In an effort to address the healthcare shortage facing Maryland's nearly half-million residents who live on the rural Eastern Shore, the University of Maryland School of Medicine last year established a program to train and place students in rural healthcare settings. This academic year, three students who received full-tuition scholarships and were accepted into the newly named Rural-MD Scholars program started gaining insight into their future practice on the Eastern Shore through interactions with local healthcare professionals, community engagement, and hands-on clinical experiences.

Rising second-year medical students Zobia Rani, Tahreem Riaz, and Sarah MacDonald, were in the first class of rural scholars to be awarded full scholarships and are beginning to embark on their specialized training.

The state initially provided funding of $1.4 million to support the program with additional funding provided by University of Maryland, Baltimore, University of Maryland Eastern Shore, the Rural Maryland Council, and $1 million from private donors. Recently, the state committed an additional $1.4 million in funding to continue the program for the upcoming academic year, and an anonymous donor committed an additional $1 million. The program’s long-term goal is to provide full scholarships for up to 10 new students a year in order to mitigate the physician shortage on the Eastern Shore.

Rising second-year medical students Zobia Rani, Tahreem Riaz, and Sarah MacDonald, were in the first class of rural scholars to be awarded full scholarships and are beginning to embark on their specialized training. After medical school and residency training in the field of their choice, they will begin their medical careers within an Eastern Shore healthcare setting, committing to a minimum of four years of service in the community. The federal Teaching Health Center Graduate Education Medical Education Program reports that out of nearly 2,000 doctors who have graduated from rural residency programs, roughly 70 percent have continued their practice in underserved areas.

“We are extremely proud of our Rural-MD Scholars who have made a tremendous commitment to address health disparities in our state,” said Leah S. Millstein, MD, Course Director for the program and Associate Professor of Medicine at UMSOM. “We are very excited to play an important part in Maryland's mission to expand access to healthcare in rural counties.”

All five of Maryland’s counties with the fewest primary care physicians per capita are on the Eastern Shore. Eight rural Eastern Shore counties have 76 percent of residents living in federally designated medically underserved areas (MUAs), with Caroline, Kent, Somerset and Worcester each having 100 percent of their population residing in designated MUAs. These residents tend to have lower life expectancies, as much as seven years shorter in some Eastern Shore counties compared to top-ranked suburban Montgomery County. In 2022, the Centers for Disease Control and Prevention (CDC) reported that many deaths in rural America were potentially preventable including 20,000 from heart disease and stroke, 6,000 from cancer and 10,000 from unintentional injuries and 6,000 from chronic lower respiratory disease.

Collaboration with Eastern Shore Physicians

Since the program’s launch in Fall 2024, five Eastern Shore physicians have committed to joining the program’s Core Physician Panel, offering students one-on-one mentorship opportunities and informing the curriculum with clinical insights from their practice in rural healthcare. This includes procedural techniques that students may need to know how to perform in low-resource healthcare facilities. The panel features a diverse group of healthcare professionals, ranging from private practice physicians to leaders of public health organizations, highlighting the various ways students can practice throughout their careers in medicine.

More Doctors, Longer Lives: Preventing Heart Disease Deaths in Rural Maryland

Rates of preventable heart disease deaths were found to be significantly higher in rural areas compared to large central suburban areas throughout Maryland. A major reason cited by federal health researchers for this disparity was lack of access to health care. Increasing physician density in rural areas could reduce the rate of preventable deaths.

“Practicing medicine in a rural area presents a unique set of challenges to physicians who may find themselves with limited access to local specialists to refer patients to or the most advanced medical equipment,” said Dr. Casey Scott, Health Officer of the Dorchester County Health Department, who serves as a Core Physician mentor for this program. “It is vital for those in training to practice in rural areas to be fully prepared for these challenges, and that is what we are trying to ensure for students participating in the Rural-MD Scholars program."

To further enhance community engagement, the program team also aims to collaborate with the Core Physician Panel to identify Eastern Shore families that students can assist in navigating their various experiences in healthcare.

“We are incredibly grateful for the partnership of these dedicated physicians who have generously invested their time and resources in the development of our students,” said Donna L. Parker, MD, FACP, Senior Associate Dean for Medical Education at UMSOM. “Their experiences in navigating barriers to care on the Eastern Shore and attending to a range of patient concerns are invaluable to our program’s success. We look forward to expanding clinical opportunities with their support in the years to come.”

Rural Health Clinical Training

Rural-MD Scholars is part of a larger effort to provide UMSOM students with a background in rural healthcare. Last year, the school began offering a two-year elective course to all students that provides comprehensive training on the medical needs of rural patients. The curriculum, called the Rural Health Equity and Access Longitudinal Elective (R-HEALE), enables students to gain early exposure to the clinical skills needed to effectively manage patient care in low resource settings.

For example, students enrolled in the elective this year learned skills in using point-of-care ultrasound, which are small portable devices that can be used in a primary care office or at a patient’s hospital bed. These devices could be used in rural settings to provide prenatal care or cardiology, for example, without having to transfer patients to distant facilities.

Four counties on the Eastern Shore are among the top five in Maryland for infant and child mortality, with Somerset and Caroline counties in the top five in both age groups. Part of this may be due to a delay in getting the appropriate prenatal care early in pregnancy due to lack of access.

“One in four residents on the Eastern Shore live at least 10 miles from a hospital, which increases the risk of delayed treatment,” said UMSOM Dean Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and Vice President for Medical Affairs at University of Maryland, Baltimore. “Caroline County has only one physician for every 2,500 residents, which is six times lower than the physician density in other parts of the state. Our rural residents urgently need access to skilled physicians like those we are training in our Rural-MD Scholars program who will understand the unique health needs of this population and strive to improve health outcomes.”

The program team also hosted a training session on splinting, teaching students the proper techniques needed to stabilize and heal injuries.

Community Engagement

Part of the Rural-MD Scholars Program involves interacting with state policymakers to help learn to advocate on behalf of residents of rural communities. Rural-MD Program Scholar Sarah MacDonald, along with program faculty, traveled to Annapolis in February to attend the Maryland Rural Health Association’s Annual Legislative Forum where they received updates on various rural health programs from several distinguished guest speakers, including Secretary Paul Monteiro, Delegate Thomas Hutchinson, and Senator Dawn Gile.  

“It was inspiring to see that policymakers in Maryland are deeply invested in patient success on the Eastern Shore,” said MacDonald. “They are actively working to enhance services and attract a wide range of health professionals like doctors, nurses, and physical therapists to work in these rural areas.”

Looking Ahead

The selection process for the next class of Rural-MD Scholars has concluded. After receiving a high volume of qualified applicants, 10 students have been selected for the incoming class with nine accepting full-tuition scholarships. Program participants will be announced this summer. Incoming and current students will attend an immersive pre-matriculation program at the University of Maryland Eastern Shore (UMES) campus in July featuring information sessions on rural health topics. Program faculty are also collaborating with the Core Physician Panel and local healthcare organizations to develop a schedule of shadowing experiences in clinical settings and community outreach activities for the July program.

Current program partners include University of Maryland Eastern Shore, University of Maryland Shore Regional Health (UM SRH), TidalHealth, the Dorchester, Somerset, and Wicomico County Health Departments, Eastern Shore Area Health Education Center (EAHEC) and the Maryland Area Health Education Center (MAHEC).