How one program helps young doctors serve rural N.C.

When UNC School of Medicine student Natalie Cuevas thinks about the kind of doctor she’s going to be, she already knows it will involve a lot more than diagnosing puzzling conditions or treating painful injuries. There will be the patient’s dog to hear about, or maybe a detailed story about their granddaughter in the school play.

Cuevas, who just finished her first year of medical school, is still learning to be a physician, but she already understands the importance of building authentic relationships with the patients she’ll be treating in rural communities. As a student in the UNC School of Medicine’s Fully Integrated Readiness for Service Training, or FIRST, Program, she’ll be starting her career working as rural physician caring for sparsely populated, and often lower-income, eastern North Carolina.

The program trains students to use their healthcare knowledge to serve at New Hanover Regional Medical Center (now part of Novant Health) and its affiliates in rural or underserved areas of North Carolina. And yes, places where you may have a nice chat with a patient about their family before diagnosing what ails them. It’s one answer to the state’s physician shortage in rural areas, and a way for students like Cuevas to give back to their home state.

“If we are successful in training young doctors to practice in rural North Carolina, it really improves access to the community and region,” said Dr. Joe Pino, associate dean and campus director of the UNC School of Medicine’s Wilmington campus.

Passion for patient care

The FIRST program began in 2015. Students complete medical school at an accelerated pace – in three years instead of four – then progress directly into an affiliated North Carolina residency program. They’ll then serve in a rural or underserved area of North Carolina for at least three years.

The program accepts students who are interested in family medicine, psychiatry, pediatrics and general surgery specialties — and are driven to reach underserved communities. Many of them are North Carolina natives who’ve seen the impact that a lack of access to healthcare can have on communities in the state.

“FIRST has the capacity to identify students early in their careers who have a passion for a particular specialty in addition to the pursuit of its practice in rural, underserved North Carolina,” said Pino, who is also senior vice-president of Medical Education for Novant Health. “It compresses the time of training even by a little, which means it gets them into that underserved area that much sooner.”

It’s also beneficial for the patients to have highly qualified, well-trained doctors in their communities.

“When you think about it, there are a lot of barriers to get to medical care, transportation being one of them,” Pino said. “To have access close to home means that you as a patient have the capacity to draw upon your support from your family when you are in a very trying time in your life, when your health may be compromised.”

Los Angeles? No thanks.

Natalie Cuevas grew up in Clemmons, North Carolina, and attended the University of California at Los Angeles for her undergraduate degree. But she quickly realized city living wasn’t for her.

“I wanted to run back home,” she said. “I really enjoy North Carolina, especially rural living, rural communities.”

Her mom moved to Brunswick County in 2015. That feels like home to Cuevas now, she said. This summer, as a student at UNC School of Medicine’s Wilmington campus, she’s working at a clinic in Burgaw. She’s the first student from the FIRST program at the Wilmington campus.

Cuevas loves that practicing rural medicine – especially general surgery, her specialty – requires her to think about the big picture when it comes to patients’ health.

“You have to have a few more tools in your toolbox because folks might not be able to travel an hour and a half to go to a major city to go to a bigger hospital,” she said.

There’s a trend in surgery to specialize on one body part or one disease, she said, and she wants “to focus on being able to do as many things as possible for folks.” She believes that helps her – and other doctors practicing rural medicine – see the whole patient.

“That’s what makes me excited to go to work every day, to get to know patients and their families,” she said. “It’s really important to expand beyond their illness and see how it affects their lifestyle. People are more than just patients with illnesses – they’re entire human beings.”