Jefferson Reflects on Nearly 50 Years of the Physician Shortage Area Program

When Klingensmith read about the PSAP while applying to medical schools, “I was like, ‘This is what I want to do,’” she says. “I want to work in a community like the one I grew up in because I know there’s a need in these communities.”

PSAP leaders attribute the program’s success largely to its admissions process. All PSAP applicants must complete a secondary application on top of their standard medical school application, which includes an interview and written questions about the applicant’s rural background and interest in the program. The program also has established a partnership with eight universities in the region, in which undergraduate students are recommended to the PSAP by a faculty committee at their respective schools after a separate interview and screening process.

Three factors known at the time a student applies to medical school—a rural background, a desire to practice in a rural area and an interest in family medicine—are particularly useful in predicting whether that student will follow through on their plans to practice long-term in a rural setting, according to the University’s analysis of student outcomes. Of all Jefferson medical school graduates still practicing in a rural area three decades after graduation, 80% met at least one of these criteria.

PSAP student Elizabeth Klingensmith completed a rotation in a family medicine office in Latrobe, Pa., not far from her hometown.

“Students who really want to be in this space will often say, ‘I grew up rural, and I’ve experienced both the good and bad of that,’” Dr. Motley says. “We hear a lot of narratives about how someone’s grandmother could not get care, or how they had to travel three or four hours to the closest major medical center, or how the only family doctor in their hometown has retired and left the town without a primary care physician.”

Applicants also are asked to submit three letters of recommendation, which must be from people who live in the applicant’s hometown or nearby—for instance, a former employer, high school coach, Boy or Girl Scout troop leader or family friend. Klingensmith asked the priest at her hometown church for a recommendation while Dr. Lavery submitted letters from her pastor and high school principal.

Ideally, Dr. Motley says, these letters will give the admissions team a sense of whether the applicant has previously talked about their desire to return to a community like the one they grew up in.

“You definitely get a flavor in the letters for whether a person is comfortable in their rural community and whether, when they say they want to go back and live there, it’s genuine,” Dr. Motley says.

‘A Wonderful Dialogue’
While PSAP curriculum requirements mirror Jefferson’s standard medical school curriculum, the program offers additional support mechanisms and rural-specific opportunities outside the classroom.

PSAP-specific faculty advisers make themselves available for advice and guidance whenever needed. But peer support is another central part of the program, with each first-year student assigned to a student mentor and each PSAP cohort holding regular group meetings to commiserate over challenges, celebrate their successes and support one another in acclimating to the school’s urban setting. In her first year, Klingensmith and her PSAP classmates met monthly, with meetings gradually becoming less frequent in their second and third years as schedules became busier.

“It’s still a really good way to decompress,” Klingensmith says. “Some months are harder than others, but then other times we’ll get to share our happiness, too.”

Coming from a rural setting and never having visited Philadelphia before her med school interview, Dr. Lavery found life in the city intimidating when she first enrolled at Jefferson, she says. “It was nice to have some extra support and to know a few faces who had the same background that you did.”

As a requirement of the program, each PSAP student must complete a six-week rotation in a rural community. Klingensmith completed her rotation in a family medicine office in Latrobe, Pa., not far from her hometown.

“It was really great for me because I could relate to a lot of the people and be like, ‘Oh yeah, my high school used to play Latrobe,’” says Klingensmith, noting the rotation also deepened her understanding of a family doctor’s role in a rural community.

“It’s very different in that the physicians there were independent and willing to do a bit more before referring,” she explains. “We think of family medicine visits as being too quick to get anything done, but in 20 minutes we could accomplish a lot.”

Dr. Lavery also completed her rotation in Latrobe, an experience that had a big impact on her—so much so that she went on to complete her residency there after graduation.

“We got to see everything there because we didn’t have to compete with different specialties or subspecialties,” she says. “The specialists only had us to teach, so they would grab us and pull us into everything.”

The program’s strong alumni network also provides students with valuable insights into rural medicine, Dr. Motley says, with graduates joining as guest speakers at group lunches or conducting virtual or in-person Q&As with students. Other program graduates have hosted current students in elective preceptorships.

“They’re getting a glimpse of, ‘Hey, what does life look like 10 or 15 years down the road for me?’” Dr. Motley says. “It’s been a wonderful dialogue.”

Tracking Outcomes
Jefferson has closely tracked and analyzed medical student and graduate outcomes since 1964, giving PSAP leaders measurable insights into the program’s success. Fifteen academic papers and one book have been published on PSAP outcomes.

PSAP students are over eight times more likely to practice rural family medicine than their non-PSAP classmates, according to data collected between 1978 and 2002, and approximately three times more likely to practice any specialty in a rural area. Another analysis of University data found the PSAP had produced 12% of all rural family physicians in Pennsylvania.

The program’s graduates aren’t just more likely to practice in a rural area—they also have a track record of staying there. A long-term study of PSAP alumni found that roughly 70% had remained in rural family practice in the same area for at least 20 to 25 years after they first began practicing, and another 10% had moved to another rural area.

A half-century after it began, the PSAP is now well into its second generation, Dr. Motley says. “We’re having applicants whose parents were PSAP graduates.”

Fifteen years after her own graduation, Dr. Lavery says that, as a rural physician, she’s seen “so many specialists come and go” from her small community, making her all the more appreciative of the PSAP’s approach to recruiting and supporting rural students. As a student, she likely couldn’t have guessed the details of exactly where she would end up, Dr. Lavery says, but with the support of the PSAP steering her in the right direction, her passion for rural medicine has remained.

“I went into the program figuring I was going to be a family doctor in a rural area,” she says, “and I’ve stuck to that.”

Editor’s Note: This article was originally published in the Rural Monitor, a publication of the Rural Health Information Hub. Reprinted with permission.