Physician assistant students enjoy challenges, rewards of rural clinical rotations

Second-year Physician Assistant Studies student Monique Whitely loves the idea of working in a rural area after she earns her degree from the Medical University of South Carolina. She wants to be closer to nature – and her patients. 

“Providers become essential members of these communities. They can form close bonds with patients, which eventually result in better individualized care and a thorough awareness of the community's health requirements,” Whitely said.

She’s preparing for life as a small-town physician assistant, or PA, through a new rural clinical rotation program funded by the federal government’s Health Resources and Services Administration. 

New program

During their second year, PA students work with patients in a variety of settings. MUSC already offered rural rotations, but the new program expanded those options through the Physician Assistant Curriculum for Addressing Rural Mental Health Education and Support Program, also known as PA-CARES.

It emphasizes caring for patients’ mental health needs, including addiction and eating disorders, as well as their physical concerns. According to the Rural Health Information Hub, substance use and misuse are widespread in rural areas. Eating disorders are a concern too, a conclusion reached by researchers in a 2023 article in the International Journal of Eating Disorders. 

It's a reminder that living in rural South Carolina doesn’t protect residents from the same issues that affect people everywhere. In fact, in some cases, it may make the problems more prevalent. 

Embracing rural health care

But like Whitely, classmate Zachary Fuchs is up for the challenges and rewards of a rural rotation. The PA program brought the native South Carolinian to the MUSC Health Black River Medical Center in Cades, a type of setting he knows well. 

“If you're familiar with the Chester/Lancaster area in the Midlands or just above the Midlands, I lived there for six years as a kid. And that's why I want to go into rural health because back then, there were no clinics,” Fuchs said.

 

“If a kid needed something, they had to go to Rock Hill or Columbia. And I did both. I mean, one of my parents would have to take the day off so that we could go up to Rock Hill to get our vaccinations, or we would carpool with another family.”

Fuchs wants to change that for other families. 

Why rural rotations – and PAs – are so important

Helen Martin, a doctor of health science, PA and division director of PA Studies at MUSC, is pleased with such reactions. She said taking care of everyone, not just people who live in cities, is important.

“We need to recognize that PAs and nurse practitioners are filling a desperate need for primary health care in rural areas. In rural areas, they are probably among the primary prescribers for medications for opioid use disorder in the public and the public sector. It's really a vital need.”

Another vital need: ensuring that people in rural areas get cohesive, not fragmented, health care. And there are further concerns. 

 

“Factors such as race, gender and economic status significantly impact health outcomes. Barriers such as geographic isolation and limited access to health care can also make problems worse.

Martin said the rural rotation’s opportunities for hands-on care, the chance to work with licensed PAs and the emphasis on culturally sensitive care help mitigate those factors.

Fuchs said he’s benefited from the program and learned how common certain problems are. “Many of my patients have Type 2 diabetes, are active smokers, they have some form of COPD and some form of renal disease. Those are all comorbidities that come from smoking and diet, not to mention alcohol,” he said.

PAs of the future

That will inform Fuchs’ future work as a PA. “I will practice rural medicine, and I will focus on Internal Medicine – but with a strong sense of education, especially with kids. The older generation, they're going to do what they want to do. But the younger generations, we may be able to get them to start thinking about how they approach food or how they approach alcohol, smoking, vaping. That's a big part of what I want my practice to be,” Fuchs said.

Recruitment tool

That student’s interest in working in small-town South Carolina is a win for the program, said Traci Coward. She serves as clinical coordinator for Recruitment in MUSC’s Physician Assistant Studies within the College of Health Professions. “This program can recruit future practitioners to rural areas.”

Whitely and Fuchs are sold. Both were already planning to work in rural South Carolina after they earn their degrees next year. The rotations cemented their decisions.

Whitely said she learned a lot. “It gives me an opportunity to see what I need to provide better care for patients in those areas that aren't able to go to the bigger cities. It's really great exposure for me and experience to become familiar with the different underserved communities and gain more experience to be a compassionate and competent PA that will help those patients realize that there are people out there who actually care for them.”

Fuchs said the rural rotations have also highlighted other obstacles for people in rural South Carolina. “Sometimes it's not just having a clinic close by. It's having transportation. An overall lack of resources has so many effects.”

Both he and Whitely spoke of their affection for their patients. “I have a soft spot for South Carolina,” Whitely said. “So, you know, God willing, I can find a good job. I do see myself working somewhere rural.”