This Rural Mission

This Rural Mission
  • 4.0 (3)
  • SOCIETY & CULTURE

This Rural Mission is a podcast that discusses pertinent topics related to rural community health and social issues around the state of Michigan. Each episode highlights rural providers, medical students, and community members who are making a difference in the lives of rural residents.

  1. 07/22/2021

    Rural Residency

    Welcome to Season Four of This Rural Mission. We're excited to connect with you again and talk more about the wonderful things that rural communities have to offer and the impact our leadership and rural medicine students and graduates are making for these communities. I'm your host, Julia Terhune and let's get started. Last season, we highlighted how COVID-19 affected residency, and I thought it might be time to talk about residency and what we as a college have been doing to impact the rural workforce. Now residency, well medical education as a whole, was a totally foreign concept to me before I started with this job. In fact, that foreign understanding is actually something we're going to talk about again this season. Why am I spending so much time talking about this? Well, I think that if we all understood the complexity of training that our doctors undergo, we might better understand the necessity and the resource that they are, especially for our rural communities. So here it goes, here is my brief recap of how doctors are trained. Four years of undergraduate work, specifically in the sciences, test number one, the Medical College Admission Test, four years of medical school, two board tests, residency with board exams throughout their entire training, three years to seven years of residency, depending on what field they go into, plus possibly fellowships. No, they don't make a whole lot of money during this residency. No, they aren't done with their training. No, they haven't learned everything. Yes. They still are under the jurisdiction of other doctors. Yep. They're still learning. And yeah, it's a lot of work. And all of this getting into undergrad, getting into medical school, and getting into residency is earned. It's not a given. You have to have the grades, the volunteering, the research, the personality, the drive, and then be accepted by the programs that you are applying to. It's a big deal. Now it's also a big deal to have a residency in a rural hospital. That's because residencies are sponsored by universities and housed in hospitals that can provide the number of faculty, aka other doctors, and clinical patients to help students finish their training, which means they need to have a lot of both of those things. In Michigan, we have some rural residencies in family medicine. They are located in Marquette and Traverse City primarily. Midland also has a residency program, which at its start was rural, but the county's population has increased to turn Midland county urban. But that limitation of rural residency is changing, both in geography and in specialty. This is all thanks to the fantastic work of our legislators, medical schools, and hospital partners throughout the state. Thanks to a program called MIDOCs, M-I-D-O-C-S, more primary care doctors are being trained in rural and underserved urban areas than ever before. So let's hear about how this program came to be from Jerry Kooiman, our Dean of External Relations at MSU College of Human Medicine. Yeah, so it goes back probably eight years ago, a number of medical school, government affairs folks got together and started talking about graduate medical education and the need for residency's really to be in parts of the state that we weren't training residents now, at that time. And in areas of residency focus that are lacking in the state of Michigan, in particular primary care. And so we began meeting, we met with legislators and began saying what if, and so the legislature gave us some planning money in one of the budget years. And we began to put together, out of research, our research in terms of what are the needs out there, just to make sure that we were data-driven, where are the parts of the state rural, urban, across the state and what are those disciplines that really are shortage areas for health professions. In the UP, psychiatry was their number one issue. In Traverse City in Northern Michigan psychiatry was their number one issue. And then with Alpena it was a matter of, they had been wanting to start family medicine in Alpena for some time from Mid-Michigan health and so that became their focus area. So it's evolved the four medical schools are Central Michigan University, Western Michigan University, Wayne State University, and Michigan State University College of Human Medicine. And so, we presented that back to the legislature and to the budget office at the state and asked for $5 million from the state. $5 million would be contributed by the medical schools. And then we would apply for a two to one match from the Centers for Medicaid and Medicare and from the federal government. And so the idea is we would have $20 million, and that would be enough to fund residents from each of the colleges and medical schools for their entire cohort. So if someone's going into psychiatry, that $20 million would cover psychiatry for all four years for that cohort. Because we didn't want to leave it up to the legislature each year with the possibility that they didn't provide the funding we'd need, be liable for the full cost of that training. Well, the CMS came in with a one to one match, and so we had to downsize the program. And so we're at five residents per medical school per year. We're actually asking the legislature for $6.4 million in this current budget process to get us up to six residents per institution. So total of 24 residents two of our residents are going into psychiatry in the UP. Two of our residents are going into psychiatry in Northern Michigan, and then one resident that's paid for by MIDOCs is going to Alpena through Mid-Michigan Health and Family Medicine. If the legislature gets us to $6.4 million in this coming budget year, we will be paying for two residents in Alpena. So that's the goal. We want to be to a point where it's sort of level funding and not ups and downs, which we've been at for the last four years. If we can recruit medical school students from these areas of the state where there's a shortage, get them to go to our medical school and have them train in, say Midland or Marquette or Alpena, and then our own residency program, which is going to train them as residents in those areas. You're just adding up all of the reasons for a resident to eventually practice in that area. We're just trying to add reasons for them to stay in. And I think this is, it's building our own. It's much cheaper to invest in this at the front end than to have to pay huge signing bonuses, to get them to go to Alpena or to Marquette or to Traverse City, even. So that's why we're in it. I'm really excited that Michigan State, a number of our own students have chosen this program as a way to do their residency program, because that's really the intent. So you heard it, this program is really in line with what our college is doing as a whole and what our college is all about. Not to mention it's meeting the mission of our leadership and rural medicine programs. And our leadership in rural medicine programs have influenced some of the direction of this program. We are all working together to make the MIDOCs program a success. In fact, our first psychiatric rural MIDOC students in Marquette started an LRM graduate. And this year we have a student piloting the family medicine MIDOCs program at Mid-Michigan Health Alpena through the Midland Family Medicine residency. Not only that, but that student piloting the program is a Leadership in Rural Medicine graduate and tipped into the Midland program, a program I'll explain, just a little bit. David Westfall is his name, Dr. David Westfall. And he is a pretty remarkable person. So let's get a bit of his mission and why he's doing what he's doing. But you stayed true to your goals and your mission throughout medical school, now in residency, you are a tenacious human David, good job. That may be even more so than you realize. I have wanted to go to med school since I was in middle school. So the idea that I didn't necessarily get accepted into medical school my first time around wasn't something that was going to deter me. A lot of my family, friends are all sort of in awe that I have gotten to this point where I'm graduating from med school now, because I never gave up on any of that. I applied for medical school five times and during med school, I struggled with my prep for step one, a little bit. So I ended up taking an extra year there as well, but none of that has... It's been a struggle, but it's nothing that I've seen as insurmountable. And I've just taken the challenge and found the best way to address it. What's kept you motivated? So my original aspirations for going to med school, were when I was growing up, I lived in a rural area where there weren't enough physicians. And when your parents are filling out documents for school, they usually ask who your primary care provider is and most of my friends just put closest in that spot because they didn't have an actual primary care provider. A couple of them did, but the number of physicians was nowhere near enough to meet the needs of the community, so that was really something that I always wanted to address. And it was a big part of why I chose primary care to go into as well as my background in public health. But seeing that need was something that I always wanted to help with. And I thought that when I didn't get into med school, okay, I'm going to continue to do that. But maybe this public health thing might be another avenue that I can help address those things. And I found that when I graduated from my Master's in Public Health. It's a lot harder to get into the realm where you would be helpful in those sorts of situations. Getting into administrative positions, you need so much experience that you can't get without experience. So it just makes it a lot more challenging. And I started doing the sanitarian thing as a way of gaining some of that experience, but it wasn't as fulfilling as I wanted it to be.

