ELKIN — A large sign marks the entrance to Hugh-Chatham Memorial Hospital.
On this day, a sunny Friday in late January, the two-lane road leading to the hospital and adjacent medical facilities is quiet.
Traffic is light, giving visitors a chance to reflect on this beautiful slice of western North Carolina. The beginnings of the Blue Ridge Mountains. The long and wandering Yadkin River, traversing a valley of the same name, marked by farms and vineyards on the lookout for spring.
Dr. Patrick Stevens (DO), a family physician in nearby Jonesville, is part of the Hugh-Chatham healthcare network. Stevens graduated from the Jerry M. Wallace School of Osteopathic Medicine in 2017, a member of its inaugural class.
Stevens and his wife, Aubrey, a second-year medical student at Campbell, moved to the Elkin area with their three children in 2022.
This is home, says Stevens.
“It’s been wonderful. The people here are amazing.”
Stevens is chief of family medicine for Hugh-Chatham, and, in a brand-new role, associate program director, for a unique residency program in North Carolina.
Hugh-Chatham Health and Campbell University’s Jerry M. Wallace School of Osteopathic Medicine have partnered for a designated Rural Track residency program, in coordination with the Accreditation Council for Graduate Medical Education.
Campbell has multiple residency programs, but this is Campbell’s first foray onto the RuralTrack, during which, according to the ACGME, all or some of the participating residents gain urban and rural experience.
Enter Hugh-Chatham, an 81-bed nonprofit community hospital in Elkin, about two hours from Buies Creek. Like many opportunities, the partnership between the hospital and Campbell Medical School started with a conversation.
Campbell President Dr. Bradley Creed then visited the hospital and community, and an emerging idea became an exciting reality. Interviews for admission to the Rural Track will start in the fall, with the first residency class at Hugh-Chatham beginning in summer 2025.
“It’s been kind of an interesting evolution of this program,” says Dr. Robin King-Thiele, associate dean for Postgraduate Affairs Graduate Medical Education at Campbell.
The goal of the residency aligns with the mission of the Medical School; serving rural communities in North Carolina with the goal of keeping physicians in those communities. Weaving, in effect, a network of healthcare providers into the already brilliant community tapestry.
Graduating medical students leave school, according to various sources, with an average of $250,000 in loan debt. The doctors jump on the path to their chosen career specialty and train for at least another three years, which is the case for family medicine. For neurosurgeons and plastic surgeons, for instance, that path only becomes more taxing, continuing for seven years after graduating medical school, which only comes after earning a bachelor’s degree.
“At that point, they start to draw a salary of about $55,000 a year and they’re no longer taking out loans,” King-Thiele says.
That, she says, is the proverbial good news.
“The worse news is that their loans start coming due six months after they graduate.”
Enter, now, Campbell residency programs, and what King-Thiele refers to as a “negative carbon footprint.”
“If we’re going to put 150 graduates out into the world to take up these training spots, then we should have as close to 150 spots as we can to kind of offset that bottleneck in the system and make sure that everybody can have success in completing their education (through residency),” she said.
Matthew Huff, associate DIO and director of Post-Graduate Affairs, said the rural track offers more flexibility in a school’s ability to design a curriculum around the resources in that community, thus allowing the Elkin hospital added flexibility in designing a program to meet the needs of a specific community.
“So, the hospitals that we partner with are in rural settings. Some of them are classified as urban, some of them are classified as rural, but we’ve not ever built a Rural Track program before now,” says King-Thiele.
The track, which also includes an urban partner, is different from a rural practice program because the training site might not include the large-volume experiences found in a typical urban setting. More than half of the education happens in a designated rural area, according to the ACGME, the accreditation body.
The goal is keeping doctors, people like Patrick Stevens, in the rural communities.
Said Stevens, “You go to the bigger cities, the bigger facilities… you’re going to be practicing in the setting of a larger city. While there are providers who are looking to do that, there’s a substantial number of providers who actually want to practice in rural areas.
