Alleviating Pain and PressureDec 31, 2019 10:20AM ● By Kara Schweiss
"For a person who’s ill with something serious, there’s a feeling of desperation,” said Greta Eckstrom, who lives about a mile outside of Stanton, Nebraska.
The small town in the northeast part of the state has a population of around 1,600. There are no providers practicing exclusively in Stanton, and that is a pain for any townsperson with a pain. Eckstrom has multiple chronic health conditions, and said she can find some of the medical care she needs in Norfolk, which is 12 miles away. Yet even in Nebraska’s eighth-largest city (population 24,000), receiving necessary care sometimes means waiting for a specialist to stop in the community on a rotation among multiple towns in the region.
Patients in rural areas also find themselves relying on available care for a diagnosis or treatment plan. “There’s no second opinion,” Eckstrom said. If the patients are not happy with their providers, well, they often learn to hold their tongues. “It would be nice if you could have at least a couple to choose from, but there aren’t other options.”
Omaha’s big-city facilities may be a workable solution for some, but it’s not easy when someone’s health problems make traveling challenging. All things considered, Eckstrom said she’s delayed or forgone care at times, especially follow-up or maintenance care that may be deemed less critical. With a husband who works as a medical professional, money or insurance is not necessarily the concern—distance is.
She’s not alone. According to the Nebraska Rural Health Association, rural hospitals across the state are struggling, and they often cut costs by reducing services. That has a negative effect on the physical health of community members as well as the economic health of the community.
Eckstrom stated that she and her husband did not think about the length of time to get to a hospital when they moved to Stanton nearly 20 years ago, as they were younger and relatively healthy. Her husband’s steady job and their ties to the community make moving impractical.
“Rural community members do need and deserve good health care,” Wayne State College junior Makayla Brockhaus said. She’s from Creighton, a city of around 1,100 people near the South Dakota border. “We have great PAs [physician assistants] and nurse practitioners there, but we lost that sense of security when the doctor left. It’s 45 minutes to a [large] hospital.” The town does have Avera Creighton, but that hospital has less than 75 beds and the only specialist is an obstetrician-gynecologist.
Brockhaus is pre-med and unsure of her future specialty, but she is sure about her intent to practice medicine in a rural community, possibly her hometown. She made that commitment as a high school senior when she was accepted as a participant in the Rural Health Opportunities Program.
“The Rural Health Opportunities Program is…a pathway program for rural communities across Nebraska to identify those students who are interested in a health profession and get them into an undergraduate institution with a guaranteed admission into one of nine needed health professions across the state,” said Nicole Carritt, director of rural health initiatives for the University of Nebraska Medical Center.
Students are guaranteed admission to UNMC if they meet program requirements and complete their pre-professional studies at Wayne, Chadron, or Peru state colleges, or the University of Nebraska at Kearney (through Kearney Health Opportunities Program, or KHOP). The professional fields available include dental hygiene, dentistry, medical laboratory science, medicine nursing, pharmacy, physical therapy, physician assistant, and radiography.
“Students who are accepted into this program do not pay tuition during their undergraduate years, and we support them in being successful throughout the academic process,” Carritt said.
“It’s so exciting that as a senior in high school you’re already accepted into med school,” Brockhaus said.
Scottsbluff native Alisha Huynh, an RHOP participant in her junior year at Chadron State College, agrees.
“I feel like everyone has our best interests in mind,” Huynh said. “They want us to succeed.”
RHOP participants must be from a rural community, Carritt said, adding that applicants go through a rigorous interview process. “We want to make sure we are selecting the students who have the best potential to be successful in the program.”
Students are not required to sign a contract committing them to a future rural medical practice, but Carritt said the numbers are good so far. Nearly half of the students who’ve graduated from the UNMC rural pathway programs are practicing in rural Nebraska.
“A lot of them are going back home,” Carritt said. “And health care providers who have gone through the program and have gone back to practice [in rural communities] are huge advocates for the program. They also realize they may not have been able to fulfill their dreams of becoming a health care provider and practicing in their community if it hadn’t been for the RHOP program.”
RHOP is part of a long-term solution, as the state’s population distribution increasingly shifts to cities, the proportion of seniors increases as Baby Boomers age and people live longer, and health care providers retire or move to larger communities.
Medical training at UNMC considers the natural evolution of models of care as new technologies and channels emerge to create more options like telemedicine, she adds.
“Right now I’m thinking about becoming a family physician but I want to keep an open mind going into medical school because I know there are so many different routes and possibilities,” Brockhaus said. “I’m hearing about new things every day.”
“I’m not sure of specialty at this time but I’m leaning toward working with women and children,” Huynh said. “I would like to connect with my patients on a more personal level.”
The program depends on the commitment of the students, and the support of rural Nebraska high schools, the educational institutions providing the undergraduate programs, the UNMC health professions faculty, and the rural Nebraska medical community. With the rural health care shortage continuing, RHOP recruitment efforts are increasing. Although many Nebraska schools already participate, the recruiters are actively reaching out to every high school in Nebraska this academic year to ensure the schools’ staffs know about the program and are making eligible students aware of it.
“It continues to be a popular program,” Carritt said. “We’ve seen the interest either remain steady or increase over the years, but we anticipate that with some of our enhanced efforts this year we’ll see the interest increase dramatically.”
All this means that patients like Eckstrom may soon be able to receive necessary medical care, perhaps even specialty care, closer to home.
Visit unmc.edu for more information.This article was printed in the January/February 2020 edition of Omaha Magazine. To receive the magazine, click here to subscribe.