Rural Practices: Founded in Family and Community

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Michigan Medicine - March/April 2016

Monroe family legacy

When it comes to practicing medicine in a rural area of Michigan, our physicians see their job as not a challenge, but an opportunity to care for people who need it the most.

When Jonathan Pasko, MD, a solo primary care Internist and Pediatrician, started with medical school then residency in Wayne State University/DMC, he set out to care for the most in need. Doctor Pasko explains, "Coming back to Monroe, my hometown, allows me to care for people who live in the community where I grew up. Living in and being a part of this culture helps me to care for people better. My care is timely, appropriate and given in the context of when, where and how my patients live"

Doctor Pasko's father, John E. Pasko, MD, a General Surgeon, practiced for over 40 years in Monroe and his mom, Rosalie Pasko, was a Medical Technologist for over 25 years at their local hospital. Doctor Pasko says, "My family, growing up, was a part of the local culture and medical community. I have heard stories from many long-time residents about how my dad cared for them when they were in need."

Doctor Pasko emphasizes the importance of having support from like-minded specialists, especially in underserved region. "I share an office with my wife, Laura Katz, MD, a solo OB-GYN and minimally invasive robotic surgeon. She helps give birth to babies then I take over from there. It is a holistic and family-centered approach to care and one that I would not trade for the world."

Although Monroe is a small community, Doctor Pasko has become involved in several groups and initiatives that benefit the community and help him become a better physician. Doctor Pasko sits on the board of Monroe Alliance of Physicians (MAP). Being heavily involved in the group allows him to continue his practice as a solo physician while using the collective bargaining power of his colleagues to negotiate with insurance companies. Doctor Pasko explains, "MAP helps me stay in touch with a larger world of incentives for value driven care."

Marquette-based dream team

Christopher Dehlin, MD and Jennifer Dehlin, MD, longtime Marquette residents and practicing physicians are very aware of the challenges that come along with practicing in a rural, underserved area of Michigan. Doctor Jennifer Dehlin explains, "Most specialty groups up here are small, and so provider turnover can result in significant patient access issues. For example, the wait time to see a psychiatrist in Marquette right now is one year. As a result, the primary care physicians need to work to the edge of their comfort zones to take care of people"

Though the couple recognizes the challenges of practicing in Marquette, they could not imagine being anywhere else. With family in the area and several nearby towns, it is very important to them to be home. They also take advantage of the outdoor sports available in Marquette. Doctor Christopher Dehlin adds, "We have world-class nordic and mountain bike trials, we're seven minutes from our ski hill and five blocks from the beach."

As a team, Doctor Christopher and Jennifer Dehlin have recently filed paperwork to start their own medical practice in Marquette -- Singletrack Health PC. In partnership with Stevens Hardie Family Practice they will offer the full scope of family medicine including inpatient, outpatient, nursing home and obstetrical services.

Doctor Jennifer Dehlin explains what inspired them to make this move, "We think that as healthcare delivery evolves we will be better prepared for changes if we are running a small, nimble, high tech practice. We've been surprised by how enjoyable it's been to work with other professionals in the community to get our business started, and the support and encouragement from area physicians and the hospital."

State resources for rural physicians

The federal government recognizes Health Professional Shortage Areas (HPSA) and Medically Underserved Areas and Populations (MUA/P) in Michigan, which are visualized in maps found on their website. The maps show "designated" HPSA and MUA/P areas throughout the state. These designations are used to determine eligibility for state and national programs. In addition to providing the HPSA map, the federal Health Resources and Services Administration (HRSA) provides a service allowing physicians and residents to verify whether their address is considered part of an HPSA. This tool can be accessed at http://datawarehouse.hrsa.gov/tools/analyzers/geo/ShortageArea.