    26 min

  2. 03/03/2021

    Women Rural II

    This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine, Family Medicine Department. We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. In season one, I was so proud of the witty title for the episode Women Rural, R-U-R-A-L, but I was more proud of the content. Because in 2016 when I was recording the interviews for that episode, we were in the middle of an uneasy presidential campaign where for the first time in our history, one of the major presidential contenders was a woman. Now, four years later, we've made history. For the first time we have a female vice president of the United States. Thanks to social media and memes I think we are all acutely aware of how the "other side" feels about Vice President Harris's appointment. From my vantage point, her appointment was described as either one of the greatest feats in gender equality and female leadership, or as a political ploy aimed at winning minority votes. And that's where it starts to suck. Because on either side of the argument, that is a heavy lift for Vice President Harris. That's a heavy lift to be a pawn and it's a heavy lift to be the first. And so no matter how you slice it, being a female leader of her capacity is huge. Being the first one to do anything is huge. You have to move so much rubble and take so much heat so that you can clear a path for everyone else. Tony Morrison is one of the most famous black female authors of our time. She has a very famous quote from a 2003 O Magazine interview. Perhaps you've seen it. It said, "I tell my students when you get these jobs that you have been so brilliantly trained for, just remember that your real job is that if you are free, you need to free somebody else. If you have some power, then your job is to empower somebody else. This is not just a grab bag candy game." If you've read the whole article, you know that she's speaking generally about how marginalized groups who make a way to do something first need to do the heavy lifting so that those firsts don't continue. She says this because she was a first. In the 1960s she wrote her novels without any consideration for a white audience or white acceptance of her work. She went on to receive a Nobel Peace Prize and write some of the greatest novels of our time. Her achievements were not without a lot of heavy lifting that cleared a path for some amazing modern black authors like Kylie Reed or one of my favorites, Jesmyn Ward. She writes from a black impoverished rural perspective. And if you haven't read Salvage the Bones, you need to. So in order to make the heavy lifting a little easier task today, we're celebrating. Celebrating four outstanding female hospital CEOs who are serving rural communities all around the state, from the upper peninsula all the way to the thumb. While not all of them are the first female CEOs to be with their hospitals, they are still doing the hard work that is changing and caring for rural communities in a real way and making an empowered path for young women to come right alongside them. We're about to get into the heart of the interviews today. But before I do, I want to share some statistics compiled by the Harvard Business Review. That is to say, in 2018 women made up over 80% of the healthcare workforce, but only 6% of all healthcare CEOs were women nationwide. Women provide a unique and different worldview, challenge, and set of skills to the workforce in general, a difference that is vital to the vitality and completeness of any organization, effort, or mission. Women deserve equal and equitable representation in all areas of the economy. And therefore when discrepancies like the distribution of leadership roles in healthcare is askew, I believe it's the job of all of us to find a way to remedy that situation. So how do we do that? Well, we're going to find out. We're going to learn about how to really empower and make a difference in the workforce and in the lives of others through these four fabulous interviews. One of the things I often take for granted when doing these interviews is the consistencies that emerge among my participants. But in this episode, the commonalities between these remarkable women was too positive and too interesting not to take note of. The things I noticed about all four of these stories was this: mentorship is the best way to make impactful leaders. Leadership is not about you, but everyone around you. And to reach your potential, you have to take risks. And sometimes that risk is being the first. Our stories today come from Marita Hattem-Schiffman, who is the CEO of MidMichigan Health System in Gratiot, Isabella, and Clair counties. Yes, that many counties and that many hospitals. Karen Cheeseman from the Mackinac Straits Health System in St. Ignace; Jean Anthony, the President and CEO of Hills and Dales Hospital in Cass City; and Lyn Jenks, who is now retired, but was the CEO of the Munson Health System in Charlevoix, Michigan. A little secret about Lyn? She hired our director, Dr. Andrea Wendling, for her practice in Charlevoix and is very well-loved and respected in Northern Michigan. So let's start with some origin stories. We'll start with Marita and Jean and then move on to Karen and Lyn. One thing I think you'll find with these stories is that not one of these women started their career with the plan to become a CEO. But with mentorship from trusted guides, they learned their own potential, took risks, and found a way to empower others to take the reins too. While Marita is a Michigan native and a graduate of Central Michigan University, Marita began her time in hospital leadership in a hospital system in Wisconsin. She took on a major strategic leadership role with a bank before realizing what she really wanted to do with her career and where she wanted to go back. Here's Marita. And throughout the whole time I talked to the CEO about, "I still love healthcare and odds are I'm going right back again." And he kept going, "No, no, no, no, no. We're not for profit. We're helping people too. You're going to love this. You're going to want to stay." And I got to that two year mark and had already decided like six months earlier that when I hit two years, it was going to be time to go back to healthcare. And in the middle of all that I had come back to Michigan for a college reunion. Had not been back in I won't tell you how many decades. Really long time. And driving back to the airport I called my husband back in Wisconsin and I said, "I don't know what's happening to me, but I want to come home." So he said, "Well, sure, why not? I'll support you in that." And that was July of 2016. February of 2017 was that two year commitment to the credit union. And at that point before I did anything, all these doors and windows started to open and some of them had Michigan on them. So I remember sitting down with my husband and saying, "Okay, here's all these crazy things that are coming up. Clearly the message God's giving me is you were right to make a two year commitment. Now it's time to go back to healthcare. Here are all these different places you could explore or people who are calling you." And we both agreed Michigan would be our first priority. And it all turned out, which is fantastic. I am Jean Anthony, President and CEO of Hills and Dales. And my current role as CEO came to fruition probably almost four years ago, but I have a long, long history in healthcare. I started as an LPN and I tell the employees here during orientation, "I came with the building," and they love it. They all love it and they laugh about it. But I started as an LPN. I learned the organization, went back and received my associates. And then from there had that desire to do more in management and continued my education through bachelor's and master's and continued in the organization to pick up more and more management administrative duties until I became the COO approximately 17 years ago. And took on services with physicians, physician practices. And it was all exciting to me. It was a wonderful experience. And so I worked in human resources for a number of years, really had the opportunity to really [inaudible 00:10:48] the program and develop it. At that time, the hospital was starting to expand. Big physician recruitment initiative underway and we were adding a number of services. So I was really fortunate to be a part of that. In about 2005, we started planning for the new hospital. And I was really fortunate to be a part of that in a number of different ways. And that led me to really be involved in a lot of different operational aspects throughout the years and throughout that process. And so I began just becoming involved and taking on other roles and responsibilities. Ultimately then became the COO and then had the opportunity to apply for the CEO job. [inaudible 00:11:55] been in that position for a year. That's such a [inaudible 00:11:59]. Also in between I went back and I did my master's degree in organizational management in 2012. So just really tried to take every opportunity I could to advance and grow as the health system would allow. You are now retired? Yes, I am. Are you excited? Is it good? It's getting there. Let me just say that. It's getting there. When you've been going a hundred miles an hour for your entire adult life, going to zero miles an hour is hard. It's very hard. And I think what it is is when so much of who you are is wrapped up in what you do then it's not only a question of having something to do, but who you are. So I'm still dealing with that and I'm reinventing myself. And so I'm getting used to it. I don't miss getting up at the crack of dawn. I don't miss going in on a midnight shift. I don't miss taking 400 people to bed with me ev

