A new Pitt-UPMC residency program is bringing better health care to patients in rural Pennsylvania

A family doctor in a place like Tioga County, Pennsylvania, might play the role of cardiologist, pulmonologist and palliative care physician all in one day, due to a lack of specialists in their area.

John Boll, associate director of UPMC Williamsport Family Medicine Residency, is one of the driving forces behind an initiative to prepare burgeoning physicians for the challenges of practicing in such a setting.

Primary care providers in the U.S. are unevenly distributed: Only 10% of physicians work in rural areas, yet one in five Americans — 60 million people — live in them.

“We identified a need for a residency program to increase health equity and to address health disparities in rural areas,” said Boll. “Most residents train in urban areas, and they tend to remain working in the area they train.”

Doctors in the new Pitt-UPMC program will spend their second and third years of residency training in either Tioga or Potter counties, which are currently underserved. Nationwide, 56% of family medicine residency graduates will practice within 100 miles of training, so the launch of a rural-specific residency could provide long-term benefits to the Northern Tier. When the program’s first class matriculates in July 2024, the UPMC residency will be the only one of its kind in north-central Pennsylvania.

As president of UPMC Cole and UPMC Wellsboro hospitals, where these doctors will train, Janie Hilfiger can attest to the health care needs of her neighbors. Born and raised in the area, she returned to her hometown after completing a nursing degree. “It was important to me that I could care for my friends and family in the community,” said Hilfiger, who has served as a registered nurse for 40 years.

“By creating the UPMC Rural Family Medicine Residency​ program, we are trying to not only expand our training in rural areas but also create a pipeline for practitioners who are committed to working in these kinds of settings,” said Hilfiger.

“My hope is that our family medicine residents will develop relationships with members of our community and will want to stay here and work as a primary care provider,” she said.

“The connections you build with your neighbors are what makes practicing medicine in rural communities worthwhile,” Boll added.

Room for growth

The groundwork for the residency program was laid in 2019, when Barbara Barnes, associate dean for continuing medical education in Pitt’s School of Medicine, approached UPMC about starting a rural family medicine residency.

Overall, rural populations are older and sicker than urban populations. People residing in rural areas experience higher rates of mortality from heart disease, respiratory disease, cancer, stroke and unintentional injury​.

“We have a societal responsibility to understand how we can serve all our populations, whether they be urban or rural,” said Barnes.

In the 70s, after she completed her internal medicine residency, Barnes established a private practice in Titusville, another rural Pennsylvania town.

“I got totally burned out,” she said. “It was overwhelming to try and do both inpatient and outpatient medicine because I didn’t have the level of support I needed. This new residency program offers a vast network of resources and support for rural physicians that I didn’t have.”

Barnes said she is committed to addressing the issues that made practicing in a rural community so difficult.

“We are very interested in developing models of care delivery that are sustainable,” she said. For example, “one model is an interprofessional practice where we develop a cadre of colleagues who provide support services or who relieve a doctor when they go on vacation.”

Another challenge specific to practicing medicine in a small community is negotiating dual patient relationships — that is, when the relationship extends beyond the medical realm. Sometimes a patient is also a member of a physician's church or their mail carrier, for instance.

“My husband jokes that when I go out for a loaf of bread it's an hour trip to the store,” said Hilfiger. “It’s an hour trip because those you take care of know you and they want to ask you something.”

For Barnes, despite the burnout she experienced, practicing medicine in a rural community was one of the most rewarding experiences of her career because of “the connection to the community and close relationships with my patients.”

Though the UPMC Rural Family Medicine Residency program is still in the development phase, it has already received significant regional and federal financial support from the Laurel Foundation, Susquehanna Health Foundation and the U.S. Health Resources and Administration’s Rural Residency Planning and Development Program.

— Nichole Faina