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When a family doctor leaves a small town

VCU student Paulius Mui is speaking with residents throughout rural Virginia about what happens when small communities lose their doctors. “Some people are losing their best friend,” he said.

What happens when small communities lose their doctors? VCU School of Medicine student Paulius Mu...
What happens when small communities lose their doctors? VCU School of Medicine student Paulius Mui is speaking with residents throughout rural Virginia in search of the answer. “Some people are losing their best friend,” he said.

If you are from a small town, you may have a family doctor who has been present at the most important moments of your life: birth, serious illness, a child’s broken arm, a parent’s death. So, what happens to patients when that doctor retires or moves?

That’s what Paulius Mui is trying to uncover. Mui, who is entering his second year in the Family Medicine Scholars Training and Admission Trackin the VCU School of Medicine, has spent considerable time driving to small localities in southwestern and eastern Virginia that have lost their primary care physicians, interviewing residents about the personal impact of these losses. Earlier studies have examined the doctors’ side of this issue, but Mui said there has been little research into patients’ viewpoints.

“Some people are losing their best friend in that regard,” Mui said. “A rural physician really ties a community together.”

Mui’s goal is to capture people’s perspectives and use that information to inform policy decisions to attract and retain primary care physicians to low-population, sometimes isolated, communities. He hopes to expand the interviews beyond Virginia with the help of other medical students he’s working to recruit across the country.

Mui’s project is funded by a grant from the Collaborative for Rural Primary care, Research, Education and Practice.

Mui was born in Russia and raised in Vilnius, Lithuania. He moved to the Chicago suburbs with his mother when he was 14, and attended college at Boston University — so he has never lived in a small town. Mui calls family medicine “the coolest specialty there is. You get to know a little bit about everything. It allows you to take care of anyone who walks in your door.”

Paulius Mui, in gray shirt, calls family medicine “the coolest specialty there is. You get to know a little bit about everything. It allows you to take care of anyone who walks in your door,” he said. (Courtesy photo)
Paulius Mui, in gray shirt, calls family medicine “the coolest specialty there is. You get to know a little bit about everything. It allows you to take care of anyone who walks in your door,” he said. (Courtesy photo)

After graduating with a bachelor’s degree in economics in 2013, Mui worked in administrative positions at the National Brain Tumor Society and the Harvard Medical School Center for Primary Care. The Family Medicine Scholars Training and Admission Track is the main reason he said he decided to apply to Virginia Commonwealth University for medical school.

In 2012, the School of Medicine started the Family Medicine Scholars Training and Admission Track — or fmSTAT — as a dual-admission program for students certain of their goal to become family physicians. In an effort to attract and retain students, the fmSTAT Scholarship Fund aims to build an endowment to provide future fmScholars the equivalent of one year’s tuition.

Mui regularly makes suggestions to improve the medical school’s programs, said Judy Gary, assistant director of the Department of Family Medicine and Population Health’s medical education programs.

Mui’s line of study could have national implications, said Department Chair Anton Kuzel, M.D. Family medicine was VCU’s most popular specialty among 2018 medical school graduates, but that is not necessarily the case across the country.

Virginia prioritizes VCU’s, the University of Virginia’s and Eastern Virginia Medical School’s family medicine programs in its state budget. Some other states do likewise, but there is concern that without widespread attention to medical school admissions policies and addressing student debt for those interested in primary care, there will not be enough family physicians and other primary care clinicians to care for an aging U.S. population. This will be particularly true in rural areas such as the ones where Mui is conducting interviews.

VCU’s fmSTAT program and the International/Inner City/Rural Preceptorship, which trains doctors for underserved areas in urban, rural and international locations, are somewhat unusual, Kuzel said, and draw students like Mui who “by and large see medicine as a calling.”

Kuzel calls Mui’s project the most ambitious student study in his experience. Making connections with community leaders first is important in gaining other residents’ trust, which can be a lengthy process, Kuzel added.

In June, Mui presented his early findings to leaders from the National Organization of State Offices of Rural Health and Rural PREP, who were encouraging and offered to advise him in the future.

“It was really an incredible opportunity for me to get guidance in very targeted ways to make this project more successful,” Mui said. He feels he already has succeeded in his personal objective to “put myself out there and leave my comfort zone.”

Kuzel predicts Mui will go on to make a national impact, despite his interest in local care: “His gaze is much bigger than that.”