Rural Arizona Physicians Model the ‘Art’ of Practicing Medicine

Jul 9, 2013
“In every art beginners must start with models of those who have practiced the same art before them,” said poet, professor and mentor Ruth Whitman (1922-1999). This summer, a select group of physicians are modeling the “art” of practicing medicine in small Arizona communities as part of the University of Arizona College of Medicine program to help alleviate the shortages of physicians in rural areas, especially critical as older physicians retire and health-care coverage expands under the Affordable Care Act.
 
The physicians are rural faculty members in the UA College of Medicine’s Rural Health Professions Program (RHPP), volunteering for four to six weeks to mentor medical students from the UA College of Medicine – Tucson and UA College of Medicine – Phoenix. Working side-by-side with the students, the physicians demonstrate the multiple roles they play, the personal connections with patients and the sense of community that attracted them to rural practice, and encourage the medical students to choose rural practices in the future.
 
RHPP was established in 1997 by the Arizona Legislature to encourage medical school graduates to practice medicine in rural communities and today RHPP graduates are practicing in rural communities throughout Arizona.
 
RHPP physicians volunteer as preceptors – or mentors – to UA medical students between their first and second years of medical school. Several of the physicians are UA College of Medicine graduates who participated in RHPP as medical students and now are serving as RHPP mentors to the next generation of rural physicians.
 
The medical students work with the physicians at their practice sites and reside in their communities for four to six weeks between the end of May and early August. Students are matched with preceptors based on medical specialty interest and community preference. Physician specialties include family practice, pediatrics, internal medicine, obstetrics and gynecology and surgery. The students continue to work with their preceptors over the course of their three remaining years of medical training, returning to the rural communities in their third and fourth years.
 
Communities hosting students this summer include:
  • Bisbee: Peggy Avina, MD, family medicine, mentoring Jennifer Min, June 26-July 31
Dr. Avina is a 1994 graduate of the UA College of Medicine. She first served as a RHPP preceptor in 2003.
 
Min is attending the UA College of Medicine – Tucson.
  • Douglas: April Alvarez-Corona, MD, pediatrics, mentoring Ana Casanova, June 4-July 5.
Dr. Alvarez-Corona is a 2006 graduate of the UA College of Medicine, where she also completed her residency in pediatrics in 2009. She has been a RHPP preceptor since 2011.
 
Casanova is attending the UA College of Medicine – Tucson. 
  • Flagstaff: Cynthia Martin, MD, internal medicine/pediatrics, mentoring Sasha Staack, June 17-July 19.
Dr. Martin has been a RHPP preceptor since 2008.
 
Staack is attending the UA College of Medicine – Tucson. 
  • Lakeside: Elizabeth Bierer, MD, family medicine, mentoring Chandra Tontsch, June 10-July 5.
Dr. Bierer is a 2008 graduate of the UA College of Medicine and has been a RHPP preceptor since 2012.
 
Tontsch is attending the UA College of Medicine – Tucson.
  • Payson:  David Cluff, DO, and James Schouten, MD, both family medicine, mentoring Jeffrey Robertson, July 1-Aug. 2.
Drs. Cluff and Schouten first served as RHPP preceptors in 2004.
 
Robertson is attending the UA College of Medicine – Tucson. 
  • Amalia Pineres, MD, family medicine, mentoring Katherine Nielsen, June 10-July 12.
Dr. Pineres has been a RHPP preceptor since 1999 and also is a clinical assistant professor with the UA College of Medicine – Tucson Department of Family and Community Medicine.
 
Nielsen is attending the UA College of Medicine – Tucson.
  • Polacca: Jon Stucki, MD, family medicine, mentoring Melissa Lin, June 5-July 12.
Dr. Stucki is a 2004 graduate of the UA College of Medicine and has been a RHPP preceptor since 2009.
 
Lin is attending the UA College of Medicine – Tucson. 
  • Prescott: Jeffrey Osburn , MD, obstetrics and gynecology, mentoring Lucy Cheng, July 1-Aug. 9.
Dr. Osburn first served as a RHPP preceptor in 2007. A 1994 graduate of the UA College of Medicine, he is a clinical assistant professor with the UA College of Medicine – Tucson Department of Obstetrics and Gynecology.
 
