Some University of Arizona medical school students are gettingfree tuition in exchange for a promise to practicein underserved rural areas for at least two years after they graduate.

The scholarship money is from state funds earmarked to alleviate a physician shortage that is particularly acute in rural Arizona, where more than one-quarter of primary-care physicians plan to retire in the next five years.

Arizona currently ranks among the worst in the country 44th of 50 statesin its number of active primary-care physicians per capita, UA officials say.

Most primary-care doctors in Arizona work in heavily populated Maricopa and Pima counties, creating vast inequalities between provider coverage in urban and more rural areas of the state.

A combined 94 students who attend the UA College of Medicine-Tucson and the UA College of Medicine-Phoenix, which isnearly one-10th of the students at both medical schools, will receive free tuition in exchange for practicing in a rural area for at least two years,UA officials announced Friday morning.

The commitment must be started within six years of graduation from medical school and completed within 10 years of graduation. Once begun, service must be continuous. Students who don't fulfill the commitment will have to return the tuition money, UA officials confirmed.

"It is a huge deal. It is very exciting," saidDr. Jonathan Cartsonis, director of the rural health professions program at the UA College of Medicine-Phoenix. "... It's an investment in the future of Arizona and in ensuring that rural areas of Arizona have access to even basic medical care."

There's also a looming problem with what are known as "ob deserts" where rural expecting mothers can't remain in their community during the later stages of pregnancy because there is no one to deliver their baby.

"It's already happening," Cartsonis said.

La Paz and Greenlee counties have no maternal care, research from the UA Center for Rural Health shows. The same research shows Pinal, Graham, Cochise andSanta Cruz counties have limited access to maternal care.

Ensuring every Arizona resident, whether in rural communities or urban cities, has access to quality health care is a top priority for Arizona, Gov. Doug Ducey said in a written statement. The University of Arizona Primary Care Physician Scholarship is another example of the innovative steps the state is taking to address this critical workforce shortage facing Arizona and the entire nation."

Medical students can be reluctant to serve in rural areas because of a number of barriers, including student debt that can exceed $100,000 by the time they graduate. Rural health jobs, particularly in primary care, oftenpay less than those in urban areas,Cartsonis said.

Also, many students have grown up in urban areas and that's all they know, he said, stressing that the scholarships are only one component of getting providers into rural areas. Students need the righttraining, too, he said.

"In a vacuum, I'd say it might not be the best plan, to just drop a large amount of money to scholarships to go to rural areas to practice medicine," he said. "But that's not happening. We have our rural health professions program, which prepares students and supports a medical school track in rural medicine."

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The UA is already supporting clinical education from six weeks to more than six months in far-flung areas of the state, including Williams, Fort Defiance, Page and Williams.

Another key pieceis finding students who grew up in rural areas and want to serve their home communities as health-care providers, he said.

"Pipeline programs are really important. It's so important we identify the talented and motivated youthin rural areas who want to go into medicine," he said. "We're working hard to recruit at younger and younger ages students from underrepresented backgrounds, including geography."

The scholarships will be available to incoming first-year students, as well as students in their second, third and fourth year at both medical schools, UA officials said.To be eligible, applicants must be an Arizona resident.

Arizona needs nearly 600 primary-care physicians today, and the number is expected to grow to more than 1,900 by 2030, said Dr. MichaelDake,senior vice president for UAHealth Sciences.

As the states only two designated medical schools, the College of Medicine-Tucson and the College of Medicine-Phoenix are taking full advantage of the public investment approved by our state legislators, who recognize the time to address this shortage is now.

The money is coming from $8 million in annual funding appropriated by the Arizona Legislature in May. The remaining funding is being used to expand the UA College of Medicine-Phoenix's class size.

Under the new scholarship programs guidelines, a primary-care physician is someone who successfully has completed medical school at the UAand completed residency or fellowship training in one of the following specialties: family medicine, general internal medicine, geriatric medicine, general pediatrics, psychiatry, or obstetrics and gynecology.

The scholarships are a step in the right direction, but it will be important to carefully select the students who receive them, said Dr. Judith Hunt, who has been practicing internal medicine and pediatricsin Payson for the past 24 years.

Practicing medicine in a rural area is not urban medicine in a small community, she said. Students need to be prepared for what it means for themselves and for their families, she said.

"There are fewer job opportunities for their spouses. They may feel more isolated," she said. "Rural medicine takes an incredible amount of creativity."

There may not be specialists to consult and the work is demanding.

"We are slammed. We have probably half of the primary-care doctors that we need," she said. "For patients who are new to the community, it's difficult to get a primary-care doctor. So we have higher ER visits because patients don't have access to their doctors."

A graduate of the UA College of Medicine-Tucson, Hunt initially moved to Payson fromPhoenix Children's Hospital to fill a need Payson did not have a pediatrician.

"I fell in love with the community, became part of the community. It's my home, it's my daughter's home," she said.

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Thenext step in addressing the physician shortage should be creating more postgraduate residency spots inArizona, Cartsonis said.

Mostmedical school graduates who take residency positions in other states will notreturn to Arizona, data shows.

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

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