“Georgia has so many rural areas that need help,” Lord said.

Hospitals and academic medical centers in Georgia are working together to build rural healthcare workforces through programs that bring doctors-in-training to rural communities and encourages them to stay there after their training ends. The programs rely primarily on government scholarships and student loan forgiveness programs.

Lord, a rural native herself, benefits from a new alliance between Children’s Healthcare of Atlanta and Mercer University School of Medicine in Macon to train and send more pediatricians to rural areas of the state. “It’s going to give our patients and parents of patients hope they will finally receive the same healthcare as patients in urban areas, especially in an emergency situation.”

The Mercer-Children’s alliance is just one example of how hospitals and academic medical centers in Georgia are working to strengthen the rural healthcare workforce.

Emory University also has multiple programs underway that send students into rural areas for training. The Emory School of Medicine shares surgeons who are nearing the end of their training programs with Colquitt Regional Medical Center in Moultrie, Georgia. A separate program with Emory’s School of Nursing sends students to provide mobile health services in underserved areas, including southwest Georgia.

The state has acknowledged the gaps in rural medical care. Gov. Brian Kemp announced plans earlier this year to spend $50 million in state money on construction of a new medical school on UGA’s Athens campus to help address the statewide physician shortage. He said at the time that the new medical school would “help tackle our rural health care needs.”

Marc Welsh, Children’s chief diversity officer and vice president of child advocacy, said the pandemic made Georgia’s healthcare challenges worse.

“We want to know kids across the state can get care,” Welsh said. “A ZIP code shouldn’t define the care they receive.”

Pandemic-fueled change

Last year, Children’s funded the first group of 10 full-tuition scholarships for Mercer medical students specializing in pediatrics who commit to serving in rural Georgia for at least four years after their medical training is complete. The annual scholarships will be offered for up to 10 years.

In areas short of pediatricians, physicians and nurses specializing in adult care were often called upon to stabilize a child with more complicated issues such as asthma, and then transfer them to a better-equipped hospital, he explained. Or parents with sick kids would have to take a day off work or drive long distances to a larger hospital for specialized pediatric care.

Children’s alliance with Mercer, named Kids Alliance for Better Care (KidsABC), not only hopes to solve that shortage, but also provides funding and training for existing nurses and physicians to be prepared when certain pediatric illnesses come through the emergency room.

Post-pandemic, rural providers are also struggling to keep up with rising mental and behavioral health issues. To address that need, Children’s this year awarded scholarships to five marriage and family therapy students who agree to provide mental health services to rural children after graduation.

“After we saw what we could do in pediatrics, we decided to expand to mental and behavioral health,” Welsh said. “We need local providers trained to meet the mental health needs of children determined to need that care.”

Children’s will help Mercer train family therapists to counsel public school children. A Children’s subsidiary, the Marcus Autism Center, will also lend its expertise to improve the care and treatment of rural children with autism. Students will connect with telehealth services if mental health services are not available locally, Welsh said.

‘Transformational initiative’

Dr. Jean Sumner, dean of Mercer’s medical school and one of its first graduates, called the alliance with Children’s “one of the most transformative initiatives in rural health.” The improvement of rural services might have occurred over time, she said. But with the help of Children’s, it can occur much sooner.

Mercer University School of Medicine is a state-funded private university that only accepts Georgia students. Most are from rural areas. More than 60% of Mercer’s graduates practice in the state and of those, more than 80% practice in rural or medically underserved areas.

Sumner said pediatrics is one of the most underserved specialties in rural Georgia. “I’m not sure of any more need than the need for good pediatricians in the rural community.” She pointed to the disparity between rural and urban healthcare resources and said she believes that the Mercer-Children’s initiative could help “level the playing field.”

The alliance also benefits other rural hospitals, who can consult through telehealth with pediatricians at Children’s and around the state, including other regional children’s hospitals in Savannah, Augusta, Macon, and Columbus.

