New rural training opportunities
Every Thursday morning I hop into my car with a fresh cup of coffee and drive northeast out of town. Usually dark outside, much of the “Bull City” is quiet and still in those early morning hours. The streets lead me past Duke University Medical Center and then by the Durham Veterans Affairs Medical Center. Merging onto Interstate 85 I pick up speed, passing an exit for a more popular outpatient clinic site and Durham’s very own local Federally Qualified Health Center. Just on the outskirts of town, I spot one of a dozen pharmacies where we often call in prescriptions. But, it isn’t long before the highway gives way to rolling green fields and dusky pine groves. Soon, I’m watching the sunrise over Falls Lake, sip a little more coffee, and find myself in an unmistakingly more rural climate with far less health care to offer.
Crossing into Granville County, eventually I arrive at my destination: Oxford, N.C. (the Granville County seat) which is home to several new and exciting rural training opportunities for Duke Family Medicine residents. For example, as second- and third-year residents, we now have the opportunity to join Duke Primary Care Oxford for a primary care continuity training experience in the rural part of the Duke Health catchment area, with Thomas Koinis, M.D., as a preceptor. In addition, we also have the opportunity in our third year of residency to work amongst the inpatient team of providers at Granville Medical Center. These are incredible opportunities for us as physicians-in-training at Duke, particularly given recent studies by the Centers for Disease Control and Prevention (CDC) which highlight increasing health disparities for rural Americans.
Rising rural health disparities
Several of these recent studies show that people living in rural environments are at an increased risk for five leading causes of death in the United States (in comparison with those living in urban environments) such as: heart disease, cancer, unintentional injuries, chronic lower respiratory disease and stroke. Many of these diseases are often preventable when access to health care is readily available and health care services are utilized. In regard to these increasing rural disparities, former CDC Director Tom Friedman notes “there is a striking gap in health between rural and urban Americans.” It is estimated that approximately 45 million Americans (approximately 15 percent of the U.S. population) currently lives in rural environments.
According to the CDC, this rural population is also aging and often times subject to increased rates of smoking, increased rates of uncontrolled high blood pressure, increased obesity, decreased opportunities to exercise, lower socioeconomic status, lower rates of health insurance coverage, lower health-care utilization rates, and lower seat-belt utilization (in comparison with those living in urban environments.) As a result of their studies, the CDC has teamed up with Health Resources and Services Administration (HRSA) and their Federal Office of Rural Health Policy to increase efforts to close these health disparities gaps within rural environments. For example CDC, and HRSA recommend the following should be pursued by health care providers in rural environments:
- Screen patients for high blood pressure and make control a quality improvement goal. High blood pressure is a leading risk factor for heart disease and stroke.
- Increase cancer prevention and early detection. Rural health care providers should participate in the state-level comprehensive control coalitions to focus on cancer prevention, education, screening, access to care, support for cancer survivors and overall good health.
- Encourage physical activity and healthy eating to reduce obesity. Obesity has been linked to a variety of serious chronic illnesses, including diabetes, heart disease, cancer and arthritis.
- Promote tobacco prevention. Cigarette smoking is the leading cause of preventable disease and death in the United States and is the most significant risk factor for chronic lower respiratory disease and lung cancer.
- Promote motor vehicle safety. Rural health care providers should encourage patients to always wear a seatbelt and counsel parents and child care providers to use age- and size-appropriate car seats, booster seats and seat belts on every trip.
- Engage in safer prescribing of opioids for pain. Health care providers should follow the CDC guidelines when prescribing opioids for chronic pain and educate patients on the risks and benefits of opioids and using nonpharmacologic therapies to provide greater benefit.
As a result of these new rural training experiences and increasing awareness of rural health disparities, I feel very confident that Duke Family Medicine Residency Program is preparing us as family medicine residents for the challenges ahead facing rural parts of the country. I also feel incredibly grateful to be working alongside the many dedicated health professionals and community leaders who have welcomed Duke Family Medicine to Oxford, N.C.
Jonathan Hedrick is a third-year resident with the Duke Family Medicine Residency Program. Email jonathan.hedrick@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine or Duke University.