Dr. Audy Whitman is an eastern North Carolinian, through and through. He was born in the farming town of Seven Springs – a town of roughly 80 people – in Wayne County.
Like in many towns in eastern North Carolina, its citizens struggle with poverty and access to health care. It is there, in Seven Springs, where Dr. Whitman’s rural upbringing helped him discover a love for medicine that influences his work today.
Today, Dr. Whitman is a family medicine physician for ECU Health and clinical assistant professor at the Brody School of Medicine at East Carolina University, but back in Seven Springs, he was a helping hand in the tobacco fields, braving the eastern North Carolina heat and humidity.
“There is no more powerful motivator in the universe, in my humble opinion, than standing in the middle of a tobacco field in the late summer with 99 percent humidity, no shade and it’s 100 degrees outside,” Dr. Whitman said. “Your hands are caked with tobacco gum. The nicotine is soaking through your skin, so you feel nauseous all the time. Those long days taught me a great work ethic but they were also powerful motivators.”
Rural health care realities
Americans who live in rural areas make up 20% of the United States population and residents in these areas face a myriad of challenges: shorter life expectancy, higher mortality, higher rates of poverty, fewer local doctors and greater distances to travel to see health care providers. Only 10% of U.S. physicians currently practice in rural areas.
Physician shortages are no secret across the country, with the Association of American Medical Colleges estimating a shortage of up to 124,000 physicians by 2034, and rural areas are at an even greater risk.
The Brody School of Medicine was founded over 40 years ago to train primary care physicians to provide care for rural eastern North Carolina. These challenges inform the medical school’s mission and its proven track record is best represented by the fact that Brody is No. 1 in North Carolina and No. 2 in the United States in the percent of graduates in the last decade who chose careers in family medicine.
Programs like the Rural Family Medicine Residency Program take that work a step further by focusing on initiatives that help place providers in rural areas. Studies show that 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.
“Rural health care is under duress, and our rural communities need solutions,” said Dr. Michael Waldrum, ECU Health CEO and dean of the Brody School of Medicine. “The Rural Family Medicine Residency Program is another great example of ECU Health and Brody understanding what the community needs are and creating new pathways to educate physicians to meet the community’s needs and improve the health and well-being of those communities.”
Setting a path forward
After Dr. Whitman was approached to create and administer the program, things moved quickly. A “national guru for all things family medicine” made a visit to eastern North Carolina to consider the best locations for residents to begin their rural training. Dr. Whitman and team reached out to other universities and health systems with established programs and traveled to learn about rural organization structure and rural curriculum best practices. Two years later, the Rural Family Medicine Residency Program had its first cohort ready for training.
The first year of the program features training at ECU Health Medical Center, a Level I Trauma Center, and helps set the residents up for success when they get to the rural environments in their second year.
“Anything and everything you can imagine seeing in residency training, you’re going to see at the medical center,” Dr. Whitman said. “We provide this very intense, inpatient-heavy first-year experience for these rural residents where they get to see really sick, really complicated patients with lots of resources at their disposal so they can learn how to take care of these really complicated patients. After their first year of training, when they’ve taken all of these lessons learned, they can go out into these rural communities and apply those lessons learned where they’re the only show in town.”
Dr. Whitman added that while Greenville and eastern North Carolina are rural, the more than 1.4 million patients served through the ECU Health system creates a high volume of patients at ECU Health Medical Center, and the exposure to so many patients during their training is also hugely beneficial for the rural residents.
“An institution like ECU Health boasts a 974 bed, Level I academic medical center where residents train alongside some of the best and brightest health care minds in the state,” said Dr. Jason Higginson, executive dean at Brody. “Medical residents can then serve in our more rural hospitals to apply that knowledge to underserved populations, building a connection to the community in which they serve and making a real difference in the lives of patients.”
Dr. Zeel Shah
Drs. Zeel Shah and Jim Jaralene Porquez are part of the inaugural cohort for rural family medicine residents. Dr. Shah practices and trains at Roanoke-Chowan Community Health Center in Ahoskie and Dr. Porquez at Goshen Medical Center in Beulaville, both of which are Federally Qualified Health Centers (FQHC) that serve at-risk and underserved rural populations. The mission and vision of these FQHC organizations align with the mission and vision of ECU Health. Together, they seek to augment scarce health care resources in rural communities, improve the health metrics of the communities they serve, and encourage the residents that train in these rural communities to establish roots and continue serving these rural communities after graduation from their residency training program.
Dr. Shah said the year in Greenville was a great experience before continuing her residency training with a focus on serving the rural community of Ahoskie.
“In Greenville you have a lot of resources, but it’s a learning curve to rotate through the different specialties,” Dr. Shah said. “In Ahoskie, the challenges are different. Social determinants of health care, such as finances and distance, play a significant role, and you don’t have the same resources. You learn quite a lot about how to make your limited resources go a long way by relying on creative strategies while using medical expertise you picked up in Greenville.”
Now, as third year residents, Drs. Shah and Porquez feel established in their respective communities and have built trusting relationships with patients, families and fellow team members. Both said the community aspect and truly knowing their patients are among the most rewarding parts of their rural experience. For Dr. Porquez, feeling love, trust and appreciation from her patients has made her time in Duplin County special and a place that she plans to call home after her residency.
“What really drew me into my community clinic in Duplin County specifically, is that my patients are very appreciative of what I do for them,” Dr. Porquez said. “They care so much about my time, my effort and my expertise, and I think in just a couple of years I have built that strong trust and relationship with them. I feel like I don’t just treat them with their disease, but I go further than that. I treat them as a whole, and I get to know their whole well-being. I see them as a whole person and not just the disease that I treat.”
Early milestones
Dr. Jim Jaralene Porquez
For Drs. Shah and Porquez, the personal connections built through the program are so strong that both have decided to practice in eastern North Carolina following the completion of the program in 2024. Their graduation, along with the other residents in the first cohort, will represent a significant milestone in the program’s short history and help ensure rural communities have access to specially trained, high-quality rural family medicine providers.
Dr. Whitman said he’s proud to see two members of the first cohort choose to stay and make a difference in communities like the one in which he was raised. The successful launch has the team thinking bigger for the program, and recruitment for the next cohort, featuring a new site and more residents, is underway. The Roanoke Rapids area will benefit from the program and begin seeing its first residents from the program in 2024, and the program in general will grow from its current size of 10 residents to a total of 27 residents over the next three years.
“Moving forward, I see nothing but growth for us,” Dr. Whitman said. “We are truly doing mission-driven work and trying to bridge the chasm of health care disparities of urban centers and rural areas here in North Carolina.”
Dr. Waldrum agreed and said he sees the program as the beginning of something special for eastern North Carolina and rural medicine.
“My hope is that we can take the knowledge gained through the Rural Family Medicine Residency Program and apply those lessons towards other specialized clinical areas of expertise in the near future,” Dr. Waldrum said. “We are proving that we can be highly successful in creating rural residency tracks and our historic success training rural providers who go on to practice here in North Carolina is a further testament of our ability to create unique solutions that meet the needs of those we serve.”