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By PATRICIA CORRIGAN

Lung cancer. Heart disease. Diabetes. All three, often complicated by obesity, are prevalent in rural northeastern Kentucky. St. Claire HealthCare in Morehead — a town of about 7,000 — draws patients from 13 counties in the region, 12 of which are said to be medically underserved. The hospital is the largest employer in the region, employing nearly 1,000 staff members and more than 100 medical providers.

Dr. Ashley Brown, a physician in the hospital's emergency department, is one of them. She has been on staff since 2017. A native of Greenup, a town about an hour from Morehead, Brown is a graduate of the Rural Physician Leadership Program. The program was founded in 2008 by St. Claire, the University of Kentucky College of Medicine and Morehead State University with the mission of educating doctors to practice medicine in small communities that need health care.

"The idea is that doctors who train in Kentucky will stay in Kentucky," said Brown, who also serves as the program's director of admissions and outreach. Medical students in the program complete their first two years at the University of Kentucky's campus in Lexington and then acquire core clinical experience for one year at St. Claire HealthCare. The fourth year consists of elective clinical rotations in different departments in Morehead and the surrounding counties.

A strategic value
Is the program working? Bodie Stevens, site administrator at Morehead, reports that it is.

The program has tripled in size since it started, and receives about four times as many applications each year as can be accepted. After graduation next month, a total of about 110 students will have completed the program, with all of them trained at St. Claire. After residency training, about half the program's graduates have chosen to practice medicine in rural Kentucky.

"The program is a strategic value on several levels," said Dr. William Melahn, senior vice president of quality and clinical affairs at the hospital. "In the short term, it helps us attract physicians of the caliber that they are able to become faculty at a medical school and teach. In the long term, we demonstrate that top high school and college students who live in eastern Kentucky can have the opportunity to have a highly competitive medical school to apply to in eastern Kentucky. We are teaching them that high-quality medicine happens here."

Connecting to community
While at St. Claire, the medical students routinely become involved with the community, said Dr. Rebecca Todd, associate dean of the program. They work at a free clinic one day a week, they partner with the library to promote public health literacy and they present educational programs for addiction recovery organizations and at a domestic violence shelter.

"In their fourth year, students partner with local nonhospital-based organizations to do community needs assessments and then present their findings to the other medical students," said Todd, who has been with the program since the first graduating class in 2012. Others have developed online resources such as a blog on health care topics and a Twitter account that offered healthy recipes. Todd added, "Some speak to high school students throughout the region on depression, suicide prevention and the dangers of vaping."

Brown, the emergency department doctor, is one of the medical professionals at St. Claire who volunteer to work with the students in the Rural Physician Leadership Program. While she was a student in the program, Brown particularly had appreciated the opportunities for one-on-one, hands-on experience under a doctor's supervision, a benefit of the small class size. Brown now makes that experience possible for leadership program students.

While in the program, Brown also determined that emergency medicine suited her better than surgery, which she had considered.

"My job is a perfect fit, and really fun," Brown said. "I get to talk to people of all ages, help them with minor and major injuries, even sometimes help them in grieving — and because this is rural medicine, I realize I may be the only doctor they see." That's just one difference between practicing medicine in a rural area versus an urban area.

Todd pointed out another. "Often, it all comes down to distances," she said. "When you run out of supplies in an urban hospital, you can get what you need from another facility. If you run out of something in a rural area, you may have to send a police car to pick it up an hour's drive or more away, so you have to practice with the mindset of conserving resources, using everything in an efficient and frugal fashion."

'I feel like I'm home'
Another difference is that doctors, medical students and program staff often encounter patients at local stores, festivals or just out for a walk. That appeals to Sheyanne Trent, 25, a third-year medical student from Breathitt County. "I love the family environment here," she said. "When I first came to Morehead, I fell in love with the campus, with the program and with its mission. I feel like I'm home."

Trent arrived in Morehead with an abiding interest in women's health, and she's sticking with her goal to become an obstetrician/gynecologist. She recalled how satisfying it was one day in training to help a young single mom having a planned cesarean section delivery. While another medical student assisted the physician, Trent sat with the woman, talking and holding a cold cloth on her head when she struggled with nausea.

"I got to know more about her, and I found her so inspiring," Trent said. "Also, when the older ladies came in for their breast exams or other cancer screenings, by the time they left, I knew all about them, and we were friends. That human connection is so important."

After her graduation in 2024, Trent will seek out a medical residency in her chosen field, she said. After that, she intends to practice medicine in rural Kentucky, maybe even in her home county. She said, "I'm so grateful for all the people who have been involved in my becoming a doctor, and I want to come back and help take care of them, bring accessible care to them."