Introduction

The Mississippi Rural Physicians Scholarship Program (MRPSP) was established in 2007 to address the shortage of primary care physicians (PCPs), particularly in rural Mississippi.¹ The program would accomplish this through efforts to identify and recruit students interested in becoming a primary care physician and who have a desire to practice medicine in a rural area of the state. The following information will review the problem the program was created to address, how the program achieves its goals, and the many successes of the program since its inception.

Problem

In the mid-2000s, the medical community and patients of Mississippi faced a litany of problems, the most prominent among them being a lack of much-needed primary care physicians and a dire need for primary care physicians in rural areas of the state. Data from the American Association of Medical Colleges showed that in 2007, Mississippi ranked 50^th in the nation for active PCPs per 100,000 people.² There were 1,850 PCPs practicing in Mississippi, which equates to 63.6 PCPs per 100,000 people. The United States average for the same time was 88.1 PCPs per 100,000 people. Mississippi was also faced with an aging physician population as more than 21% of physicians in the state were 60 years old or older.³ At the same time Mississippians suffered from many common health issues at higher rates that than citizens of other states. In 2004 Mississippians had the highest rates of adult obesity in the nation.² The prevalence of diabetes in the state was 9.5%, higher than the 7.0% rate in the nation overall. Obviously, drastic measures were needed to address these health disparities and bring more physicians into the areas of the state where they were most needed.

Proposed Solution

Physicians, lawmakers, academics, and many others from across the state came together to discuss how best to tackle these issues. Borrowing some ideas from similar programs across the country, the passage of House Bill 1465 established the Mississippi Rural Physicians Scholarship Program (MRPSP) in hopes that it would help breathe life into primary care in rural Mississippi, with primary care defined as covering generalist specialties including family medicine, internal medicine, pediatrics, medicine/pediatrics, and OB-GYN (and a scholarship opportunity for psychiatry was later added by the Legislature). The idea behind the program was simple: a student would be offered a scholarship for medical school in exchange for agreeing to serve in a rural area of the state. However, finding and recruiting those students was a much more complex undertaking.

The legislation designed a pre-matriculation, or undergraduate, pipeline program to recruit students with a connection to a rural area into the program to mentor them, introduce them to rural primary care, and help them successfully apply to medical school, as well as provide support through medical school, residency, and even their initial practice. In order to recruit these students, MRPSP staff would reach out to pre-professional advisors and professors at community and four-year colleges to present presentations and visit with students who had an interest in going to a rural area to practice. Each year, approximately 15-25 students are chosen to participate in the undergraduate program with the understanding that not all of those students are likely to matriculate into medical school. There are two main reasons behind that assumption.

1. Some students simply do not get accepted, because of grades or Medical College Admissions Test (MCAT) scores or some combination of the two.

2. Other students take part in the program and realize medical school is not for them, but many of them still become part of the health care system in Mississippi. Former members of the MRPSP undergraduate program have gone on to become nurses, nurse practitioners, physician’s assistants, and even dentists, so they are still contributing to the overall health and well-being of patients across Mississippi. (NOTE: There is some limitations of our analysis here regarding collection of data from students who leave the program to pursue other careers. That is not something the MRPSP currently monitors.)

In the undergraduate program students become a part of a network of current medical students, residents, and practicing physicians, all of whom share the same goal of working to increase access to care in rural Mississippi. That community provides the students with opportunities to grow as future medical professionals and learn about the many aspects of primary care as well as challenges facing physicians in rural areas of the state. These students also receive support for the MCAT and for applying to medical school, such as application seminars, as well as shadowing and hands on learning opportunities to help them prepare to enter medical school.

Mentoring is one of the most important aspects of the MRPSP. Many of undergraduate students in the program are first generation college students and/or from disadvantaged backgrounds, so leveling the playing field for those students is important. Here is just a sampling of the mentoring the MRPSP provides:

• Providing knowledge about and preparation for the MCAT

• Supporting students and answering their questions about the application processes

• Introducing students to the areas of primary care via Medical Encounters activities as well as through interaction with residents and practicing physicians who specialized in those fields

• Offering opportunities to get hands on medical experience through skills training in suturing, checking blood pressure, identifying heart and lung sounds, casting, phlebotomy, joint injections, intubation, OB/GYN procedures, IV placement at the simulation centers at both School of Medicine at the University of Mississippi Medical Center and the William Carey University College of Osteopathic Medicine.

