Small Towns Sponsor Their Own Doctors

By Tom Banse

Colfax, Washington

22 January 2008

Across the country, communities in rural areas have a hard time recruiting doctors, who are more attracted to the lifestyle and salaries of big cities. But the small wheat-farming town of Colfax, Washington, has come up with a clever solution to the problem. The community hospital and some of its doctors are paying a local woman's way through medical school. The med student has committed to return to her hometown to practice after completing her studies. Tom Banse reports.

Hospital administrator Jon Davis is pretty much always recruiting for doctors. He manages the Whitman Hospital and Medical Center, which has a lovely view of rolling wheat fields and not much else. "The challenges are that if either the doctor or the spouse are from an urban area where they're used to [having] a lot of things available to them and all, it may not be the right setting," he explains, adding that that's more the rule than the exception. Potential hires also shy away from the long hours and the fact there's little privacy in a small town.

Davis says there's been a shortage of doctors in the countryside for decades, and expects it'll only get worse. But then he heard an intriguing proposal from a hometown kid. Tiffany Ludka asked if the hospital would pay for all or part of her medical school education to guarantee that she returns to Colfax to practice.

Ludka was valedictorian at Colfax High School. More recently, she graduated from nearby Washington State University. Now, she's confronting the annual $30,000 tab for tuition, room and board at medical school. "Debts can mount if you're not careful," she says. "And then that can have a bearing on where people go after they graduate. Sometimes you can't go to a small town to practice right out of residency if you need to make the big bucks and pay back all of your loans."

The first person Ludka convinced about a sponsorship was her own doctor, Kim Mellor. He ran it by the other doctors in his practice, then spoke to officials at the hospital. "[I] sold the concept that this is probably the least expensive way they could recruit for the future if they would look at it that way, because it costs anywhere between $20,000 to $30,000 on the average to pay a recruiter for a physician."

The physician's group and the hospital eventually agreed to pay a little more than half of Tiffany Ludka's medical school expenses. By the time she graduates, the community will have invested more than $45,000 in her education. In return, she has committed to come back to Colfax to practice for at least three years. Hospital chief John Davis hopes she stays longer. "If you look at it from how many years she'll be taking care of these folks who need it, it pencils out without question in our mind." She'd be the first female doctor in town.

While Ludka looks forward to that, she admits that her plans may change. "In the proposal that I wrote up, I kind of put a little backdoor clause that if I'm unwilling or unable to fulfill my obligation to Colfax that I will pay them back as though it were a loan with interest and all of that. I don't intend to do that. But you know, you can never predict exactly what's going to happen."

Colfax will have to wait a long time to see this gamble pay off. Medical school takes four years. Then a new doctor does a residency that lasts three to four more years. Tiffany Ludka expects to be 29 years old when she returns to her hometown -- in 2012.

Independent of Ludka, a student from Moscow, Idaho, struck a nearly identical deal to pay his way through medical school. For each year of support Moscow's small hospital gives him, he commits to return for an equivalent year to practice.

In both cases, the National Health Service Corps inspired the idea. That federal government program offers full scholarships through medical school or loan forgiveness for young doctors who agree to practice in underserved communities. But that program gives participants little say about which rural or inner city clinic they get sent to in order to work off their obligation.