that's a pretty time-intensive process to do that, to put through your application and get accreditation — the time to fund the individuals who are really working on this, including myself, Bob, Jennifer, our behavioral scientists, faculty, and consultants to help us write the application. There have been some other resources that it gave us that were really important, such as the ability to have telepresence to connect rural Amador with Sacramento for meetings and didactic sessions when we have the residents up in Amador. These are quite expensive processes and, especially right now with COVID, most health systems including ours are really strained. It was really good that we had this funding because there would not have been the resources to really put together the program.

Hartmann: We had this idea germinating to establish a rural track residency and we really couldn't get it off the ground until we had the financial backing of HRSA. That enabled us to hire a consultant, and the consultant was indispensable in terms of putting together the grant application, the ACGME application, and moving forward over the first two years of the grant itself.

Shoemaker: Additionally, with the RRPD grant through HRSA, we have already participated in our first application season, with very positive results. We successfully matched our first two rural track residents from our rank list, and they began their residency training two months ago. As Dineen mentioned, our rural training track residents will spend their intern year in Sacramento then join us in Amador, starting in July 2022. Our community members and faculty are excited for this next phase to begin. We're also already gearing up for our second interview season quite soon and looking forward to continuing the success we've had so far with our rural track program.

Greer: I think some of our successes too have really been the partnership that we've been able to have and leverage the experience that we have here in Sacramento. The rural training faculty for several months now have been joining our faculty meetings, doing faculty development work with us to really get the program on solid footing. The faculty will be well-prepared and ready for residents from day one, because we've been able to establish the foundation of what faculty need to train residents. It will be seamless when they go out to Amador. They'll already really know the faculty; the faculty will know them and their co-residents.

Hartmann: I think another major impact in the future is going to be that the continuity clinic for the residents will be embedded in the same clinic office that the current family medicine and internal medicine offices are. And the residents will have their own continuity patients. So it's going to right away increase the availability of primary care providers.