• Helping to establish mentoring relationships with practicing rural physicians through required shadowing

MRPSP students learn more about the program and medicine in general at Medical Encounters, biannual meetings where get to know each other, meet medical students, residents, and physicians, and join a community of like-minded people who are also excited by rural medicine. These meetings introduce the students to each area of primary care, give them opportunities to learn about telehealth and emergency services, and provide them firsthand experience at the University of Mississippi Medical Center and the William Carey University College of Osteopathic Medicine. For the final Medical Encounter, the students go out and learn about residency programs and have opportunities to see patients with practicing rural physicians.

Once these students matriculate into medical school, they are under consideration for a scholarship of $35,000 per year. Originally, the scholarship was $30,000 per year. In the 2022 Mississippi state legislative session, the increase in scholarship was achieved. The scholarship is for each year they attend medical school, totaling $140,000. The scholarship agreement dictates that the future physicians serve one year in rural Mississippi in exchange for one year of the scholarship for a maximum service requirement of four years. Based on FY 2022 funding, the Legislature is currently funding 62 scholarships for students interested in rural primary care or psychiatry.

The mentoring offered through the MRPSP does not stop once a student begins medical school. Program staff offers support for these students, assists with residency and specialty selection, and even makes connections for future employment in rural Mississippi. They are also even further connected to a strong group of rural primary care physicians who remain involved with the program through mentoring students, offering a continuity across the program as they will in turn be able to do the same thing for future participants. Even in residency and in the initial stage of practice, the program offers support in finding employment opportunities, making connections, and growing in their roles as a leader in their rural areas.

Results

We reviewed data about the physicians who have participated in the program from its inception to the current date and also included ancillary benefits for the state of Mississippi through MRPSP scholars practicing in rural areas. The definition of “rural” as used for the MRPSP is specific to the program. Originally, for a city to be considered rural, it must have a population of 20,000 residents or fewer and be at least 20 miles from a medically served area. In 2019, the population threshold was lowered to 15,000 residents or fewer.

As of the summer of 2022, 66 primary care physicians have been placed in rural, under-served areas around Mississippi. Projections show 75 physicians serving rural Mississippi after the summer of 2023 and approximately 220 MRPSP scholars in practice by 2030. In addition to practicing physicians, there are 54 physicians in residency training, 64 medical students, and 62 students in the pre-matriculation portion of the program.

Current practice locations are listed in Table 1.

Several important points about the successes of the Mississippi Rural Physicians Program:

• MRPSP physicians have served a combined 216 years in rural Mississippi, leading to approximately 1.2 million visits with rural patients.⁴ This includes physicians who have completed their service and are still practicing in a rural area as well as those who completed all or a portion of their service and moved to a non-rural area.

• Thirty-two MRPSP scholars have completed their terms of service to the state of Mississippi, and, of those, 27 (84%) are still in practice in a rural area.

• Mississippi’s percentage of primary care physicians per 100,000 increased nearly 4 points to 67.4% in 2021 from 63.6% in 2007, according to data from the Association of American Medical Colleges.

Outside of benefits to patients who otherwise may not have had access to a local primary care physician, MRPSP scholars have also been an economic boon to their local areas and the state as a whole. These physicians have contributed nearly $120 million in economic benefits to the state, with a projected total of approximately $400 million by 2030.⁵ Total state and local tax revenue generated by these physicians is more than 4.4 million dollars. Additionally, each physician supports around 11 jobs, meaning MRPSP physicians have added 726 jobs to local economies across the state.

Conclusion

Mississippi’s medical community has faced unique challenges over the years. The Mississippi Rural Physicians Scholarship Program by the Mississippi State Legislature was founded as a way to increase access to primary care in rural Mississippi, and, based on data gathered over the last 15 years and thanks to increased funding and scholarship opportunities from the Legislature, it has shown to be a success. With 66 primary care doctors currently in practice in rural areas and many more in the pipeline, rural health care is changing in Mississippi. These new physicians are impacting patients every day and spending their time making the state a healthier place, one small town at a time. As the program continues to grow and produce more doctors – a nearly decade long process – and send them to even more rural, underserved areas of the state, more patients will have access to quality health care and the need for new primary care physicians across the state will continue to be met.