    26 min

  3. 02/24/2021

    What the Virus Spread

    This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine, Family Medicine Department. We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. So, I remember it being the week of March 9th, that we got the news about us needing to pretty much convert our lives in the office, working directly with our students and I remember that being the last time that I walked into the office until I went back in late July. That's Susan Tincknell. She's the director of student programs at our Marquette Campus in the Upper Peninsula. In November, I asked her to recount what's gone on since that early March date last year. It felt like we were talking about a time long, long ago, but I also hear from Susan in just a bit the impacts of COVID on our health care systems and our medical education at MSU, all of those impacts are happening still and right now. To explain a few of these ongoings, I want to walk you through a very rough timeline of everything that happened to our students from that March 9th date, going onwards to today. COVID landed in the United States, but seemed to relegate itself to major cities. That was until it didn't anymore. When it hit Michigan, it felt inevitable and unbelievable at the same time. Maybe you can resonate with that feeling as well. Once it hit Michigan, our students were pulled first from the Traverse City Campus, and then from all of our other six campuses. The reason really was that there just wasn't enough personal protective equipment to keep our students safe. And the more people gathered in one space, the more likely they were to contract and spread the virus, so they were pulled. Since our curriculum at MSU put students in clinical settings starting year one, all 800 of our students at the college were not in clinical settings for several months. Now, doctors, medical students, residents, all of these individuals who go into a medical career are smart and resilient people. It seems like an understatement, they obviously are smart and resilient, but you'll never really know how smart and how resilient you can be until those skills are put to the test. And the physician faculty at MSU and our medical students are some of the most resilient and smartest people I know. Within days of things going into lockdown, our college had online learning that was keeping students on track with their education and helping give them the skills they needed to tackle COVID-19 when they return to the clinic. The online education that was implemented was revolutionary. But as we know from other forms of online experiences, it's not ideal and can't last forever, especially when you're talking about clinical learning. Nevertheless, it was the best thing we could do with what we had, but learning wasn't the only thing that moved online. Match Day 2020, and Match Day was Friday, March 20th. And that was supposed to be a grand celebration, in-person to celebrate some really hard work and accomplishment in finding out where everybody goes to residency. And that was converted last minute to virtual. It's not the same. That was really an eye-opener that this is actually happening and we're not able to gather with people. And moving forward, that same thing happened with commencement. We are going to share the perspectives of students on this episode. Something that I think many people are interested in, but there was a whole group of non-clinical people who have been affected by this pandemic and their story is important to hear too. There's something we at the leadership in rural medicine programs share about our campuses. And that's the real personal connection you have with our staff and faculty and preceptors. But we don't just say that to promote our program, we say it because it's true. Not only that, but we have staff members in these communities that want to have connection with students, that have gotten into this work because they like and desire to work and impact student lives. COVID-19 has taken away a lot of human connection for a lot of people. And that has extended to our medical school administrators as well. Very, very strange and somewhat difficult to change my life working with medical students to remote work. Zoom, although it's nice that we have it, isn't the same as meeting in person. And I'll just give you a little view of what the days were like if I were in my office. I would be sitting in my office and doing whatever it is I'm doing and a student would pop in and they'd say, "Hey, can I talk to you for a minute? I'm really wondering about finding a mentor in the specialty of surgery." And that would turn into a 30-minute conversation about their goals for their life, why they love surgery, who would be great mentors, okay? And then they'd leave and I'd have a smile on my face. And I'd think, "Wow, that was just a really great connection with that student." And then maybe an hour later, a student would come in and say, "Hey, do you have a minute?" And they're struggling with something personally and we talk about that, or they've decided that they no longer want to be an anesthesia. They don't want to do that anymore, they want to go into pathology. And so we just have this great conversation that happened on the fly, in-person. I could give them a hug if they needed a hug and Kleenex if they needed to dry their tears. And because now we have to schedule, schedule, schedule, schedule. We're going to now fast forward to the fall. The campus and the Upper Peninsula was able to send their students back to in-person learning first. At the time, there were limited cases of the virus in the Upper Peninsula region. It was a wonderful thing for these students and for the staff at the campus, but it didn't last long. After the summer months were over, Marquette County and parts of the Upper Peninsula and Wisconsin showed the highest rates of COVID-19 in the country. And all of a sudden, the situations that the UP campus had thought were in the past were blazing a new trail for their students. I am now finding myself having to tell students, I'm sorry, you can't do this elective because COVID has affected that physician's office. I'm sorry, they're shutting down whatever office it is due to COVID. And to be honest, that the UP was immune from all of that. I thought, "What? Can this be happening?" And it is, and our students are being affected by it. And our community is definitely affected. Our hospital is affected and I'm scared. I'm scared for the remainder of the year. I am not so much scared that it's going to be harder work for me, but I do worry about our students' safety first and foremost. They'll become physicians, okay? I truly believe that that is going to happen, but for them to have the potential of not being safe, scares me. When I reflect on what's gone on in our college, within our hospitals, within our personal lives and the lives of our students and faculty, preceptors, and doctors, I just feel heavy. I don't know if there will ever be enough words or interviews to tell you all what it's been like to be in medical education, let alone rural medical education during a pandemic. But like I said before, you just don't know how resilient or smart you are until it's been put to the test. And if the pandemic was a test for our medical students, I would say that they would graduate with the highest honors. I would say that since our world was turned upside down, I think the students' resilience has been absolutely amazing. They amaze me every day. I could actually tear up talking about it because they're the heroes in this, they made it through. I'm here no matter what. I get paid to do this job, right? These students, yes were scared about their future, right? They were asking a lot of questions. Their rotations were all affected by this virus. We had students that really had some big plans to go and do some pretty amazing away rotations and to check out residency programs and cities and towns that they'd never seen before. And they were so excited and we've been prepping them for the whole year. And then I know isn't going to happen. And these students took it with class. They just amazed me and still do. And they still do. I just think, "Wow, you'd never know that you guys have gone through medical school in the craziest time of this life." It's insane and they are rolling with the punches and they will do great things. We graduated students during a pandemic, okay? But then we kept the next group going and we started another group and all of these students have smiles on their faces. I am proud of our students. I am proud of our students. And what, if we didn't have great people helping the students and our staff has been amazing, it's just everybody's pulling together. Everybody's just wanting the same thing and that success for our students. So there it is in a nutshell, the timeline of COVID-19. Students were pulled in March, by May, June, we had students back in learning situations in hospital systems with fantastic PPE and lots of precautions and yet with surges, ebbs and flow, changes in vaccination availability and the like, our students are still always being tossed back and forth. But that's what this story is about today. It's about our students, our residents, our faculty, it's telling the true tale of the type of people that we recruit to the leadership in rural medicine programs, the people who are going to serve your rural communities as leaders in the future, and the people who are currently leaders in your hospital systems, rural communities and larger urban centers. Shelby, who you'll hear in our podcast about 20 Years of Medical Education in the Thumb was in the Thumb when she found out that she wouldn't be returning. Here's her story of leaving an