Along with providing resources to identify underserved areas, the state of Michigan recognizes the importance of supporting rural physicians and offering them with the programs and assistance they need to be successful and best serve their patients. The following programs are designed to support rural physicians and their practices:

Conrad State 30 Program

Under the Conrad State 30 Program, Michigan accepts applications from physicians on J-1 Visas who want to waive the 2-year home residence requirement in exchange for a commitment of 3-years of service in an underserved area. Michigan may sponsor up to 30 physicians each fiscal year. Priority is given to safety net providers, primary care physicians and placements in Health Professional Shortage Areas. Check the Conrad State 30 website at http://www.michigan.gov/conrad30 for more information.

Medical Opportunities in Michigan

Medical Opportunities in Michigan (MOM) is a non-profit job search website designed to connect physicians directly with private practice and hospital employers. Physicians register for free on the site and can make themselves available to employers or just browse the job market. Posted job opportunities include detailed information on the community, practice environment, employer size and benefits offered. Go to the MOM website at https://michigan.medopps.org/ for more information.

Michigan Center for Rural Health

The Michigan Center for Rural Health (MCRH) assists both Critical Access Hospitals and Rural Health Clinics. MCRH provides training of on-site recruitment coordinators, represents rural Michigan at conferences, develops site specific marketing, promotes collaboration and helps rural sites navigate state and federal loan repayment, the National Health Service Corps Scholar Program and Health Professional Shortage Area status. More information is available on the MCRH website at http://www.mcrh.msu.edu/Default.aspx.

Michigan's Rural Recruitment and Retention Network

The Rural Recruitment and Retention Network (3RNet) website lists job opportunities for physicians at Critical Access Hospitals and Rural Health Clinics in rural Michigan. Registering for an account with 3RNet is free and allows physicians to browse job postings and be contacted about opportunities. Many job opportunities posted on the website are eligible for loan repayment. Visit the 3RNet website for more information at https://www.3rnet.org/locations/michigan.

Michigan State Loan Repayment Program

Michigan administers the Michigan State Loan Repayment Program (MSLRP) to encourage qualified doctors to practice in Health Professional Shortage Areas in Michigan. MSLRP will assist those selected by providing $50,000 in tax-free funds to repay their educational debt in exchange for working in an underserved area for two years. Participants compete for the renewal of the contract of up to three more times for a total of eight years and up to $200,000 in loan repayment. 40 percent of the loan repayment is funded by the state, 40 percent by the federal Health Resources and Services Administration and 20 percent by the participant's employer. More information is available on the MSLRP website at http://www.michigan.gov/mslrp.

National Health Service Corps Loan Repayment Program

The federal Health Resources and Services Administration offers the National Health Service Corps (NHSC) Loan Repayment Program for qualified doctors to work at an approved NHSC site in an underserved area. Providers may receive up to $50,000 in tax-free funds to repay their student loans in exchange for a two-year commitment in an underserved area. Participants may apply to extend their service commitment and receive additional funds after completing the initial two-year commitment. Applicants will be more likely to be selected for loan repayment if they are employed at approved practice sites with Health Professional Shortage Area scores of 14 or higher. Check the NHSC website at http://www.nhsc.hrsa.gov/loanrepayment/loanrepaymentprogram.html for more information.

National Health Service Corps Scholarship Program

The federal Health Resources and Services Administration National Health Service Corps (NHSC) Scholarship Program pays tuition, fees, other educational costs and provides a living stipend for students committed to primary care in return for a commitment to work at least 2-years in an underserved community. Service begins in a high-need area upon completion of primary care residency training. Scholarship payments, other than the living stipend, are federal income tax-free. Go to the NHSC website at http://www.nhsc.hrsa.gov/scholarships/index.html for more information.

National Interest Waiver Program

The National Interest Waiver (NIW) Program allows international medical graduates to extend their commitment to practice in underserved communities in return for expediting their status as a permanent resident or citizen in the United States. The Michigan Department of Health and Human Services provides letters of support for NIW petitions. Visit the NIW website at http://www.michigan.gov/niw for more information.

Rural Health Clinic Certification

The Centers for Medicare and Medicaid Services (CMS) provides certification letters to Medicare participating clinics located in rural areas that are designated as shortage areas. The main advantage of the certification letter is to receive enhanced Medicare and Medicaid reimbursement rates. Go to the CMS website at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/RHCs.html for more information.