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State’s first family medicine obstetrics fellowship hopes to increase access to maternal care in rural areas

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The state’s first fellowship to train family physicians to care for pregnant and postpartum women is poised to start next July.

The proposed fellowship will train two to three family physicians a year in obstetrics, which the medical community hopes will provide rural and underserved areas with prenatal, delivery and postpartum care.

More than half of Mississippi’s counties are considered maternity care deserts, meaning there are no practicing OB-GYNs and no hospitals that deliver babies. For family physicians looking to practice obstetrics, the lack of training programs and difficulty getting affordable malpractice insurance coverage are challenging.

Aside from two hospitals that have been able to cut through the red tape and use family physicians in maternal care, nearly all pregnancies are handled by OB-GYNs, who are in short supply in Mississippi and mostly practice in urban areas. 

The state is an outlier when it comes to how little it uses family physicians in obstetrics. Across the country, family physicians play a significant role in providing obstetric care to expectant mothers. Neighboring Alabama, for instance, boasts five fellowships in obstetrics for family physicians.

Family physicians deliver babies in more than 40% of U.S. counties, and “are the sole maternity care clinicians delivering babies in 181 (maternity care deserts) … serving more than 400,000 women” nationwide, according to a report by the American Academy of Family Physicians.

Dr. James Lee Valentine and Dr. Melissa Stephens of EC Health Net, a family medicine residency program in Meridian, are designing the new one-year training program to focus on increasing access to rural maternal care.

“The fellowship will train family physicians to be able to go into some of our rural, underserved communities, and provide obstetric care for these women close to home, who may have limited access and are facing challenges,” Stephens said.

University of Mississippi Medical Center is home to the only OB-GYN residency in the state, which graduates five or six residents each year. Of those, an average of two residents remain and practice in Mississippi.

On the other hand, a record 37 family physicians graduated in 2023 from residencies in Mississippi – more than any year in the past five years, according to the Office of Mississippi Physician Workforce.

Meanwhile, the state’s maternal and infant mortality rates are worsening. Valentine and Stephens see the fellowship as one way to combat that.

 “These patients sometimes don’t get any (prenatal care) and they show up in the emergency room, delivering … that’s got to change,” Valentine said. “And I’m not saying that we ought to put family practice doctors out there doing all kinds of GYN surgeries and all that, but we got to deliver better prenatal care to our patients in the rural areas.”

The fellowship will set physicians up on three-month rotations between EC Health Net in Meridian, South Sunflower Hospital in Indianola, and Wayne General Hospital in Waynesboro. Valentine and Stephens hope to also add a stint at a larger hospital studying gynecological surgeries.

South Sunflower and Wayne General are the only two hospitals in the state currently using family medicine OBs, despite the bureaucratic challenges. The family physician OBs at these two hospitals are attending the majority of births in their counties.

Dr. Kelvin Sherman, the only practicing family medicine OB at Wayne General, delivers between 180 and 280 babies a year from Wayne County and some neighboring counties. In 2022, 256 babies were born in Wayne County, which has no practicing OB-GYN, alone.

Sherman, who did his obstetrics fellowship in Alabama, said in his experience, women who are farther from obstetrical care tend not to seek help when experiencing symptoms because they can’t justify the long drive or using the county’s only ambulance. Having a family doctor nearby can make a huge difference in pregnancy outcomes.

“If they’ve got some place to go that’s 15 minutes away, then maybe they go get something checked on and find out that ‘Yeah, you are in preterm labor, but it’s early and we can stop it, and we can prolong your pregnancy and you can have a healthier baby – a baby that goes home with you rather than having to deliver early a small baby that ends up in the NICU that stays sick a lot in the first few years of life,’” he explained. 

Sherman is breaking ground not only as one of the state’s only family medicine OBs, but also by working closely with a certified nurse midwife, a rarity in Mississippi – a state with no certified midwife program. Opening the doors to certified midwives could increase the amount of care available to women.

Advanced nurse practitioners are also qualified to give prenatal care. But in Mississippi, restrictive and expensive collaboration agreements limit the care nurse practitioners can provide

Sherman’s partnership with the certified nurse midwife is the kind that Wayne General CEO Andrew Porter hopes the new fellowship will facilitate.

“The FMOB (a family medicine physician who practices obstetrics) can really be a multiplier,” Porter said. “They can be the captain of a ship that has these other providers working under them and it just multiplies the amount of care that can be provided to patients.”

South Sunflower in Indianola has three family physician OBs on staff who average about 250 births a year in a county that had 263 live births in 2022.

