Dr. Benjamin Balin attended medical school at St. George’s University in Grenada. The Caribbean medical school exposed him to a much different healthcare landscape than what he was used to growing up in Southeastern Pennsylvania.
“Although it's not necessarily rural, because the hospital is located in one of their cities, it is absolutely underserved, just because of the nature of the economy there,” Balin said, noting that the country relies heavily on tourism. “That gave me an initial exposure to what it's like to deal with patients and an underserved setting.”
This experience encouraged Balin to apply for a rural residency. Balin is now a second year resident at University of Pittsburgh Medical Center, or UPMC, Wellsboro in Tioga County through UPMC’s rural residency program.
UPMC’s rural residency program
The program is in its second year. Dr. John Boll, the program director, said he and colleagues started its development in 2019.
There are two rural residents per year. They start the three-year program at UPMC Williamsport before moving to either UPMC Wellsboro or UPMC Cole in Coudersport, Potter County, for the last two years.
“The reason that we actually have limited our rural program to two per year is because ... we're training in an area of scarcity, and so one of the problems is, if you actually inundate a community with too many trainers or trainees, that you actually end up decreasing the quality of your education,” Boll said. “So we have limited it to two residents per year, and I don't think we're going to expand that out, although there has been talk about expanding out the concept across other rural communities across Pennsylvania, where UPMC hospitals are.”
Boll’s goal is to bolster the rural healthcare workforce.
“About 20% of Pennsylvania and United States population live in rural areas, and unfortunately, the physicians that work in rural areas are also aging. In Pennsylvania, there's about 800 rural physicians, and 25% of them are at retirement age or older," Boll said. "It's really pretty clear that in about a decade, there's going to be a really big crisis for rural medical care, simply from whether or not there's going to be access for physicians alone."
The 20% of Pennsylvanians living in rural communities, are served by about 10% of the state's physicians, Boll said. With that in mind, he periodically looks at the number of primary care physicians per 100,000 residents in Tioga and Potter counties, where the residency program places doctors.
“Tioga County is at 50 per 100,000,” Boll said. “There's very clear evidence that there is a direct link between the number of primary care docs per 100,000 and life expectancy and so, when we talk about health disparities, getting physicians out there in those rural areas is really, really important.”
Only in its second year, the program has yet to graduate any residents. But Boll is hopeful that the residents will want to pursue careers as rural doctors. While Balin does not know where his life will take him after residency, he knows he wants to be a rural doctor at a critical access hospital.
And to Boll, that’s a win.
“My goal really is to have more than 50% of the residents stay in Northcentral Pennsylvania over a period of 10 years. That's kind of our goal of our program. But I will call it a win if a resident wants to leave our program and go work anywhere in the US or in Pennsylvania in a rural community,” Boll said.
So far, the program has been popular.
“When we initially opened up our applications that first year, it was in 2023, I thought we would have maybe a couple dozen applications come through. We had actually over 440 applications for those two spots,” Boll said.
He believes the new generation of doctors, many of whom were in undergraduate or medical school during the COVID-19 pandemic, are aware of health disparities.
“There's been more and more studies just showing the links between social determinants of health and patient outcomes and the importance of addressing health disparities. And this generation seems to be attuned to that,” Boll said. “It also has made them much more eager and excited about working in underserved communities like rural areas.”
The appeal of working in a rural hospital to Balin is meeting patients where they are.
“The challenge is always travel distances,” Balin said.
“If you identify a pathology in a certain patient that is going to require some kind of special input or specialist management, they typically will need to travel for those appointments," Balin added.
"Here in Wellsboro, we are very lucky to have both the oncologist and cardiologist, a couple other scattered specialties around like general surgery and whatnot. However, the majority of the patients still need to travel several hours if they needed a kind of specialist referral,” he said.
Doctors become a part of the communities they serve
Research found that 56% of family physicians practice within 100 miles of where they graduated from residency.
The program covers housing costs. Residents live in homes and apartments owned by UPMC.
“It's a pretty much universal issue that people run into in rural areas, that housing for trainees is really difficult to get,” he said. “So this has been really nice to be able to address that issue.”
The housing was not the biggest draw for Balin when he was applying. But it does add to the positive experience he’s had so far.
“The majority of physicians going to school today take on hundreds of 1000s of dollars for the debt, in some cases,” Balin said. “So it's really effective to not have to have that housing cost, because that money can be put either towards retirement or towards paying down student loans.”
He started at UPMC Wellsboro in July of this year. He already feels like a part of the community he’s serving.
“Some of the really interesting things, or kind of bonuses about being in the rural community is because the population is small, you're more likely to know everybody,” Balin said. “Like the small town saying goes, everybody knows everybody. It fosters this feeling of community and camaraderie in the town and the health community that is really, really nice.”
