Rural and underserved areas need primary care nurses. That’s where Decker College steps in

You never quite know what the day will bring in rural healthcare: a baby receiving their first vaccines, an elderly person managing medication. Injuries, acute illnesses, chronic conditions — a primary care practice in a rural community sees it all.

“That makes my job very interesting on a daily basis,” acknowledges Kathryn DeWitt Phillips ’16, MS ’18, a family nurse practitioner at the Susquehanna Family Health Clinic in Susquehanna, Pa.

Around 46 million Americans — 20% of the total population — live in rural communities, which experience challenges to healthcare access. According to the Health Resources and Services Administration (HRSA), primary care providers are in short supply in 65% of rural areas. In New York state, rural communities have only 86.1 primary care providers per 100,000 residents, compared to 113.8 in urban areas, according to the Primary Care Development Corporation.

HRSA, a federal program, seeks to mitigate those shortages by providing the funding to train the future healthcare workforce in rural and underserved areas. Binghamton University’s Decker College of Nursing and Health Sciences has received several consecutive HRSA workforce grants, and more than 100 Decker-trained nurse practitioners have gained this funding, with 17 graduating in May 2024 alone.

Financial help such as loan repayment is more readily available at hospitals in larger metropolitan areas, observes Heidi Roggie, MS ’21, a family nurse practitioner at Lowville Medical Associates. Rural healthcare centers simply don’t have the resources to offer something similar, even though they need dedicated providers. By covering recipients’ educational costs, HRSA enables them to practice in these high-need areas.

“We’re known more for cows than people,” Roggie says of the small North Country community she calls home. “It’s a great place; families are strong, and a lot of people are related. HRSA has allowed me to be able to come back and work in the community and not worry about the financial part of it.”

Finding providers who stay

Healthcare organizations in rural or underserved areas can spend thousands of dollars attempting to recruit physicians, nurses and advanced practice nurses, only to discover it’s a bad match. If the provider or their spouse isn’t content with rural living, they will leave after fulfilling their two- or three-year obligation.

When you consider that it takes around two years to build up a patient base, that scenario can be disruptive to healthcare access, points out Associate Professor of Nursing Nicole Rouhana, who directs Decker’s graduate nursing programs.

Other grants are available, such as the National Health Scholarship, which funds educational expenses and offers a stipend to individuals who commit to working in a medically underserved area for two or three years. However, no payback is required for Decker’s HRSA grant; instead, Rouhana is tasked with matching students with a healthcare organization in their region that will increase their likelihood of getting hired — and remaining to practice long-term.

“We go into some of the most rural and remote parts of New York state to recruit,” she explains. “A lot of people don’t want to work in a rural and underserved area for their primary employment, but if they were raised in that area and have family there, they are more likely to stay.”

At maximum, 30 Decker students a year have received HRSA awards; the program is now funding 24 nurse practitioner (NP) students, Rouhana says. To qualify, students must first be admitted to the Decker School of Nursing graduate program, be registered nurses and have an unencumbered nursing license.

They must also live in a rural area, which is defined by the Rural-Urban Continuum Code (RUCC) determined by the U.S. Department of Agriculture’s Economic Research Service. The USDA currently defines a rural town as having fewer than 5,000 people; another measure, Rural-Urban Commuting Areas (RUCA), correlates rurality with the length of residents’ commute to work.

“We have some flexibility in who we are going to fund,” Rouhana says. “We give preferential funding to students who might live in a medically underserved area or an area that’s underserved for mental health.”

Once admitted, students are interviewed to see if they would be a good fit for the award.

Decker has cultivated community partners in remote areas of the state, including Plattsburgh, Canton and Ogdensburg. About 88% of alumni work as NPs in primary care or rural settings once they have completed their programs, Rouhana says.

To address the challenges of rural practice, students receiving HRSA funding are required to take two courses: one in rural sociology and another in caring for individuals with opioid use disorder. A previous grant mandated a course in telehealth for rural healthcare providers, according to Rouhana.

“One of the characteristics of rural healthcare is that you don’t do specialization; you have to be ready for anything that comes through the door,” she adds.

The community fabric

Roggie, who grew up in the Lowville area, started her nursing career in 2001 and spent 20 years in different areas of nursing, from maternity, labor and delivery, to work as a nursing supervisor and lactation consultant. Along the way, she and her husband spent seven years in Alaska, where she worked at a hospital. After graduating from Decker in 2021, she started a private practice as a family NP, seeing patients of all ages.

“It takes special people to be able to work in rural medicine. Communities are close, and the medical needs are really great,” she says. “You have a connection to everyone in your community. It’s more than just your patient.”

Sometimes practices themselves are a family affair. DeWitt Phillips’ clinic is around 40 years old. She has spent six years there; her father worked there as a physician and also delivered babies at the hospital across the street.

When forging her future, she initially headed to an urban area, earning degrees in English and business management from Temple University in Philadelphia. After meeting her husband, they moved to his hometown of Lancaster, Pa., for a few years, and DeWitt Phillips found a job at the local hospital that she enjoyed. She decided to become a nurse and ran the idea past her dad. His advice: become a nurse practitioner.

Having her tuition covered by HRSA proved a significant help. DeWitt Phillips did many of her clinical rotations at a federally qualified health center in Honesdale, Pa., which gave her a different view of rural health than her father’s practice.

Overall, rural healthcare providers treat the whole person, which instills deep trust. Sometimes, patients with acute issues choose to visit DeWitt Phillips’ clinic first rather than the emergency room just across the street, for example. Roggie frequently treats diabetics, many of whom choose to forgo the hour-long drive to the endocrinologist in Watertown, N.Y.

Of course, there are also tough situations, such as delivering a difficult diagnosis to patients you have come to know well. Take pancreatic cancer, for example. While Roggie refers such cases for treatment, her practice performs the initial testing, scanning and lab work.

HRSA ensures that the next generation of rural healthcare providers will be ready to take up the mantle. Roggie’s daughter, who is attending nursing school, has just applied.

“HRSA allows future providers to get an idea of what it’s like to work in rural healthcare,” DeWitt Phillips says. “It brings a lot of students into our office, and some of them might want to stay and practice with us, becoming a part of our community.”