    37 min

  4. 02/17/2021

    20 Years of Rural Medical Education

    Unfortunately your browser, (Chrome 79), is not supported by the Rev Transcription Editor. In order to edit your transcriptions, please update your browser. Update   20 Years of Rural Medical Education_WAV_Final_01 arrow_backMy Files   All changes saved on Rev 2 minutes ago. more_horiz DownloadShare               00:00 00:00 22:50 Play replay_5 Back 5s 1x Speed   volume_up Volume   NOTES   Julia Terhune   This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine Family Medicine Department. We are so excited to bring you Season Three. I'm your host, Julia Terhune, and I hope you enjoy this episode.   Julia Terhune   When I first started this job, I was overcome with the needs of rural communities and the wonderful things that doctors get to do in their professions. I was, I guess you could say, fangirling a little about rural doctors. And I told my spouse that this was really what I wanted to do, that I think I wanted to be a doctor. So I had it all figured out. I was going to go to Michigan State University College of Human Medicine. I was going to do the TIP program at the Midland Family Medicine Residency, and then when it was all said and done, I was going to set up a practice with Scheurer Hospital in the Thumb.   Julia Terhune   Now, I have to tell you two very important things that came out of this conversation with my spouse. One, he instantly reminded me that I can barely handle a paper cut, let alone a surgery rotation, and he also reminded me that I would hysterically cry before every anatomy, biology, physiology and chemistry test that I took in college. He also reminded me that my GRE examination for grad school almost killed me with stress, so medical school is not in my future and I will stick to making rural doctors out of the likes of all of you.   Julia Terhune   But one subtle thing that also came out of this conversation was how much I love the Thumb community. Prior to starting with the College of Human Medicine I had never even been to the Thumb, but after six years of working with the Scheurer Hospital and the health departments and other agencies in these communities, I am smitten. I love the people from the Thumb. I love the history, I love the coastline, I love these communities. A story, not unlike many of our medical students, including Shelby Walker.   Shelby Walker   Yeah, so when I found out I would be going to Pigeon, I had never been there before. I don't think I had ever been to the actual Thumb before, maybe close to it but I don't think it was within what they count as the Thumb. And so I had my boyfriend at the time drive me out there just so I could see where I'd be going. So I thought it would make me feel a little bit more comfortable, and we got there and everything was so small. It was such a small town that I almost didn't believe that there was a hospital and a health system there that could especially accommodate students, so it was kind of an odd like, "What am I going to do for two years with a lot of time out in Pigeon?" It was a very odd feeling.   Shelby Walker   And so when we started, my first rotation of third year actually started in the Scheurer Health system with Dr. Scaddan in Sebewaing, and everyone was so welcoming and nice, and who let me do things, which as a third year medical student I was like, "Wait, am I qualified to do actual things?" And I think I had so many unique experiences out there because of where I was at. With Dr. Scaddan I got to be introduced to the ER, maybe a little bit earlier, and their definition of an ER was not what I had seen in the past but they still had some pretty intense situations and things that really were true emergencies that maybe you wouldn't expect in the middle of nowhere in, I think, a five-bed ER situation.   Shelby Walker   We went to the prison to do some healthcare with the inmates. That was an interesting experience that I wasn't really expecting when I had first pulled up into Pigeon. And from there I got to meet so many other amazing physicians and EPPs and just everyone there has been so nice [inaudible 00:05:05] Oh gosh, the administrative staff knows who you are when you show up to their meetings in the morning, because the physicians invite you to go with them to all of these meetings that you feel like you have no business really knowing what's going on, but they bring you to these meetings and the administration staff, they know who you are. They ask how you're doing, they asked how you're liking it. It was such an odd thing to, I guess, stumble into kind of on accident. I'm really grateful that I got that chance.   Julia Terhune   And if that's not enough anecdotal evidence to prove that Pigeon will win you over, well listen to this.   Shelby Walker   So I was talking to Chad about this, and then with Dr. Wendling actually, how odd this all turned out that I didn't want to go to Pigeon and I wanted to go to [Alma 00:05:57] and then I was like, "Okay, I'll do the nice thing." And Chad and I got engaged in Caseville. We went to Caseville on the beach.   Julia Terhune   Our rural medical affiliation with the Scheurer Hospital network didn't start just six years ago. We have a much longer history with the hospital and have been training students in Pigeon for more than 20 years. I sat down with the former CEO, Dwight Gascho, and the current CEO, Terry Lerash, who served and serve the Scheurer Health Network and learned just how it all got started.   Terry Lerash   Well, interesting story. I was working in Saginaw. I had a good position, felt satisfied, but my wife and I were on a Saturday afternoon or morning, we were standing in a field on an Amish farm in Gaylord or near Gaylord attending a wedding of a daughter of my CFO at the time, a guy that worked with me over many, many years. We were good friends so we got invited to the wedding and we're standing in this field and across the field walks Dwight and Theresa. And we had known each other for some time, Dwight and I had, probably over the last 20 years, involvement in hospital council, and health care executives, it's a pretty small circle in the State of Michigan. Most of us know each other.   Terry Lerash   Anyways, I said hello to Dwight. He says hello to me, and I said to Dwayne, "Well, I hear you are interested in retiring," and Dwight said, "Yes, I am. Would you like my job?" And I was a little bit stunned. Said, "Well, geez, I don't know." My wife was looking at me weird and I said, "Well, are you serious?" And he says, "Absolutely am serious." And he said, "Why don't you do me a favor? Why don't you come to Pigeon and just visit with me for a day? That's all I'm asking. No commitment, no strings attached, just come up and visit with me for a day."   Terry Lerash   And out of our friendship, I said, "Okay, I can do that. I can spare a day and run up to Pigeon. This is my old stomping ground anyways. I was born and raised in Bad Axe." So I had been away for probably 40 plus years from my hometown of Bad Ax and it was a chance for me to just get reacquainted with Huron County. So I drove up and I think within the first hour I was so enchanted with Scheurer Hospital because of its culture, friendliness, cleanliness, organization, and clearly Dwight's leadership was a big plus.   Terry Lerash   And as I talked with Dwight through the course of that day and learned more about Scheurer, I understood that the core values of the organization really matched me, kind of fit my dress code, if you will. And so I was intrigued and left and then made a subsequent visit and met with the board and long story short, here I am and I couldn't be happier. This was really a great opportunity for me [inaudible 00:09:29]   Dwight Gascho   And as I reflect on that side of the story, my story would match it almost exactly. I was born and raised in the Pigeon area. I was on a farm, left for a few years for school and the service, et cetera. Came back in 1972 and in 1987, I was invited to serve on the Scheurer Hospital Board of Trustees. And we were having some issues at the time, and in 1990, the board asked if I would take the leadership position in the hospital as the CEO. And I agreed to do that on an interim basis saying, "I'll give it a shot, but if it doesn't work maybe I could help find the next leader." Well, after just a matter of a few months, the board took the interim assignment away and gave me the full-time assignment and so I worked here from 1990 until July of 2016, 26 years plus.   Dwight Gascho   Obviously the hospital was struggling early on. The hospital became more profitable as years went by. We became more successful at recruiting young physicians. And there had been a gentlemen that had served on the board by the name of Loren Gettel. Loren Gettel was a farmer in this area and had a very strong interest in seeing students find opportunities to train in some rural community, and he put that bug in my ear. As a matter of fact, Julie, when I was being asked to serve, Loren asked the board chair if he could spend a day with me. And I'm fully aware of what it was. It was part of a program to see once if I passed the exam, so I think I was being vetted by Loren Gettel.   Dwight Gascho   So we jumped in the car. We drove to MSU and we walked the campus of MSU. He's a very, very strong MSU campaign leader. I mean, he loves that organization. He was grinning away. And he showed me places that were memorable to him an

