When Dr. Jonathan Buchanan moved home to practice family medicine in Carthage in 2017, he was the first physician to come back to Leake County in 26 years.
Many residents had avoided going to the doctor unless it was “dire straits,” Buchanan said. They drove to Jackson or Meridian if they had to. Elderly patients would pay for someone else to take them.
The community was glad to see him.
“It was absolutely an amazing welcome,” he said. “My parents still live there, like a lot of people I grew up with, who raised me or taught me, those kinds of things. To be gone for a while for college, medical school, residency, and then come back, it was very exciting.”
Buchanan is one of the 55 practicing alumni of the Mississippi Rural Physicians Scholarship Program. The scholarship launched with 10 awardees in 2008, aiming to tackle the state’s shortage of medical providers, one rural doctor at a time.
Half of all Mississippians live in medically underserved counties, where there are more than 2,000 people for every primary care physician. In four counties – Benton, Carroll, Kemper, and Tallahatchie – there were no such doctors at all as of 2021, according to the health department’s Primary Care Needs Assessment. To close the gap, the state needs 323 more primary care physicians in underserved areas.
Just shy of 90% of program alumni who have completed their service requirement are still practicing in Mississippi. And the scholarship is still ramping up. Behind the 55 alumni are 64 people in residency, 64 in medical school, and 67 still completing their bachelor’s degrees.
“It takes a long time to grow a doctor– a minimum of nine years,” said Wahnee Sherman, executive director of the scholarship program.
The program awarded 65 scholarships this year, spread across four years of medical school. Recipients are required to spend one year practicing in Mississippi for every year they take the money.
Sophomores in college can apply to join the program’s two-year “nurturing phase.” They get academic support, Medical College Admissions Test (MCAT) preparation and guidance on applying to medical school. If they maintain their grades and score well on the MCAT, they can earn admittance to the University of Mississippi Medical Center or the William Carey University College of Osteopathic Medicine (WCUCOM), with annual funding of $35,000. (Current or admitted medical students who didn’t participate in the undergraduate program can also apply for the scholarship.)
The undergraduates participate in “medical encounters,” where they learn about the profession. On Monday, about 20 of them traveled to William Carey for a day of classes. Most scholarship recipients study at the University of Mississippi Medical Center, but a handful each year enroll at WCUCOM, which was founded about a decade ago with a focus on training primary care physicians.
Christian Hollis and a University of Mississippi classmate, Taylor Lampkin, stood in a small exam room on Monday morning. Both wore white lab coats embroidered with the motto of the scholarship program in green: “Growing our own physicians.”
Hollis was born with a heart condition. About twice a year, his family made the two-hour round-trip drive from his home in Morton to Jackson so Hollins could see his heart doctors. The experience showed him how geography can become a burden and barrier to patients in need of care.
Now a junior, Hollis dreams of practicing medicine close to home. He also wants to own a farm like his grandfather, who keeps chickens, cows and donkeys.
“I still go out there now,” he said of his grandfather’s farm. “I want a lot of land and to put animals on it. You can’t do that in, like, California or a big city.”
Hollis and Lampkin’s patient – an artificially intelligent knee joint – lay on the table between them. Dr. John Gaudet, a longtime Hattiesburg pediatrician and now a full-time instructor at the school, showed them how to palpate the knee and insert a needle into the joint to withdraw fluid.
It reminded Hollis of the time his mother had gone to the doctor with a knee swollen with fluid.
“I saw the doctor do what we just did,” he said.
Mississippi ranks 49th in primary care physicians per capita, behind only Utah, according to a 2021 report on the physician workforce by the Association of American Medical Colleges.
There’s both a national and local explanation for this trend. First, around the country, specialists are better paid. On average, they earn about $150,000 more than primary care doctors.
Dr. Italo Subbarao, the dean at WCUCOM, said specialty care, like neurology and plastic surgery, is “what’s glamorized in medicine.”
“We try to show people the power of what a family doctor can do,” he said.
The school is ranked number one in the country for the percentage of graduates who practice in rural areas. (UMMC ranks third.)
Second, people with higher education tend to leave Mississippi. In 2020, only half of recent graduates of public universities were working in the state, according to a recent study by the state auditor.
Steven Smith, a second-year student at WCUCOM, grew up in Terry. His parents were both volunteer firefighters, and as a kid he went with them to car wrecks and fires because they didn’t have a babysitter.
He would play with hoses on the firetruck, and when his parents were done working he would ask them what happened to the people after the ambulance took them away. They told him the people went to the doctor, who made them better.
“Well, if the doctor is who makes ‘em better, that’s what I want to do,” Smith thought. He has never really considered leaving Mississippi, but he knows many people with his education do.
“A lot of people use that as their way out,” he said.
“We’re doing the opposite,” said his classmate and fellow scholarship recipient, Ti Smith, from Okolona.
Steven Carter, associate director of the scholarship program, said the COVID-19 pandemic highlighted the importance of family doctors rooted in their communities. While state leaders like health officer Dr. Thomas Dobbs became the highly visible face of Mississippi’s pandemic response, scholarship alumni were intubating patients in their rural hospitals’ tiny ICUs, then rushing to interviews with the local TV station to share public health guidance.
During the pandemic, Buchanan saw patients at the clinic and did hospital rounds, too. He advocated for masking and offered telehealth services. After the vaccines became available, Buchanan started conversations about them whenever he saw a patient.
“My patients trust me with their medical care,” he said. “They trust that I know what’s most up to date and available and what’s been proven versus what’s not. A lot of patients did not even have the thought of vaccination until they had a visit with me to go into detail. They saw how adamant I was about vaccination, that they felt good about receiving it.”
Mississippi’s sheer need for physicians is daunting. It would take hundreds of new doctors to fill the gap. Does one make a difference?
Sherman believes the stories of Buchanan and his fellow alumni make the answer clear.
“When you go into these communities that haven’t had a new doctor in 20, 25 years, you see that impact immediately,” she said.
When talking to Mississippi students and alumni involved in the scholarship program, the state’s data on brain drain seems perplexing; no one seems to have given much thought to leaving.
“I always wanted to stay in Mississippi after I graduated,” said Kayla Redmond, a junior at Mississippi University of Women. “I’m a country girl. I’ve traveled out of state. It’s not hospitable.”
Most of the participants are from rural areas themselves. And though they’re from all over the state, they share the perspective that the people in their communities deserve the best health care the country can offer.
In between activities Monday, Khadeejah Franklin, a University of Mississippi junior from Vancleave, and Lauren Sumrall, a Mississippi College junior whose parents live in Poplarville and Purvis, talked about their goals. Franklin would like to practice back home, so people in Vancleave don’t have to travel so far for care. Sumrall wants to open labor and delivery clinics serving rural communities.
“I don’t feel like anybody should have to drive 45 minutes in labor,” she said. “Where you live should not determine—”
“The level of care you receive,” Franklin nodded.