In addition to Children’s psychiatry department, Mercer tapped into Emory’s experts in child and adolescent psychology to help develop mental health and wellness plans for public school students. Mercer will screen students to determine what services they need beyond what the schools provide, Sumner said.

Mental health screenings began during the last school year in Washington and Jefferson counties and will expand to include Ben Hill County. The goal is to provide services locally and prevent students’ families from waiting months for an appointment and then driving several hours to receive care. Such initiatives also help rural communities become self-sufficient, Sumner said.

Rural training ground

Emory’s School of Medicine also has expanded its outreach to rural communities through a surgical program that began last year at Colquitt Regional Medical Center in Moultrie. Every month, a fourth- or fifth-year general surgery resident rotates through Colquitt to care for patients. “Residents” are physicians who are practicing under more senior clinicians to get necessary experience in a specialty.

The interaction with medical residents also helps ease patients’ anxiety when they are referred to Emory for treatment that can’t be provided locally, said Dr. Jahnavi Srinivasan, director of Emory’s general surgery residency program. In turn, the training will help residents learn what it’s like to work in a rural practice even if they decide to specialize beyond general surgery or work in an urban setting. “We want every surgeon to have this training,” she said. “If they see how rewarding it is, some who may not have thought they wanted to serve rural areas may make the decision they want to do it.”

A $4 million grant from the federal Health Resources and Services Administration (HRSA) also will allow Emory’s School of Nursing to begin offering 10 scholarships a year to train its students pursuing bachelor’s and advanced degrees to provide mobile health services to underserved areas of the state, including rural southwest Georgia.

As part of the new Emory in MOTION (Mobile Opportunities for Training and Innovating: Nursing) program, students will spend up to two weeks in the summer providing primary care mobile health services to migrant farmworkers in Moultrie and other medically underserved communities in the state.

Credit: Emory University School of Nursing

Credit: Emory University School of Nursing

The scholarships don’t require students to serve in rural settings after graduation, nor is it the program’s intent, said Quyen Phan, project director of the program and an associate clinical professor at the school. “We cannot make someone commit to working in rural areas. But we prepare them to work in a mobile health setting, serving the underserved and rural communities, should they choose to work in these settings later.”

The program, along with the Ellenton Clinic, which serves farmworkers in Ellenton, Ga., acquired a mobile medical unit in April.

Through the program, farmworkers can get primary care such as screenings for high blood pressure, blood sugar or cholesterol, along with more urgent health needs. There are plans to expand the program to include prenatal and pediatric care, Phan said.

Committed to rural Georgia

Growing up in the rural community of Maysville in North Georgia, Lord was empathetic to the healthcare needs of such areas. She knew when she became a medical resident to complete her training, she’d serve a similar demographic.

She attended Mercer School of Medicine and trained at at Atrium Health Navicent, a Macon hospital associated with Mercer. She became one of the first Nathan Deal Scholars, chosen because of their strong ties to rural Georgia. That scholarship meant working in rural Georgia after her residency. Lord, 33, now mentors new scholars in the program.

Lord said she realizes not all medical school graduates have the same commitment to serving rural areas because they might not earn as much as urban doctors or have the same access to advanced equipment they trained on in medical school. Rural doctors may also have to treat patients who don’t have access to regular healthcare or insurance coverage.

But when looking for a job after her residency ended four years ago, Lord saw firsthand the need for pediatric care in rural Georgia.

“I met with other pediatricians that would have loved to bring on another (doctor) but couldn’t financially. … There are a lot of medically underserved (areas) that don’t have a pediatrician, or one that tries to serve the whole county. It can be tough to do by themselves.”

Lord said it’s been a privilege to help rural patients overcome the healthcare obstacles they face on a daily basis. “It is rewarding to see changes, such as the KidsABC program being put in place, so that my patients can finally get the healthcare they deserve without having to make sacrifices that shouldn’t have to be made.”