    23 min
  5. A Drop in Yields: Farm Stress and Farmer Suicide in Rural Michigan

    02/10/2021

    A Drop in Yields: Farm Stress and Farmer Suicide in Rural Michigan

    *PLEASE BE ADVISED: This episode discusses very sensitive and triggering content including suicide and self harm. Please continue reading/listening at your own discretion. This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, The Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine Family Medicine Department. We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. On January 24th, 2020, the CDC published the following, "In 2017, nearly 38,000 persons of working age, that is, 16 to 64 years, in the United States died by suicide," which represents a 40% rate increase in less than two decades. 79% of those 38,000 people were male. And the breakdown of those men in different occupations was as follows, fishing and hunting workers, machinists, welders, soldering, and brazing workers, chefs and head cooks, construction managers, farmers, ranchers, and other agricultural managers, and retail sales persons. In addition to this devastating data, the CDC has shown that suicides are around 30% higher in rural communities in general when compared to urban communities. What do these two things have in common? Farmers. That's the population that I want to pay attention to on this list, though I want to acknowledge the depravity and the sadness that this list holds. The thing about farmers is that they are a really important population. They take care of our plates, of plates around the world. And in 1900, 40% of the workforce was in agriculture, but by 2002, that number was down to a staggering 1.9% of the workforce. The United States Bureau of Labor Statistics predicts that there will actually be an even greater reduction, a 6% reduction in farming jobs over the next 10 years. And since the 1990s, the rate of suicides by farmers when compared to the general public is 3.5 times higher. So here we are. In the last six years, more than 450 farmers have killed themselves. The numbers of farms totally has decreased, but the productivity and output of the farms that are left has increased more than 50%, partly because it's had two. And the total amount of debt that farmers owe has increased 5%, which may not sound like a lot, but that number equals $16.4 billion, billion with a B, that farmers owe since 2017, in addition to what the debt already was. There's a fantastic article that USA Today has published, and we will link to that on our website. This article goes over many of the reasons why this phenomenon of farmer suicide is happening, but I wanted to provide all of you a perspective from the people who are working with this population, live with this population, love this population, and are trying to do something about this problem. I conducted interviews for this podcast in late 2019 and early 2020, but the stressors and complexities for farmers that my interviewees talk about are not outdated. If anything, they've become more acute than they were before. The first thing I want to show is that the stressors that the CDC, NIH, USA Today, and so many others have identified as problems were also identified by my interviewees. And I think that these are issues we're all worried about. We all care about the environment, and obviously we all want to have financial stability, but these are all real stressors for farmers because it affects their livelihood, and their livelihood affects our livelihood. Literally. It's actual food. They make our food. Without farmers, we don't eat. And of course, there's a lot to say about small farms versus big farms and how that business phenomenon and how that transition is affecting our food, but the idea of farm stress and the idea of farmer suicide doesn't hit one sized farm over the other. It's something that is taking a toll on everyone, and something that my first guest, Sarah Zastrow, knows firsthand and professionally. So I grew up on a farm out kind of in Freeland, south of Midland a little ways, and my dad and his brother farmed sugar beets, corn, soybeans, and wheat. And I swore that I would never shovel manure again after I left for college. And my dad said, "Don't marry a farmer," and so of course I did. So we just farm a little bit, both with his grandparents, and so that's kind of fun. It's interesting to see the dynamic of several different farms. We've got a lot of farming families, and so it's kind of cool to see that dynamic and the different ways that every farm operates. So that's kind of cool. And then what I do is I have my own wellness business where I teach people how to manage stress, which has turned into teaching farmers how to manage stress. And so that's been really, really interesting this year and really has just taken off this year with this terrible farming season and all the pressure with these tariffs and different things like that. So you came across the issue of farm stress organically? Yes. Can you tell me that story? How did this come to into your purview? Yeah. So I think that farm stress has always been really evident in our family, both my mom's brother's farm and my dad and his brother's farm, and everybody sort of has a touch of anxiety and you just notice things that are affected by that stress. And so I think that I have always known that sort of growing up and that people just handle stress very differently, however, it's always been really apparent to me that farmers in particular are stressed out. And especially when the weather doesn't cooperate and when there's so many factors outside of your control, that contributes to a level of stress because everything feels so crazy and so out of control. And so I think that that was kind of the first introduction I had to farm stress. We had a farmer neighbor who committed suicide a little while ago earlier this fall. And it was just devastating. And I'm going to be honest, I didn't know him at all, however, we heard the gunshot and then heard through the grapevine later that day that he had committed suicide. And I thought, "This is terrible." And then we went out for breakfast a couple of days later, and the girls in the restaurant at the breakfast joint realized that there was something different about him, but what do you do? What do you say? And when you notice something is off like that, at what point do you say something? At what point do you mind your own business? At what point does another person need to reach in and help? And so that was another kind of determining factor for me that this and what I'm doing, this talking about stress management, giving people the tools to communicate with their spouse, with a counselor, with different people, whoever you feel comfortable with is really, really important and really, really needed on every single farm. This issue of farm stress and farmer suicide is so big that people from the community and people outside of the community, people at the state and federal level have taken note. Eric Karbowski is a community behavioral health extension educator for Michigan State University Extension, and Eric's job was created by Extension to tackle the immense social issue that is plaguing Michigan farms. Eric's job is to help find large-scale solutions and also develop grassroots and educational efforts to help this targeted population. Well, my name's Eric Karbowski. I'm behavioral health educator working with Michigan State University Extension. My path to becoming here, I really had no intentions of working for Extension. I grew up in a rural area. My grandparents were farmers. I had the opportunity to participate as part of the CMU football team, which is really part of the reason I actually went to college. My parents never attended a university or anything like that. My dad worked for GM and my mom worked in the post office. And so athletics really was my opportunity to go to the university. And then, so after that, I started my career. I worked in inner city Saginaw in Detroit, working with individuals with mental illness and helping them find jobs, competitive employment. Eric's job was created by Extension, and Sarah was developing her business at the same time that the CDC and other health entities were shocked at the suicide rates among farmers, a discovery that was being published and made known at the same time that huge tariffs and trade wars with China were being conjured up by the Trump administration, an administration that was largely supported by a rural farming base. It was a great opportunity for me to give back, because I married into a farming community, and give back and stay connected with really where my roots are, working with the farmers and talking about farm stress, talking about a lot of the hard discussions, suicide, mental health, mental illness, that really aren't comfortable conversations for people to have. And so it's been a really unique and good opportunity for me to connect with the farmers and really try to make a profound difference in their lives. So with an America first mindset playing out internationally, huge hurdles for selling commodity farm goods were being positioned for farmers in the United States, something that has led to new cultural and social issues that are developing for many farming families, families like Carolyn's. Carolyn is one of our leadership and rural medicine students and she grew up on a small farm in the center of our state, one that is still running today, and one that has been managed by her parents, partly because they ran it as a second full-time job, having other means of income outside of the farm. Yeah. So I just spoke with my father about the tariffs and what his perspective of it was. And he thinks that they lost, because of the tariffs, about $40 to $50 an acre money-wise for... I guess we had soybeans for the tariffs [inaudible 00:12:19] how prices went down. And then a big conversation that's been

