Dr. Mattson Mathew and Celeste Keelin huddled around a laptop in an examination room. Mathew asked Keelin about the patient she saw this morning.
“Just looking at her x-ray here, was there any additional workup done in the emergency room that kind of pushed the team in the direction to think [it’s] croup?” Mathew asked.
Keelin took a moment to think.
“She had been diagnosed with croup a month prior and kind of treated,” Keelin replied.
“And then, can you think of the classic pathogen that precipitates croup?” Matthew followed up.
“Is that homophilious?”
“Parainfluenza.”
Mathew is a family physician at Hot Springs Health in Thermopolis. Keelin is a medical school student through a regional program called WWAMI, which stands for the five states that participate in it, including Wyoming.
Keelin is in WWAMI’s Targeted Rural Underserved Track (TRUST) program, which pairs students with a dedicated physician mentor. In Wyoming, the TRUST sites are in Powell, Douglas, Fremont County and Thermopolis. Many of the students in the program want to come back to practice in Wyoming’s farther-flung hospitals and clinics.
It’s a success story for recruiting and retaining healthcare professionals in the Equality State. The Wyoming Department of Health (WDH) hopes to expand on opportunities like this with federal Rural Healthcare Transformation Program funds to address the state’s healthcare workforce shortage.
“ Those programs work,” said Dr. Tracy Haas, WDH’s Medicaid medical director. “People stay in either the community they trained in or nearby. The more we can get a geographic diversity, a bigger footprint in our state, the better.”
This is Keelin’s third rotation at Hot Springs Health in Thermopolis.
“When I spent four weeks here over the summer, I was doing sutures, I was helping with deliveries, I was helping cauterize the nose – very hands-on, very in on the action,” Keelin said.
These clinical experiences are usually reserved for the later years of medical school. But Keelin is just in her second year.
Mathew said they throw students right into the thick of things. Many medical programs are more of a shadowing experience.
“If a student is with an attending for the day and we have a lesion removal, they're [the student] gonna be doing the numbing injection, they're going to be performing part of the biopsy,” he said.
As a WWAMI student, Keelin and her cohort have an incentive to return to the state once they graduate. If they work here for three years, Wyoming will pay almost the entirety of their tuition.
“Two out of every three students who graduate come back into practice in Wyoming, said Dr. Todd Guth, Wyoming’s WWAMI director. He said 10 years ago, they started the TRUST program.
“ Those are all rural-focused experiences where students get to spend extended periods of time in rural clinic spaces, and they're not just bouncing around. They're staying there,” he said.
Guth said the hands-on clinical experience in rural Wyoming has helped increase the retention rate.
“ Students wanna come back and work in Wyoming because they've had those experiences within the state and part of their education is in the state,” Guth said. “And we think that's really powerful to kind of motivate people to come back.”
The program relies on state funds to help pay for about three-quarters of students' overall tuition. But tuition costs increase a bit every year, and state funds to make up the difference can lag.
Guth also said the number of applicants has been decreasing.
Back in the exam room, Keelin said before this morning, she had only read about croup, the case she reviewed with Mathee, in a textbook.
“So it was just really nice to see that,” said Keelin. “Well, nice for me, but poor for the little girl. But it was just really nice to see that [croup] brought to life and actually have a real-world example to kind of tie that to. That way, I won't necessarily mistake it going forward. It just kind of cements that information in my brain.”
Keelin’s from Rock Springs. She wants to be a family physician in Wyoming.
“I wanna be just like the docs that are here in Thermopolis that are doing it all,” she said. “They're in the clinics, they're in the ER, they're in the hospital. They're really just this great team that's working so hard to meet the needs of the community that they love and live in.”
In fact, Mathew’s education is very similar to Keelin’s. He’s from Green River, and he said if WWAMI didn’t exist, he’s not sure if he would be a doctor.
“ I don't know that I ever would've strongly considered medicine without particular options being available to me to explore,” Matthew said.
Mathew and Keelin’s experience might become more common if the state wins those federal dollars to transform rural healthcare. Part of the plan is to partner with more hospitals around the state to create more hands-on clinical programs, as well as create awards to cover the costs of medical school. The health department will find out early next year.
