Rural Medicine: A Little 'MacGyver' and a Love for Patients

April 12, 2022
By: NHRMC
Beste Pino
Note: This blog first appeared on Novant Health's Healthy Headlines page.

Rural medicine is for doctors who aren’t afraid to think unconventionally.
 
That’s what Dr. Janalynn Beste, family medicine residency chairwoman and residency director at Novant Health New Hanover Regional Medical Center, wants future rural family medicine residents to know.
 
“Rural medicine means being creative, good at problem-solving and truly advocating for your patients,” she said, “and sometimes doing things in a very unconventional way.”
 
Sometimes, that unconventional thinking involves a MacGyver attitude: One 16-year-old patient could not afford a spacer for his asthma inhaler. (Spacers can help the device work better.) Beste and her residents made him a homemade version out of a 16-ounce plastic soda bottle, which helped him get the asthma medicine into his lungs more efficiently.
 
Or there’s the elderly patient who had been to the emergency room several times after falls. On a home visit, Beste and her residents noticed that many of her ceiling lights were burned out. After a tall resident replaced the bulbs, her fall visits stopped.
 
Or there’s Beste’s personal favorite, a story not unusual in the eastern part of the state, when residents set up mobile health care units in tents after Hurricane Florence ravaged the area. One resident – because of their experience in rural family medicine – was “completely comfortable” delivering a baby in that tent.
 
Beste, along with Dr. Joe Pino, associate dean and campus director of the UNC School of Medicine’s Wilmington campus, will be starting a rural family medicine track at Black River Health Services in Pender County in July 2024. In December 2021, Black River Health Services, in partnership with Beste and Pino, received a $500,000 grant from the federal Health Resources and Services Administration to support the creation of a teaching health center at Black River.
 
Residents in the track will spend their first year working at New Hanover Regional Medical Center with a half day each week at Black River. In their second and third years, they’ll provide full outpatient family medicine services to patients at Black River and will also care for patients at Pender Medical Center.

Beste, Pino and their team will spend the next two years (2022 and 2023) developing the residency’s curriculum and recruiting a director, assistant director and program coordinator, along with the first class of residents.

Rural challenges

Getting young doctors to move to and invest in a rural community can fundamentally change health care in that area. North Carolina has a physician shortage in rural areas, and as a result, many rural residents often struggle to find a health care provider nearby – or to rearrange their lives to get to a larger city to see one regularly.
 
If you live in central Pender County, you have a 50-mile round trip to Wilmington. And it’s a tale of two counties, Pino said: The eastern side, Hampstead, is growing rapidly because of its proximity to the ocean and its location on Highway 17. It’s also closer to Wilmington than just about any other town in the county.
 
“Then there’s everything else in Pender County,” he said. “It’s very rural. Many farming communities populate the western half of the county.”
 
A long drive to a larger city with more healthcare options isn’t the only issue facing patients in rural areas, Beste said. Rural residents are more likely to use Medicaid and Medicare than patients in other areas, and not all health care providers accept those payment sources.
 
That’s why stationing the new rural family medicine residency at Black River Health Services made sense. Black River is a federally qualified health center look-alike, which means it qualifies for special reimbursement through Medicare and Medicaid. The healthcare providers who work there can also receive loan repayment.
 
And to Black River CEO Lee Ann Amann, working in a rural area is working “for the true love of being a doctor,” she said. “What we provide is the true love of what you went to school for. People here are truly appreciative of every physician they see.”
 
A health center like Black River is a game changer for patients in Pender County. Beste and Pino hope that the new rural residency track will attract the kind of doctors with a penchant for unconventional thinking – and a willingness to take on a different mindset.
 
“The sheer breadth and depth of resources are fewer in a rural setting,” Pino said. “As a physician practicing in Wilmington, we have the luxury of having everything short of specialists in burns and transplants.
 
“When you think about it, a lot more is shouldered by practitioners in rural settings. Patients can certainly go to Wilmington, or to Chapel Hill or Duke, but generally speaking, people don’t like to leave their community. Access to care close to home really resonates.”

Staying local

Wilmington’s existing family medicine residency program has been successful in keeping graduates in the area, Pino said. Beste hopes this new rural track will do the same – and she’s hoping to keep more than one doctor.
 
Millennials are accustomed to working together – they came of age during schools’ “group project” era, she said. “If you have three doctors and one of them is stumped, they go to their partner and say, ‘Hey, I’m totally stuck. What do you think is going on with this guy?’”
 
The rural family medicine residency track gives the Pender County community access to better health care – but it also gives them a cohort of doctors and the faculty to teach them, people who “get really invested in improving the health of that community,” Beste said.
 
“It’s an exciting challenge to figure out how to take care of your own community,” she said.
 
Top photo: Dr. Janalynn Beste (left) and Dr. Joe Pino.

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