    21 min
  6. Arts Rural

    02/03/2021

    Arts Rural

    Transcript  Julia Terhune: This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. And Grace A. Dow Foundation, and the Michigan State University College of Human Medicine, Family Medicine Department. Julia Terhune: We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. Julia Terhune: A common pastime for rural residents and tourists alike is the local farmer's market. I love them, and it seems to be a hallmark for many rural communities. Not only do farmers attend these events, but often you'll find local craftsmen, artists and even local musicians. Julia Terhune: So maybe that's what you were thinking when I said art in rural communities or arts rural for this podcast episode. And you'd be right. After all, there are many artists who are at these events, but my perspective takes a little different turn. Julia Terhune: When I say arts rural, I was actually thinking about some of the doctors and future doctors that I know. So that might sound kind of confusing, but it's not when you think about it this way. I describe it like a Venn diagram. There's one circle with art. There's one circle with medicine and in my world, where they seem to overlap is in rural communities. Julia Terhune: You see, growing up in a small town, I experienced a place where people used their crafts to survive, but also where many arts and skilled crafts have survived. If you've ever been to one of those markets that I mentioned, you know what I mean. People make their living off of the things they make, but they also make things to serve them on their farm, in their home. Some families I know, and maybe you know too, have simplified their lives, to make more room for art and music. And there doesn't seem to be a community gathering without those things in many small places. Julia Terhune: So what does that mean for the doctors that want to serve in these bucolic communities? Julia Terhune: We've talked at length on this podcast about the social and economic complexities that make doctoring in rural communities a little harder. Harder problems sometimes cause more creative solutions, which is definitely something our partners today will speak about. But I think that the people who serve in these rural communities as physicians are themselves a little more complex. They seem to not only come at physical issues with a multi-faceted approach, but have several sides to them as people. Julia Terhune: We've said on this show that doing rural medicine is a brave thing to do. Now, I would like to propose that serving rural communities is a creative thing to do. Julia Terhune: Let's start with some student stories. Right now in the leadership and rural medicine programs, we have two pretty creative women learning to become rural doctors. Kayla, who you'll hear from first, is originally from Minnesota, but is now completing her clinical medical education in Traverse City and preparing to become either an OBGYN or a surgeon. She's not a hundred percent sure quite yet. Julia Terhune: Ellie is originally from Illinois, but came to the upper peninsula during her undergrad and has stayed in Michigan ever since. She will also be going to Traverse City this summer. Both students got a fine art degree along with their pre-medical requirements in undergrad, and yet nothing deterred them from medicine. Kayla: So I went to undergrad. I had actually already completed 60 college credits before I even got there. So I only had two years left to do. Kayla: But I had this four year scholarship that covered a good amount of my tuition. And I was like, "I don't know if I'll be ready to graduate in two years." So I went to undergrad. I knew I was going to do something science, but my whole family is kind of artistic and no one's really been able to go and entertain that or build on their artistic skill. The [inaudible 00:05:00] high school art classes and then my oldest sister just stopped and my mom kind of stopped and I was like, "I would love to do art." Kayla: So I went to undergrad and I did a double major. I did biology and then studio art and then a chemistry [inaudible 00:05:14] but no one cares about that. Julia Terhune: And Ellie reiterated that point. Here she is. Ellie: I kind of have always wanted to go into medicine. From when I was younger, it was like the first thing that I said when I was five. And I feel like it's very cheesy, but then I never really came up with anything else that I liked. Ellie: I just kept finding more reasons as I got older to like medicine. Until I got into high school, I didn't really have any other ideas. And I took my first real art class. I took a ceramics class in high school and I was lucky to be in an area where we had lots of different art classes. So I was able to take a couple years of ceramics back then. Ellie: And I just really fell in love with it and I love working with my hands. I've taken so many science classes to try to do well and prepare myself for the future, being a doctor, that I wanted. Just being in art was really nice and relaxing. It kind of gave me a creative outlet that I didn't know that I needed and I just really enjoyed it. Ellie: After I took those classes and I was a senior in high school, I said, "You know what? I'm just going to be an art major." And I can still take all of my, my science classes. And I had actually met with my future advisor, pre-medical advisor in college. His name's Dr. Lucas. He's at Northern Michigan University. And he told me to just go for it. He was like, "There's so many people that apply as science majors. And a lot of medical schools now are really interested in people that are doing something different. So have other passions. " Ellie: So I just decided to go full force with it. And I really have no regrets. It was one of the best decisions that I made. Kayla: And it worked out really well. It's been kind of a stress relief. I'd go to these really intensive biochemistry and then biochem lab. And then I would go and I'd worked 15 hours on a sculpture and it would be like the perfect little ratio for me. Kayla: It took me a long time to figure out what I was going to do with my senior art show, a big project you put together at the end of your four years of undergrad. And it's a big group show. I was applying to medical school at the time, going through all my interviews. And I started sculpting all of these heads. And I tried to like convey what does it feel to be anxious or to be so stressed out? Kayla: And I kind of just went for it. I just started sculpting this giant head. And then of course it fell apart because art just always falls apart on you. It's really good for problem solving though. So I had to rework it a couple of different ways and it turned out better for it, so that was nice. Kayla: But I ended up doing these five heads on these giant four-foot pedestals. So you'd walk into the gallery and all these heads are staring at you. And each one was kind of a different representation of anxiety or stress or kind of depression, but more anxiety and stress. And I had interviewed some of my friends and siblings and I was like, "Okay, what does stress feel like to you?" I was trying to capture how we all feel stress so differently. Kayla: So the first one I made, it was based off my face and it was screaming. And then half of it was kind of exploded off. Kind of like if you've ever felt so frustrated, your head's going to explode. So I literally made that, but then I did it very realistic on the side and then where it was exploded, it was very artsy and abstract. And I really wanted to highlight clay and what clay can do. Kayla: And then the other four, one was really spiky. It had all these spikes, kind of like how you get really defensive and shove everyone away from you when you get stressed out or at least I do. And then there was another one. My mom was like, "How come none of your sculptures are smiling?" And I was like, "Oh, I got this." The last one I made was smiling, but then it was like empty inside. Kind of how you can put on a smile, but sometimes they're not always... It's just like a face, right?iSo it was empty on the eyes. And the head was crumbling down around it. You put on the face, like I'm still smiling, but on the inside, you're kind of empty. Kayla: And it was just such a cathartic experience. I don't think I even understood the stress and anxiety that I was carrying and just shoving down until I put it into these art and it's so therapeutic. It was amazing. Julia Terhune: I had to ask Kayla at this point, if she ever felt like the two sides of her brain were at war with one another. Kayla: I think in undergrad a little bit. When I was going for it, I had been accepted into medical school and then I had completed this big project and I was so proud of all those sculpted heads. And my art teacher's like, "Are you sure? It would be so like..." She was like, "You would love the art community. You can join us still." And it definitely crossed my mind. I was like, "Oh, if I do medicine, will I have time for art?" But I'm trying to. I'm trying to force myself to incorporate it in, and time management so that I get to embrace both. Julia Terhune: What is always fun and interesting about doing these podcasts is the similarities that come out of your conversations and the commonalities that people have with each other, even if they aren't related. Julia Terhune: This idea of art, not only being a place of relief, but also a way to think about serving patients holistically was something that I found out from Dr. Julie Phillips as well. Julia Terhune: Dr. Phillips is a wonderful partner and friend. While she may not be a rural doctor, she serves in one of the state's largest hospitals as a family medicine doctor who also does OBGYN. So she sees many rural patien

