By Josh Bell, MD
My mom always told me she gave me the "doctor name" (apparently my name looks good with an MD after it), so in some ways I knew from an early age that this was going to be my profession. Though I toyed with the idea of being a bank teller in kindergarten, I realized after a while that this was really not the job I thought it was (no offense to bank tellers, but you don't actually get to keep any of that money and the little vacuum tubes for the drive-thru probably lose their wow-factor eventually).
Now, I don't come from a medical family, or any other kind of "old money," which quite frankly seems to be where a lot of our medical professionals come from (well, a lot of our plumbers come from plumbing families too, and I don't necessarily mean anything more sinister than that). In fact, I was the first college attendee in my family. I didn't realize how atypical this was until after I had been accepted to medical school, so it was never a discouragement. I also didn't realize how few doctors come from towns with 1 stop light. As far as I was concerned, my good test scores and extracurricular activities were the only parts of my background that mattered in deciding if I would succeed in college or medical school. Maybe this is correct, but I certainly have a different perception now than I did then as a rural high school student.
In the summer before my senior year of high school, I spent 5 weeks on the UA campus taking classes with 25 of my peers in the Rural Health Scholars Program. Basically, this is a group of 25 students selected from rural areas all over the state that have some interest in medicine as a profession. After returning home for my senior year of high school, I was pretty much checked-out of that part of my life and couldn’t wait to get out of high school and go to college. I had been taking classes at the local junior college during high school, but being 3 hours away from home on a major college campus was a world of difference. I applied several places and had some [looking back] impressive scholarship opportunities mostly out of state, but I enjoyed my summer at UA so much that I chose to go back. The peers, counselors, and staff of the RHSP were the primary reason for this. I felt that this program understood me and had mutual goals, and I knew I would walk in to a support group on day 1 of college that would stick with me for the rest of my educational experience.
My expectations were well met, and I got some part-time work, volunteer experiences, and some meet-and-greets that I would have never had without RHSP. I was continually encouraged to stay after my goals, and was later accepted to the Rural Medical Scholars Program as part of the "Pipeline" that was created at the College of Community Health Sciences for students just like me. This program gave me early admission to medical school and a year of graduate work in community medicine, environmental and occupational health, epidemiology, etc... basically things that a doctor out in the country might need but won't get in medical school. As peers from my RHSP class drifted away, peers from RMSP took their place as friends with similar goals and challenges ahead. So, I entered day 1 of medical school with a group of peers that I had already spent a year with... a helpful advantage in a class of 160 ruthlessly competitive type-A young adults.
I completed medical school, entered residency, and am now less than 6 months away from starting practice as a rural family doctor. In the meantime I have continued to have opportunities to incorporate my ruralness into my profession because of the Pipeline programs at UA. I have met many of the RHSP and RMSP students behind me, and hopefully have been as helpful to them as some of those ahead of me were in getting me to this point. I have, since medical school, seen and heard a lot of discouraging things about rural medicine and primary care in general, but I have never felt pressured to change my goals or lost in the wilderness of medical education because of the support I have continually received from these programs.
Without the rural programs early in my career, I probably would still be in medicine but I'd likely have uprooted to a place far from home, and I can't imagine that I'd be doing rural primary care like I set out to do originally... considering all the deterring factors that most urbanites focus on. I encourage students to participate in, legislators and administrators to support, and peers to cultivate the rural health programs in their area. I owe a particular debt to the programs at UA, and I can imagine there are similar stories for other programs that have followed this model. This is the life I chose, but without the support I had from the Pipeline I might be living someone else's dream instead of mine.
Josh Bell is from rural Alabama. He has done all of his training at the University of Alabama and is currently finishing his last year of family medicine residency in Tuscaloosa. He is preparing to begin practice in rural Alabama this summer.
Strengthening the Primary Care Pipeline, by Kenny Lin, MD
Portrait of a Pipeline: From Pre-med to Practice, by Erin Mundy, M.P.A.
The Future Faces of Family Medicine Program: Inspiring a Future Primary Care Workforce, by Randi Sokol M.D., M.P.H., Alisha Dyer, D.O., and Charlene Hauser, M.D., M.P.H.