“Without the experience of what a rural setting looks like — what is available, how you handle things that are coming in … you wouldn’t really have that experience. So being able to train providers in a rural setting is a unique aspect.”
Mary Blackburn is chief clinical officer/vice president for Care Innovation at the hospital in rural Surry County. Blackburn, an Army veteran with an extensive clinical background as an emergency and trauma care nurse, was instrumental in bringing the Rural Track to northwestern North Carolina.
Elkin’s population is about 4,000, though Hugh-Chatham, Blackburn says, has a large physician network and primary care base, which includes an array of specialists. That footprint, spanning five counties in North Carolina and crosses into southern Virginia, isn’t a small one.
“For most care — stroke or the need a cardiac stress test, or those kinds of things — they’re going to come down the mountain to us,” Blackburn says.
As for specialty services, Hugh-Chatham has the only psychiatrist in a multi-county area. The hospital has neurologists, as well as a nationally recognized orthopedic program, including certification programs to perform advanced hip and knee replacements.
Yet, Blackburn says, “We are definitely rural,” which carries its own pack of challenges, inherent and ongoing.
“Primary care is needed and is at a deficit, and it’s always challenging,” Blackburn says.
The health network appears ready to meet them.
Hugh-Chatham Memorial was recognized as one of 153 “Great Community Hospitals” by Becker’s Hospital Review, a trade magazine and website for the healthcare industry. It also was recognized as the cleanest hospital in North Carolina five times in the past year by Press Ganey, a healthcare improvement company, Hugh-Chatham says. The monthly ranking is based upon a patient’s perspective of the care they received during a hospital inpatient stay.
A wonderful place to live and grow, personally and professionally. A great place to raise a family.
“We have great quality outcomes in our hospital in our practices and felt that we had the framework to provide a Residency program,” Blackburn says. “We have been able to recruit some providers already because they’re interested in teaching, they’re interested in practicing in a rural area and in having the ability to also continue to grow their career by entering into a faculty standing,” Blackburn says.
Passing knowledge to others who will follow behind them into rural communities.
The Rural Track partnership will be relatively small, at least to start, with four residents entering each year. Eventually, the three-year program will have 12 residents, who have trained in a rural program and, optimistically, will want to practice in a similar environment, whether with Hugh-Chatham or nearby in northwest North Carolina.
A study published in the Journal of Graduate Medical Education found family medicine residents who spent 50% or more of their training time in rural settings were at least five times more likely than residents with no rural training to practice in a rural setting.
The findings were reported by the American Medical Association and gathered from a sample of more than 12,000 family medicine physicians who completed residency training between 2008 and 2012. They also indicate that even a small amount of rural training time — between 1%-9% — significantly increases the odds of a trainee subsequently opting for rural practice.
Of the 2023 graduating class at Campbell Medical School, 27% entered residencies in North Carolina, with 80% of the class graduates entering GME pursuing specialties of need, which include family medicine, pediatrics, psychology, OB/GYN, emergency medicine and general surgery.
Supporting the local schools, the communities and the economy. Learning about the people, neighbors.
“It’s not as burdensome as a big system when you’re trying to institute change,” Stevens says. “We’re nimble, we’re small. So, we really can affect things in the long run.”
“It’s different than practicing in an urban area,” Blackburn says. “The difference is that it is a community. I can walk down the halls of the hospital, and I probably know half the patients. So, we’re either taking care of them again, because it is a relatively smaller population, and they’ve been with us before, or they go to church with me, or they were my child’s soccer coach.
“I’m going to see that patient in the grocery store. They’re going to stop and say, ‘You know, they were talking to me about a low-salt diet when I was in the hospital. What does that mean when I’m looking at this shelf?’ Those things happen, and for somebody who’s going to practice in a rural community, that is part of it.
“That’s a unique bond,” Blackburn says. “It’s not for everybody. But if it is for you, it’s really special.”
Health Sciences Writer