Episode Transcript
Interviewer: The Scope Radio is broadcasting live at Learn, Serve, Lead. Pathways in academic medicine. What are pathways? Well, pathways connect. They advance, they empower, they transform and they can inspire. And we're talking about bringing better care to patients, bringing better opportunities to providers. And we're talking about bringing better opportunities to students, faculty, and patients. And today, pathways to rural care from a couple of perspectives. The first perspective is how do we get more medical students interested in rural care? The second is, are there some improvements from their perspective that could be made that would provide better care to individuals in rural situations? We're talking with Rachel Pernick and Tashi Hackett, both medical students at University of Utah Health. And let's start with you Rachel. How did you get interested in rural medicine? Because you do not come from a rural background.
Rachel Pernick: That's right. Yeah. I grew up in Metro Detroit in Michigan. After college, I went to college in Michigan. After college I spent a lot of time commuting back and forth. I did summer work in parts of Alaska. And then I would do winter work in Detroit and then also up north in Northern Michigan in the UP. So while I didn't grow up in a rural community, I did spend a lot of time working in rural communities. And I think I just really liked living and working in a smaller community and was always curious about what that would be like practicing.
Interviewer: And when you decided you wanted to pursue rural medicine, was it easy for you to follow that passion or was it somewhat difficult? Was there a pathway for you to easily get into that track?
Rachel Pernick: I feel like here in Utah it's easy. I think it's built into the structure of the medical school curriculum here at U of U. We do have an unusual geography in Utah. There's just one road that goes all the way up and all the way down, and pretty much all the towns are off that single road. It's not the smallest population in the state. Everything is quite a bit spread out.
Interviewer: And you came from an urban environment. You were interested in rural health. Did you find yourself at University of Utah Health because of the ability to pursue your passion in rural health? Tell me about that.
Rachel Pernick:
It was clear to me right when I applied that there were going to be opportunities to train and practice all along the I-15 corridor all across the state of Utah. I was living in Southern Utah at the time. There's not a whole lot in between, but there's plenty of towns that I was surprised do not have the same access to care as they do in the northern and the southern parts of the state.
Interviewer: And when you were applying for medical school, you learned about a program at U of U Health that helped facilitate that. Tell me about that program.
Rachel Pernick: Yeah, from the beginning. I was aware of the TRUE program, the Tribal Rural Underserved Education Program for MS1s, MS2s and leading into the third and fourth year from students at the U of U. Then I also applied to the RUUTE program, which is the scholars program for folks who are interested in rural health education.
Interviewer: And did that help pay for some of your medical? How did this provide an easier path to what you want to achieve?
Rachel Pernick: Yeah, there is funding support. I was really pleased to see that there was funding support. And I know that the state of Utah offers a lot of loan reimbursement for folks who do go on to practice in rural Utah. And I feel like we are made aware of those opportunities very early on. So you can start to think about the possibility of practicing in a rural place.
Interviewer: And that was your experience, wasn't it Tashi? You came to University of Utah and School of Medicine, and necessarily rural health wasn't on your radar. It wasn't until you got here and you saw some of those programs. Tell us about that.
Tashi Hackett: Yeah, I was born and raised in a really small town in Southwestern Colorado in the San Juan Mountains. And I always knew I wanted to go into medicine. To what extent or to where I wasn't really sure. I always envisioned coming back to the community that I would want to live in. And I love being in small towns and mountains. And so I think pursuing rural education and rural training in medicine was almost like an afterthought, because I knew I'd eventually get there. Starting at school in Utah and realizing that there's all these phenomenal opportunities to go not only get specific training for that, but to receive funding to do so, and to go actually practice in a lot of these communities that I would call my people and really can connect with is phenomenal.
Interviewer: And unlike Rachel, you were not aware of the programs here. It was after the fact you discovered some of the programs. Tell us how that has influenced your journey then.
Tashi Hackett: Well, it's funny. I didn't know about RUUTE or TRUE until I actually applied, until I had the application button open and hit submit. And it just seemed like such a natural extension to want to pursue those things. It was a really serendipitous moment for me to stumble upon it, so to say.
Interviewer: You come from a family of doctors
Tashi Hackett: Yes, sir.
Interviewer: That did provide rural care.
Tashi Hackett: Yeah.
Interviewer: What was that like and how has that influenced you?
Tashi Hackett: I think seeing it firsthand was one of the huge reasons why I wanted to get into medicine. So my dad is an emergency medicine physician. My stepmom is a surgeon, and even my mom is an anesthesiologist. But we all grew up in this really tiny town. And gosh, between my dad and my stepmom, they were taking care of almost half of the entire town, suturing people's foreheads in our kitchen. You name it. We were doing a lot. And I think in a lot of ways it was such a fundamental part of our community that really inspired me to see how much good they could do. And it wasn't until a lot later that I realized that it's probably not a normal thing for most people to have their neighbor be putting stitches in their forehead. And so I think it opened my eyes a lot to how underserved medically a lot of these rural communities can be. And I think that really lit the fire in me to pursue that as well.
Interviewer: And from that standpoint, let's come back to Rachel. As you've worked with rural communities and you've witnessed health care in that setting, what are some opportunities for improvement or what are some things that are overlooked? Where can we go to make sure that rural communities get better care?
Rachel Pernick: Yeah, I had the opportunity with the RUUTE program to do a rural rotation last summer in Cascade, Idaho, which is just an hour and a half from Boise, which is the biggest city there. And that's where the major hospitals are. It was interesting telling you the folks there, I mean, they talked about all barriers to care that were contingent on weather. And I think a lot of us who live in snowy places are aware of the very physical barriers. When there's a snowstorm, you might not be able to make it to the hospital.