    23 min

  7. 01/21/2020

    40 Years of Rural Medical Education

    To tell you that we are experts in Rural Medical Education is a bit of an understatement! We have been training and retaining rural doctors in our state for more than 40 years! So, let's take it back to where it all began, the U.P., and learn how it all happened from the man that was there!  This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the The Herbert H. and Grace A. Dow Foundation and The Michigan State University College of Human Medicine Family Medicine Department. Welcome to season two. I'm your host, Julia Terhune, and I hope you enjoy this episode. I don't think there's been a week that has gone by since I started working for the college of human medicine that I haven't talked about how we have been recruiting, training and retaining rural doctors for over 40 years. For those that I work with, I'm pretty sure they were able to dub those words with almost my exact inflection. I talk about it all the time and not just because it's my job, but because I'm really proud of the outcomes of our program. I'm really proud of the work that everyone for decades has put into the success of our medical students and the success of the rural medical systems that take our medical students. Now in 2019, I get to change my script just a little bit because this year we are celebrating 45 years of rural medical education. In these 45 years, we have been able to show the outstanding and significant outcomes related to developing the rural medical workforce, and we have expanded our rural medical education certificate programs to include two additional rural campuses where students can receive that certificate. Those campuses are now Traverse City and Midland. With that expansion in 2012, we have been able to cover the map of Michigan with rural medical education opportunities. Those opportunities provide students with an understanding of the unique needs found in many of our rural regions across the state. For those medical students who want to get rural medical training, they can pick from two different programs, the rural physician program based out of Marquette or the rural community health program that's based in either Midland or Traverse City. Both programs are under one big umbrella called the Leadership in Rural Medicine program. But this umbrella wouldn't exist at all if it wasn't for the men and women who worked so hard to establish rural medical education opportunities in the upper peninsula starting back in 1974. To honor this legacy, we wanted to showcase the man who was there when it started and let him tell you the story about how it all began. Dr. Daniel Mazzuchi was an internal medicine doctor who came to the upper peninsula of Michigan in the late 1960s. He was an integral part of establishing the program first in Escanaba and then in Marquette in later years. His influence on the college was so tremendous that much of what he's established during his medical education career is still in place today. Dr. Mazzuchi sat down with Dr. Andrea Wendling, the current director of our program, and told us the story of how it all began. To talk about medicine in Marquette, you have to kind of... Medical education in Marquette, you have to kind of break it up because nothing happens in a vacuum. The political factors that went into allowing the UP experiment, which is what it was called, to be started, the people or cast of characters involved in it, and then how it eventually evolved as medicine evolved in the UP. We owe a great deal of credit to the development of our Marquette campus and our rural medical education heritage to the late Donald Weston who served as Dean of the college of human medicine from 1970 to 1989. He's the reason why we're here. I mean, that's a simple declarative sentence. He was a fly fisherman and he and his buddies were up fly fishing somewhere in the mountains. They were dreaming. They were iconoclasts. People really have no idea how iconoclastic they were. They thought that they could develop more of an apprenticeship model of medical education. They thought about it for places like they were fishing in, Montana and Idaho and all. Eventually that became the whammy program. They were also very politically aware and connected and hung out with politicians from the state government. They were drinking and talking and talking about this stuff. One of the guys said, "The hell you thinking about Montana for? I mean, we have a problem in the UP. Why don't we do something in UP?" People up here in 1973 had an idea and that was to have this apprenticeship model on an experimental basis built around a practice. He got a lot of communities interested in it. Eventually Escanaba was the site they chose, not Marquette. They hired a guy named Paul Warner and another guy named John Hickner and they developed a family practice down there and he put students in there for all four years. Unheard of. This was an experiment. 10 students every other year. After about three or four years, the LCME called Weston and said, "If you don't stop this, we're going to discredit the school." Why did they say that? There was no way... Unless the students decided to take national boards on their own, the LCME could judge the progress of people. The curriculum was let's call it innovative to sprain the meaning of the word. In terms of available data, the students were doing fine, but the available data wasn't sufficient in the minds of the people who were in charge of the LCME at that time. The long and short of it is a compromise was reached to relocate the first two years back to campus and to make this a clinical campus, but with a different mission. That's lasted to this day. Yeah. What was that mission at the beginning? The beginning was to try to resolve the problem of rural areas in getting people to come here to practice or even more importantly, to encourage people who lived here, who would ordinarily want to stay here, to get into medical school, to open the doors a little wider for them. We, by the way, had a separate admissions committee. The thing was it was a day when the decision was placed in the hands of a small group of people who had their own ideas about who should be going to medical school and who shouldn't. Although I would say they were very, very well intended people, I was a part of them. It was a very serious matter for them. But they took to what would be viewed today as an extreme, their desire to be sure that people came back here as much as possible. The bias, if you will, was very heavily towards people from the upper peninsula as was the intention of the founder of this program. That's what he wanted, but also towards women, also towards older people in general. I would say those things have by and large continued as far as I can see in a much different way and under it. But I think this campus has almost always had at least 50 and more percent women students and has always had a handful... Always had people in their late twenties, early thirties coming in, which I think is outstanding. I think it's the way it should be, but no, it was just that they kind of went a little overboard. Can you talk about how you figured their curriculum out and how you could coordinate that with the main college? I did not figure out the curriculum. Okay? Okay. I worked with department chairs. Department chairs were responsible for the curriculum here from day one just like they were everywhere else. It wasn't a detached program. It was an integrated program. It had people in the department who believed strongly. It was not in a vacuum. It was all integrated and carried out under their distant supervision. Every department had their persons here. They were likely to be local and they made regular trips up here. The students took always the same exams that happened on campus. All that other stuff [inaudible 00:10:25] But anyway, yeah, that part I would describe it as real but imperfect. It wasn't perfect because it wasn't next door. It was far away. I went down there as associate dean in '84, five, six, and I was responsible for all the campuses. I came back here in '87. I think it was when I came back and took stock of things and I thought to myself, you know what, this place looks like every other campus there is. That's not good. It might've been while still I was... I don't remember exactly, but somewhere in there in the '80s started thinking out loud, we need to do something to make this a special program again. Yes, we were no longer called the UP experiment. They were called the UP campus. Yeah, we had had some graduates and they were practicing all over, but a lot of them are in the UP. I thought, hmm, why not a two month long family practice experience in the little towns of the UP with the people who graduated from this program as their kind of overseers and so forth? Ultimately they gave permission for us to do a two month long... In addition to the one month, a two month long family practice experience in these little tiny towns. That extended time in rural family medicine lives on for our rural physician program students in Marquette. I know students are thankful that Dr. Mazzuchi started that model, and I know this because I was able to talk to one of the graduates of the program. Dr. Nicole Zimmer is now a family medicine resident at the MidMichigan Family Medicine Residency in Midland, Michigan. Her longitudinal family medicine experience set her on that path that Dr. Mazzuchi had envisioned. What was a highlight of your time up at the Marquette campus? If you could pick a day that you could relive right now, what would it be? I really enjoyed... We do 12 weeks of family medicine up there. Four weeks was in Marquette and eight weeks we spend kind of in a rural area. Mine happened to be Ironwood. I loved everything about being up there. It was in the spring, so it was absol