Cheng is attending the UA College of Medicine – Tucson. 
  • Matthew Hinton, MD, pediatrics, mentoring Danielle Correia, July 1-Aug. 2.
Dr. Hinton has been a RHPP preceptor since 2007 and also is a clinical assistant professor with the UA College of Medicine – Tucson Department of Pediatrics. A 2001 graduate of the UA College of Medicine, he joined the practice where he was mentored as a medical student in the RHPP.
 
Correia is attending the UA College of Medicine – Tucson.
  • Prescott Valley: Shirley Rheinfelder, MD, family medicine, mentoring Samantha Romanowitz, May 28-June 27.
Dr. Rheinfelder first served as a RHPP preceptor in 2004. A 2000 graduate of the UA College of Medicine, she participated as a medical student in RHPP in Springerville in 1997.
 
Romanowitz is attending the UA College of Medicine – Phoenix.
  • Safford: Gail Guerrero, MD, family medicine, mentoring Dana McKee, June 10-July 12.
Dr. Guerrero has been a RHPP preceptor since 2005. A 2002 UA College of Medicine graduate, she participated as a medical student in RHPP in 1998 in Kingman, where her preceptor was Ismail Bokhari, MD. Dr. Guerrero, who also is a clinical assistant professor with the UA College of Medicine – Tucson Department of Family and Community Medicine, is in practice with two other UA College of Medicine graduates: Susan Jones, MD (Class of 1979), who also has been a RHPP preceptor, and Cathy Romero, MD (Class of 1997).
 
McKee is attending the UA College of Medicine – Tucson. 
  • Show Low:  Daniel Greco, MD, general surgery, mentoring Sarah Harris, June 3-July 5.

Dr. Greco has been a RHPP preceptor since 2006.
 
Harris is attending the UA College of Medicine – Tucson. 
  • William Waldo, MD, general surgery, mentoring Trenden Flanigan, May 27-July 6.
Dr. Waldo has been a RHPP preceptor since 2005.
 
Flanigan is attending the UA College of Medicine – Phoenix. 
  • Snowflake: Dallas Peterson, MD, and Alan DeWitt, MD, both family medicine, mentoring Brett Brewer, June 10-July 12.
Dr. Peterson has been a RHPP preceptor since 1999 and is a 1992 graduate of the UA College of Medicine.
 
Dr. DeWitt, a Snowflake native, has been a RHPP preceptor since 2005. A 1999 UA College of Medicine graduate, he completed his residency in family medicine at Banner Good Samaritan Medical Center in Phoenix in 2002.
 
Brewer is attending the UA College of Medicine – Tucson. 
  • Springerville: Cathy Taylor, MD, pediatrics/internal medicine, mentoring Brianna Grigsby, June 3-July 5, and Coya Lindberg, July 8-Aug. 9.
Dr. Taylor first served as a RHPP preceptor in 2007. A 2001 UA College of Medicine graduate, she participated as a medical student in RHPP in Springerville in 1998. She completed her residency in medicine/pediatrics at Maricopa Medical Center in Phoenix in 2004.
 
Grigsby and Lindberg are attending the UA College of Medicine – Tucson. 
  • Tuba City: Joachim Chino, MD, general surgery, mentoring Adam Colbert, June 10-July 12.
Dr. Chino has been a RHPP preceptor since 2012.
 
Colbert, who graduated from the UA College of Nursing in Aug. 2009, is attending the UA College of Medicine – Tucson. 
  • Whiteriver: Dianna Mahoney, MD, family medicine, mentoring Camilla Sulak, July 1-Aug. 4.
Dr. Mahoney first served as a RHPP preceptor in 2004. A 1997 graduate of the UA College of Medicine, she completed her family medicine residency at Phoenix Baptist Hospital Medical Center in Phoenix in 2000.
 
