Growing up in Mexico, a small town in Missouri, Alex Finck had known most of his doctors his whole life. So when he was considering a career in medicine, it made sense to him to head back where he was familiar.
“I always liked science, and then I kind of asked myself senior year what I wanted to do with my life,” Finck said. “I knew I wanted to have some sort of impact and a doctor seemed like a good way to do that.”
He’s passionate about helping people, especially ones who might not always have access to the best medical care.
Rural communities in Missouri and elsewhere tend to lack the medical professionals they need. In fact, while about one-quarter of Americans live in a rural area, only one-tenth of American doctors practice in one, according to the National Rural Health Association. And rural communities average less than half the number of medical specialists as urban areas.
This disparity means that while rural patients are more likely to experience poverty, alcohol and tobacco abuse, fatal car wrecks and fatal heart attacks, they have access to fewer doctors than their urban counterparts and have to travel farther to reach healthcare, according the National Rural Health Association.
The MU School of Medicine has a program aimed at helping. The Lester R. Bryant Pre-Admissions Program offers early admission into the med school on the condition that students serve their clerkships and residencies in rural areas, as well as shadow doctors in rural areas during the summer before they start medical school. Finck was accepted into the program after his freshman year of college at MU.
Kathleen Quinn is the associate dean for rural health at the MU School of Medicine. She oversees the Bryant scholars and other students who are interested in working in rural areas. She helps coordinate the programs that send medical students to rural areas, trying to get them comfortable working and living in rural areas before they graduate.*
“Some of them say, ‘Maybe I’m not cut out for this.’ But for rural students, it usually cements the decision,” she said.
Quinn believes that while all medical students can benefit from learning in a rural area, for rural students, returning home for clinical training can be a crucial first step to returning to a rural area full-time.
“It’s really important for them to understand that it’s a much broader experience than working at an academic health center where there’s a specialist for everything,” she said.
During the Summer Community Program, Finck returned home to Mexico, Missouri, to shadow doctors and work in a hospital there.
Sandra Hewlett is the administrator for the Audrain County Health Department, where she oversees healthcare in Mexico. She is really excited about the idea of a local son returning home, although she doesn’t know Finck personally.
“So for us, it’s really important when we get a doctor like that that wants to come home, wow,” she said. “That’s great.”
For Finck, family ties certainly play an important role in his decision to return home and practice medicine. For one thing, his parents are in the health care business too. They operate facilities for people with developmental disabilities.
“Every time I come home…we talk about possibilities of me helping with the business or ways that I could be involved with it,” he said. “And it definitely plays into what I could see myself doing in the future.”
Flink is close with his parents and sisters, and he likes the prospect of raising his own family nearby.
“Obviously, they want to have me around, and if I have kids, have the grandkids around,” he said. “And I want that, as well.”
Doing the Job
Finck got a dose of rural medicine last summer during his clerkship, when he spent half the summer shadowing a primary care physician and the rest of the time working with a cardiologist in St. Mary’s Hospital – Audrain in Mexico. Dr. Charles Tillman, the cardiologist Finck worked with, has lived and worked in a rural area for almost 30 years.
Tillman is an old friend of Finck’s parents and a graduate of MU’s medical school. He thinks physicians in rural communities play a special role, getting to know their patients and understanding their backgrounds. And he believes having medical students work in Mexico and other rural areas helps them see the importance of the work.
“There’s a huge shortage of physicians in the rural area, so we need to lure people into that when they come into medical school,” he said.
The fact that Tillman knew Finck while he was growing up had started is just one example of what it’s like to grow up in a small town. Tillman was excited to work with Finck, putting him to work on clinical rotations, doing rounds, collecting patient histories and performing the basic physicals at the beginning of appointments.
“In a rural clerkship, you get one-on-one interaction [with a physician], so you have a feel for what it’s like to go into that field and practice in that community or setting,” he said.
Finck thinks that kind of individual attention is a bonus when it comes to studying in a more rural setting.
In June, he’ll be leaving for a six-month clerkship in Sikeston, Missouri, a town even smaller than Mexico, where he’s looking forward to shadowing doctors one-on-one, working in family medicine.
“It’s a lot smaller area than Columbia so you get a lot more hands-on experience, Finck said. “There are a lot fewer students too, so with less students, comes more educational opportunities as a student.”
Tillman agrees. When he has students for clerkships, he works with them one-on-one, and he’s able to tailor their training to his student’s specific interests.
“I like to let students be involved in care, show them why we do what we do and how we do it,” he said. “I also try to give them the basic medical school training you get in any clerkship and attack certain specifics about cardiology, as well as things you might need to know even not in cardiology.”
Challenges of Going Rural
Despite some benefits, providing healthcare in a rural area comes with some additional challenges.
In a small town, doctors are highly visible, and they have to get comfortable seeing patients at the grocery store or at church, Quinn said.
Finck is already thinking about what it might be like to have patients approach him at all hours of the day or night.
“Something that is increasingly relevant with doctors is taking phone calls, emails, texts, that sort of thing,” he said. “We’re very accessible and in a small town…that elevates your level of care, but I think it also burdens you more,” he said.
And for specialists like Tillman, there’s the added challenge of being the only person for a long distance who can treat certain ailments. As one of a limited number of cardiologists in the area, Tillman is always on call.
“Because you’re an integral part of the community’s success, you are so relied on that it can be stressful and kind of overwhelming at times,” Finck said.
It’s one reason Finck would like to stick with primary care. He wants to have some time for just himself and his family.
But even thinking about the added challenges, Finck doesn’t question his desire to be a doctor in a rural area. After all, it’s a job with two very important aspects for him.
“It’s fun and you’re helping people,” Finck said.In 2013, Audrain County, where Mexico is located, there were between only three and five staffed hospital beds available for every 1,000 people, according to a report by the Missouri Department of Rural Health.
*CLARIFICATION: Wording has been updated for clarity.