    25 min

  8. 01/14/2020

    Beyond a One Room School House

    We started off this season talking about how limited broadband access can impact student performance and the overall well-being of a community. Today we are going from worry to a celebration and talking about the people who make a positive impact on students in rural communities through the public health system.  This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the Herbert H. and Grace A. Dow Foundation and the Michigan State University College of Human Medicine Family Medicine Department. Welcome to season two, I'm your host, Julia Terhune, and I hope you enjoy this episode. Education levels in rural communities is something to talk about. While rural communities lead the nation in number of individuals who have a high school diploma, according to the USDA, the number of people living and working with any additional education drops right off. In 2016, only 19% of all rural adults had anything more than an associate's degree as compared to 33% of all urban adults. When we look at county data, rural America leads the way in number of counties where more than 20% of the working population does not have a high school diploma. The prospects for higher education in rural America is bleak and it's low educational attainment seems to perpetuate the issues of rural poverty and the vitality of these communities, but there are success stories. If we drive North to beautiful Charlevoix County, we will get to a five square mile town called Boyne city. Boyne city is home to around 3,750 people, most of whom are over the age of 40. The average family in this area makes about $31,000 a year, which is more than $20,000 less than the mean income for the state, allowing for the average poverty rate in the county to sit around 12.5%. Like the rest of rural America, the majority of citizens have no more than a few college courses. Meaning that 60% of the population of Boyne City has nothing more than a high school diploma. For all those listening who are interested in medical access in rural Michigan, the health resource and service administration or HERSA has designated Charlevoix County as a health professional shortage area for primary care, dental care, and mental health care. In 2018, Boyne City High School saw some amazing students graduate. In fact, around 115 stellar graduates came out of points city, if we're going to be straight about it. We are going to talk to three of these amazing students, but I want to quickly set the stage. Boyne City High School graduates are coming from a rural school in a county that has some big social factors to overcome. 38% of all the students at Boyne City High School receive free or reduced lunch, and around 18% of the population that lives on less than $35,000 per year are families with children. Furthermore, I took the Liberty of plotting how far a student would have to travel to get to the nearest four year university from Boyne and I posted that map on our Facebook page, but I'll give the bag away. The closest four year institution to Boyne City is Lake Superior State University, which is over 90 miles away and across a five mile bridge. Therefore, options for a close to home education don't really exist for young adults looking to get something more than a high school diploma. But I told you there were success stories for this episode and there are. It's just that the students that have found their way to higher ed had more work to do than you would've expected. So let's introduce our leading ladies, shall we? Katie is going to Northern Michigan University. Katie is the daughter of Joe McCue who you heard earlier this season and is the oldest of a big family. She's staying in the state, but remember NMU is over 150 miles from Boyne. Maddie is going to Brown. Yes, Brown, and is going to tell you a lot about her trail to an Ivy League education and Anna, well, Anna is going to Stanford, you know the number two university in the world. So what is different for them? Anna, Katie, and Maddie graduated from a class of around a hundred to 115 people and when I asked them about how many were going on to university, they had this to tell me. University, university? Maybe 40? 50? Yeah. Probably 40. Yeah, because a lot are going to [crosstalk 00:05:04]. Community college. Yeah. Okay, and is that pretty standard for your area? That's pretty good actually. Yeah, our grade I think had- very ambitious. Ambitious, very academically inclined grade at least compared to others and the three ahead. Or even the three behind. Just looking forward. Most of our students put academics before a lot of other things, which was kind of uncommon. So was there a lot of competition then in your grade academically? Yes. Yeah. Yeah. Everybody was applying for the same scholarships. It's like, "I don't know if I want my friends to read my scholarship letters because they're applying for the same ones." It was hard. If you look at the top 10% of our grade- Of level four. Yeah, it's super impressive the number of people who- The top 10 had above [inaudible 00:00:05:58]. Yeah. Okay. So what is different? Why is your class different than the three ahead and the three below? I have a little bit of theory. Okay. So in fifth and sixth grade the math classes were accelerated or there were some accelerated math classes, which was a newer thing in the middle school and they [crosstalk 00:06:21]. They took a whole chunk of us and just pushed us forward. IT pushed us up and then the chunk right behind us ended up meeting at the same place in eighth grade where we were all in an accelerated class and that was 30 students, and those 30 students continued to be the top 30 in the grade all the way through high school because they've been pushing our grade. There are lots of educators who care and care a lot about encouraging and promoting student success, but the concentrated effort that these Boyne City graduates experienced is a positive benefit of being part of a rural school. A rural school where they had the ability to identify and focus on those 30 high achievers. This concentration didn't just stop with that top 30. It had an impact on all the other students as well. Yeah and [crosstalk 00:07:12]. But it grows everybody else up because now the standards- Yes, now there's more competition. ... Were being good or academically good for lack of a better term is so much higher than everybody else raises. Yeah. There's something else about the accelerated English classes too with that. The same 30 people are in that. Because there was so much of a demand. Then it just kind of ... Everybody had to be working a lot harder to be considered the standard. So are there any other theories that you guys have [inaudible 00:07:41]? we were really close and we just so it was all this really positivity. We were are really positive grade and we all had these great outlooks on the future and every chance that we got that we could improve on those AP classes or advanced classes everybody took it, because we'd all just saw this opportunity to do better. And it almost became a social thing in the sense of if you're in honors English now you get to be with all the fun people in the honors English. So now our honors English class is 30 kids big and it's fun. Or AP World or calculus or physics. You get to be with your friends. Yes. So 98 people, that's easy to do, right? If 30 people can easily have an effect on 98 people. So if you guys were at a bigger school, do you think he would have had that same effect or do you think that that would've been the status quo? I don't think we would've. I think we would have just been that one class full of nerds. Yeah, because [crosstalk 00:08:44]. You have all the opportunities. It's open everybody normally. And so it's just kind of like, "Oh, it's still part of the thing." You don't as involved because it's just your educational process. There's nothing different. You don't have to fight. For those advanced classes. For us, we had two AP courses offered taught by teachers and so if there was an AP course everybody's is like, "Oh my gosh, there's something new. We all need to take this." It's really cool where it's like my cousin goes to a bigger school and it's like, "Oh, we have five to 10 AP courses offered and it's no big deal." You take it if you want to take it [inaudible 00:09:24] show your college [inaudible 00:09:26] college SAT scores and all of your grades throughout your previous classes and your grade point average. We didn't even have a [inaudible 00:09:35]. You have to get teacher recommendations to get into these advanced courses because everybody wants to do it. There's a benefit to that fight that Katie and Anna spoke about. It can prepare you for what comes next. We talk about the plight and vulnerabilities of rural areas on this podcast often, but we also need to highlight the resilience, the tenacity that living with limited resources can provide. Catherine Ellison was from my small town. She is one of those brave souls we speak about who goes away, gets tons of experience in education and comes right back to the community. She is currently the elected school board president for [inaudible 00:10:16] Public Schools and I asked her about the barriers, both perceived and real that rural public school graduates face. Well, talking about your perceived in reality. I think it's perceived through a disadvantage. It's a smaller school. Maybe they don't have as many offerings as a big school. You have the same teachers for years and you see the same people in the hallways but in a lot of ways, especially with today's these kids where everybody's on their phone, on the computer, you on the tablets, there isn't that social interaction. Small districts can be great. I mean, you're still going to learn how to read and write and do math, all those basic thin

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About

This Rural Mission is a podcast that discusses pertinent topics related to rural community health and social issues around the state of Michigan. Each episode highlights rural providers, medical students, and community members who are making a difference in the lives of rural residents.

Information

  • Creator
    This Rural Mission
  • Years Active
    2019 - 2021
  • Episodes
    16
  • Rating
    Clean
  • Show Website
    This Rural Mission