Sulak is attending the UA College of Medicine – Tucson. 
  • Wickenberg: William Firth, MD, internal medicine, mentoring Meredith Close, June 3-June 28
Dr. Firth first served as a RHPP preceptor in 1999 and also is a clinical assistant professor with the UA College of Medicine – Tucson Department of Medicine.
 
Close is attending the UA College of Medicine – Tucson.
  • Winslow: Greg Jarrin, MD, general surgery, mentoring Steven Taylor, June 5-July 5.
Dr. Jarrin has been a RHPP preceptor since 2012.
 
Taylor is attending the UA College of Medicine – Tucson.
  • Yuma: Ricky Ochoa, MD, family medicine, mentoring Andrea Galaviz, June 10-July 12.
Dr. Ochoa has been a RHPP preceptor since 2009. He is a 2002 UA College of Medicine graduate who participated as a medical student in RHPP in 1999 in Yuma with preceptor Roger Nutt, MD. Dr. Ochoa completed his family medicine residency at Phoenix Baptist Hospital in Phoenix in 2007.
 
Galaviz is attending the UA College of Medicine – Tucson.
 
Preparing graduates to serve the unique health-care needs of rural populations
 
“This program helps nurture students’ interest in a rural practice,” says Carol Galper, EdD, assistant dean for medical student education, UA College of Medicine – Tucson. “Many of the students grew up in rural towns in Arizona and have a desire to practice in small communities, perhaps even returning to their hometowns. Their RHPP experiences help them understand the unique health-care needs of rural populations as well as strategies to address these needs, and help them decide about where they want to practice in the future.”
 
By working side-by-side with a physician – consulting with patients, discussing lab results, helping to diagnose childhood ailments, attending surgeries – students learn about the unique health-care needs of rural populations and how to meet them. By returning to the same community during each year of medical school, students learn to appreciate the area’s culture and community character and begin to experience the lifestyle of rural residents.
 
This year, 20 students attending the UA College of Medicine – Tucson and 2 students attending the UA College of Medicine – Phoenix were selected for RHPP, using a combination of funds from the Arizona Area Health Education Centers (the Arizona AHEC Program); the Arizona Center of Excellence, funded by a grant from HRSA (Health Resources and Services Administration); and the state of Arizona. “With the expansion of the medical school to include the Phoenix campus, AHEC funding enables us to provide RHPP opportunities to Phoenix-based students as well,” says Dr. Galper.
 
RHPP students receive intensive preparation, including a course, “Issues in Rural Health,” covering health care and access-to-care issues, challenges of rural practice, referral needs, the impact of poverty and lack of health care, environmental health concerns, the influence of culture and the role of physicians in rural communities, as well as topics not taught until their second-year curriculum. This helps bring them up-to-speed and allows them to be well prepared for their initial rural rotation.
 
RHPP students learn how telemedicine technology assists rural physicians
 
RHPP students learn to use telemedicine technology in communities linked to the Arizona Telemedicine Program (ATP), a health-care telecommunications network that allows rural physicians and patients to have real-time online medical consultations with specialists at the UA College of Medicine in Tucson. The system also allows rural physician-preceptors and their students to attend grand rounds lectures “virtually” at the UA College of Medicine. The RHPP course is teleconferenced between Tucson and Phoenix, with instruction originating alternately in Tucson and Phoenix.
 
Rural physician-preceptors enhance their teaching skills by attending faculty development and continuing medical education programs conducted by the UA College of Medicine. To minimize disruption of the physicians’ medical practices, the programs are offered regionally by video links provided by ATP to the UA College of Medicine.
 
Long-Term Outlook
 
RHPP students develop long-term relationships with their rural physician-preceptors, who act as medical and career counselors, helping the students make informed choices when they decide where they will practice medicine.
 
Initial follow-up of 97 graduates of this program who have completed residency shows that 42 percent have practiced in rural Arizona, 30 percent are in current rural Arizona practice and eight percent are in rural practice in other states.
 
“We have graduates throughout the state,” says Dr. Galper. “The RHPP is creating rural physicians for Arizona, and these physicians now are mentoring the next generation of rural doctors.”
 
For more information about RHPP visit the website http://fid.medicine.arizona.edu/educational-programs/rhpp
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