North Carolina Rising

Improving Rural Health Care

Q&A with Dr. Ken Steinweg

Dr. Ken Steinweg, Brody School of Medicine, East Carolina University

Q. What is the availability and quality of health care in Eastern NC? What factors contribute to that?

A. There are tremendous health care shortages in eastern NC. Compared to North Carolina, Pitt County has higher poverty rates, overall mortality rate, age-adjusted mortality for heart disease, cancer, and cerebrovascular disease, cancer incidence, and neonatal and infant mortality. These are almost universally primary care shortages, including Family Medicine, Internal Medicine and Pediatrics. Most of the counties in extreme distress are in the East. Pitt County and the Brody School of Medicine (BSOM) are surrounded by these shortage counties and they are in the BSOM service area.

Q. Why has the development of the Brody School of Medicine been so crucial to improving health care in Eastern NC? How will it continue to help?

A. This is a three-part answer:

1. Prior to the founding of the BSOM, the medical care infrastructure in Greenville and Pitt County was also very underserved. The Chancellor of that time, Dr. Leo Jenkins, realized that for ECU to develop and thrive there needed to be a much better medical infrastructure to support the university students and faculty. His vision is exactly what happened. There are approximately 600 practicing physicians in Pitt County. No surrounding county has 1/6 of the physician density. There is finally an improving primary care base here to support the city, county and university, although we could use 10-15 more primary care physicians just in Pitt County.
2. In addition, critical specialty services are now available locally. This was not the case before the establishment of the medical school. Prior to the establishment of the BSOM, patients and their families were transferred to UNC or Duke. Examples include neonatology, oncology, high-risk obstetrics, neurosurgery, invasive cardiology, level 1 trauma service, and large numbers of intensive care beds in medical and surgical specialties with subspecialty coverage. Critically ill patients unsuited for community hospitals are often transferred here and are close to their families.
3. The shortage of primary care physicians in eastern NC is critical now. Many of these physicians, about 30%, will retire in the next 5 to 7 years. The BSOM has, by far, the highest retention rate of graduates practicing in NC of any medical school, especially Family Medicine residency graduates who stay in the state, and in particular in eastern NC. About 75% of our residency graduates stay in the state, and half of those stay in eastern NC. In this year's class, as of now, 8 or 9 out of 10 will practice in NC, and 5 plan to stay in eastern NC specifically. We are the engine replacing the retiring physicians. Without this engine, physician supply would be critical. Every county surrounding us has many of our graduates, too.

Our research shows a lessening of the health care disparities in eastern NC, as compared to the rest of NC and the nation, but we have a long way to go. Access to primary care is a big part of this, as is close access to specialty care.

Q. What is the BSOM doing to keep talented doctors in the area?

A. This is a challenge for us. With the current and worsening physician shortage, the competition will be keen for many types of physicians. Having a medical school offers access to medical advances, medical education, critical technologies, and a professionally pleasing practice environment by being able to obtain the help you need for your patients. The BSOM and Pitt County Memorial Hospital at this time have an ongoing collaborative effort to recruit and retain talented physician workforce. The medical school recently was selected and funded along with 20 other medical schools around the country by the AAMC to study faculty retention in an initiative called “Faculty Forward,” which is a two-year national project.