But something that was really very salient while I was there, it was one of the smokiest summers that they've had in a long time. They had a ton of wildfire. And they found that in some trauma and accidents, they couldn't find helicopters to medevac people from Cascade area, which is popular tourist destination, especially on the weekend and then the summertime down to Boise. So they would have to take people by ambulance who were perhaps in critical condition. And that has very real effects on people's outcomes when you can't fly due to weather. So things like that I never thought about.
Interviewer: And urban environments, you have snowplows and you have services that can help remove that snow. So it's a little bit easier to get around, but you might have some roads that don't have that. Are there any solutions to that problem or what can be done?
Rachel Pernick: I think one growing solution is the emergence of telehealth services. I know at University of Utah, there's a lot of telehealth consulting that happens, I think more than used to where specialists are able to teleconsult. I know even in our RUUTE program we have telestroke services. So if somebody is experiencing a stroke or think they might be experiencing a stroke, and they're not sure, they're in the rural community or the rural clinic, they can consult a stroke neurologist from the U of U remotely and offer their services that way.
Interviewer: Whereas before they might've had to get on a helicopter or an airplane and go to the academic medical center where that expert is. But here they can be in their own doctor's office, in their own community.
Rachel Pernick: And get those experts.
Interviewer: So yeah. Tashi, what have you noticed? Have you noticed anything in rural care that could be improved to provide better outcomes or to serve the communities better?
Tashi Hackett: I think broadly when you take a 10,000 foot view of the main issues that affect rural healthcare, it is typically from a lack of resources. Whether that is a lack of providers that wish to practice in that area, a lack of financial support available for patients and physicians alike to be able to practice there. So I think something that certainly could be improved upon is actually encouraging retention of family practice and rural physicians in these areas. Whether that is an incentive-based model, I can't say with any certainty or really suggest any ideas, but one of the things that I feel very strongly about is certainly encouraging people from rural communities to pursue medical education so that they can return to these communities and greatly strengthen healthcare system in these places.
Interviewer: Do you plan on practicing in rural communities when you're finished with your medical education?
Rachel Pernick: Yeah, I would like to.
Interviewer: And how do you see that kind of taking place? What do you see that practice looking like?
Rachel Pernick: I'm not sure.
Interviewer: Yeah?
Rachel Pernick: In truth, I'm not sure. But I've always been a generalist. I've always maintained a glut of hobbies, and I like to keep fingers in a lot of pies. And I think probably my medical practice will reflect that approach as well.
Interviewer: How about you Tashi?
Tashi Hackett: Yeah, if my dad is still kicking around, I'm sure we're going to be sewing up lots of faces in our kitchen still. Eventually I'm certain I'm going to return to a rural mountain community at some point. That's just kind of where my heart and soul belong. Into what capacity I will be practicing medicine there, I'm not entirely certain.
Interviewer: Last question. For somebody listening that maybe is thinking, "Huh, I'd like to investigate this a little bit more." What would you say to that person?
Rachel Pernick: I think everyone should spend time practicing it in a rural setting. It was totally transformative for me. This past summer, working in Idaho. I think everyone should have the opportunity to go practice there.
Interviewer: And it can make a better physician even if you're not-
Rachel Pernick: No matter what. Even if you don't aim to practice in a rural setting, or even if you're not sure, the practice is so different. The perspectives are so unique. I would encourage everyone to go.
Interviewer: Give specific. Give me a unique perspective or a unique challenge.
Rachel Pernick: To Tashi's earlier point, I think some of these rural communities have really amazing opportunities to develop local programs that serve the needs of that particular community. When I was in Idaho, there was a medical transport service that they had just developed in that town. It was basically just a van they got a grant for, and they took their patients to whatever specialist appointments that they had, whether it was down in Boise an hour and a half away, or up in McCall, 45 minutes away for surgery, or what have you. And so, yeah, I don't know. I think there's a lot of opportunity in those communities too.
Interviewer: And I feel like that could be a good perspective for somebody practicing elsewhere just to realize that sometimes getting to the doctor, no matter where you are, can be challenging. So is that on your radar and are there ways that maybe you could make it easier for your patients?
Rachel Pernick: Definitely.
Interviewer: Tashi, how about you? What would you say to somebody that is maybe on the fence or thinks, "Oh, maybe I'd like to explore rural health a little bit more?"
Tashi Hackett: I don't think I could say anything more glowingly positive about my experiences in these places, especially if you haven't spent much time in a rural environment before or you've lived in a city, but you would love to eventually get out to the mountains or wherever you're going to be. I grew up in a really tiny town and I wouldn't trade the world for it. And I think having those experiences and the people that you get to meet and spend time with, it is a long winding answer to just say that I don't know. It's the best. Yeah.
Interviewer: Yeah. I feel like when I'm listening to you, help me if this is correct or not, I feel like there's a different appreciation for medical professionals. And you could come out of that experience even if you don't go into rural health thinking, "Wow, this does make a difference in people's lives in a significant way."
Tashi Hackett: I think when you start moving to lower resource settings, it becomes really clear very quickly what you've taken for granted. And I think it is an excellent opportunity to practice having a different perspective and one of significant gratitude and appreciation. I think there's a lot of things that you can learn from the resiliency and the ingenuity of people that come from rural areas. I think for as long as I live, there's definitely a degree of me that will still be practicing pretty cowboy medicine and trying to be pretty gung-ho. Yeah.
Interviewer: Rachel and Tashi, thank you very much and good luck in your careers.
Rachel Pernick: Thanks.
Tashi Hackett: Thank you very much.
Interviewer: And being advocates for rural health.