Courtney Phillips, CEO of South Sunflower Hospital, poses for a portrait at South Sunflower County Hospital in Indianola, Miss., Friday, Oct. 20, 2023. Credit: Eric J. Shelton/Mississippi Today

The hospital has been using the family medicine OB model since it opened in the 1930s, according to hospital CEO Courtney Phillips. It’s a lifeline today, where the next closest hospital is 30 miles away, and even there, there aren’t enough OB-GYNs to take care of all the deliveries.

“So, even though the next closest hospital to deliver is 30 miles away, they may have to travel all the way to Grenada if we weren’t here, which is close to 80 miles away,” Phillips explained. 

The family medicine obstetrics model is used sparsely because while family physicians receive an unrestricted license to practice medicine, the problem lies in getting insurance and privileges at a hospital.

 “There’s a big difference between licensure and credentials,” Stephens, a family medicine physician at EC Health Net in Meridian, said.

While the licensure board allows physicians to practice according to their training without restriction, physicians also need to apply for malpractice insurance coverage, which requires proving competence to the malpractice carrier, and then proving competence to get credentialed by the hospital they are joining. Both became difficult in Mississippi after the explosion of liability insurance costs in the 1990s.

Medical liability premiums skyrocketed across the U.S. at the turn of the century, but particularly in Mississippi – known by 2001 as the “lawsuit capital of the world,” according to a 2011 case study by the American College of Obstetricians and Gynecologists – and affected physicians’ ability to practice specialties like obstetrics or neurosurgery. Mississippi was “perhaps the hardest hit of the ‘red alert states,’” a term used to denote high medical liability regions, the case study said. 

Valentine, who worked in obstetrics throughout the 1980s and had proven his competency to the board through documentation of all the procedures he performed and deliveries he attended, suddenly couldn’t afford his malpractice insurance premium when what he refers to as the “malpractice crisis” hit. 

“My malpractice insurance went up about 180% premium-wise in a year’s time,” he said. “I couldn’t justify losing money to practice OB, and then take the risk on top of that. It was almost like they were trying to push us out.”

As it stands, Mississippi family physicians interested in obstetrics have few options: pursue an official training program in another state – which often results in those physicians deciding to either leave the state altogether or stay in the state and forego obstetrics – or train unofficially in Mississippi but without the guarantee of affordable malpractice insurance or a hospital that will grant them privileges.

South Sunflower Hospital in Indianola, Miss., Friday, Oct. 20, 2023. Credit: Eric J. Shelton/Mississippi Today

South Sunflower, according to Valentine, is able to utilize family physicians in obstetrics affordably because of its highly regarded staff that helps them get coverage and credentials.

“Places like Indianola, they have a track record,” he said. “Dr. Wade Dowell has been … a champion for family medicine, doing OB and doing general family medicine for years, and so he’s got a track record, and the doctors he’s trained there – they do a good job.”

Valentine and Stephens hope the new fellowship will offer a similar standard that will help family physicians receive credentials and coverage in obstetrics at an affordable rate – though it’s never a guarantee.

“Whether every hospital in the state of Mississippi will recognize that, whether every hospital will open their doors, I don’t know,” said Valentine. “But from the standpoint of being qualified … we want to make sure that our fellowship is substantial enough that when they leave our fellowship, whether it’s one year or two years, they’re ready to practice obstetrics at the level they’re trained to do that.”

The fellowship is one proposed solution to changing the maternal health landscape of Mississippi. But experts believe programs like it are critical in shifting the pendulum.

“It’s not going to be a cure-all for some of the obstetrics needs, and issues like infant mortality, but it’s a step,” Porter, the Wayne General CEO, said. “It’s people who are acknowledging that we have a crisis here in the state and are trying to do something about it. Here in Waynesboro, Mississippi, and the surrounding area of Meridian, and those in the Delta, we're trying to take the matter into our own hands and come up with some solutions.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

On this day in 1911

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mississippitoday.org – Jerry Mitchell – 2024-12-21 07:00:00

Dec. 21, 1911

A colorized photograph of Josh Gibson, who was playing with the Homestead Grays Credit: Wikipedia

Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia. 

When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs. 

He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame. 

The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays. 

Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1958

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mississippitoday.org – Jerry Mitchell – 2024-12-20 07:00:00

Dec. 20, 1958

Bruce Boynton played a key role in the U.S. Supreme Court case that led to the Freedom Riders protests of 1961. Credit: Jay Reeves/Associated Press

Bruce Boynton was heading home on a Trailways bus when he arrived in Richmond, Virginia, at about 8 p.m. The 21-year-old student at Howard University School of Law — whose parents, Amelia Boynton Robinson and Sam Boynton, were at the forefront of the push for equal voting rights in Selma — headed for the restaurant inside the bus terminal. 

The “Black” section looked “very unsanitary,” with water on the floor. The “white” section looked “clinically clean,” so he sat down and asked a waitress for a cheeseburger and a tea. She asked him to move to the “Black” section. An assistant manager followed, poking his finger in his face and hurling a racial epithet. Then an officer handcuffed him, arresting him for trespassing. 

Boynton spent the night in jail and was fined $10, but the law student wouldn’t let it go. Knowing the law, he appealed, saying the “white” section in the bus terminal’s restaurant violated the Interstate Commerce Act. Two years later, the U.S. Supreme Court agreed. “Interstate passengers have to eat, and they have a right to expect that this essential transportation food service,” Justice Hugo Black wrote, “would be rendered without discrimination prohibited by the Interstate Commerce Act.” 

A year later, dozens of Freedom Riders rode on buses through the South, testing the law. In 1965, Boynton’s mother was beaten unconscious on the day known as “Bloody Sunday,” where law enforcement officials beat those marching across the Selma bridge in Alabama. The photograph of Bruce Boynton holding his mother after her beating went around the world, inspiring changes in voting rights laws. 

He worked the rest of his life as a civil rights attorney and died in 2020.

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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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‘Something to be proud of’: Dual-credit students in Mississippi go to college at nation’s highest rate

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mississippitoday.org – Molly Minta – 2024-12-20 06:00:00

Mississippi high school students who take dual-credit courses go to college at the nation’s highest rate, according to a recent report. 

It’s generally true that students who take college classes while in high school attend college at higher rates than their peers. Earlier this year, a study from the Community College Research Center at Teacher’s College, Columbia University found that nationally, 81% of dual-credit students go to college. 

In Mississippi, that number shoots up to 93%, meaning the vast majority of the state’s high school students who take college classes enroll in a two- or four-year university. 

“When we did this ranking, boom, right to the top it went,” said John Fink, a senior research associate and program lead at the research center who co-authored the study. 

State officials say there’s likely no silver bullet for the high rate at which Mississippi’s dual-credit students enroll in college. Here, “dual credit” means a course that students can take for both high school and college credit. It’s different from “dual enrollment,” which refers to a high school student who is also enrolled at a community college. 

In the last 10 years, participation in these programs has virtually exploded among Mississippi high school students. In 2014, about 5,900 students took dual-credit courses in Mississippi, according to the Mississippi Community College Board. 

Now, it’s more than 18,000. 

“It reduces time to completion on the post-secondary level,” said Kell Smith, Mississippi C0mmunity College Board’s executive director. “It potentially reduces debt because students are taking classes at the community college while they’re still in high school, and it also just exposes high school students to what post-secondary course work is like.” 

“It’s something to be proud of,” he added. 

There are numerous reasons why Mississippi’s dual-credit courses have been attracting more and more students and helping them enroll in college at the nation’s highest rate, officials say. 

With a few college credits under their belt, students may be more inspired to go for a college degree since it’s closer in reach. Dual-credit courses can also build confidence in students who were on the fence about college without requiring them to take a high-stakes test in the spring. And the Mississippi Department of Education’s accountability model ensures that school districts are offering advanced courses like dual credit.

Plus, Mississippi’s 15 community colleges reach more corners of the state, meaning districts that may not be able to offer Advanced Placement courses can likely partner with a nearby community college.

“They’re sometimes like the only provider in many communities, and they’re oftentimes the most affordable providers,” Fink said.

Test score requirements can pose a barrier to students who want to take dual-credit courses, but that may be less of a factor in Mississippi. While the state requires students to score a 19 on ACT Math to take certain courses, which is above the state average, a 17 on the ACT Reading, below the state average of 17.9, is enough for other courses. 

Transportation is another barrier that many high schools have eliminated by offering dual-credit courses on their campuses, making it so students don’t have to commute to the community colleges to take classes. 

“They can leave one classroom, go next door, and they’re sitting in a college class,” said Wendy Clemons, the Mississippi Department of Education’s associate state superintendent for secondary education. 

This also means high school counselors can work directly with dual-credit students to encourage them to pursue some form of college.

“It is much less difficult to graduate and not go to college when you already possess 12 hours of credit,” Clemons said.

Word-of-mouth is just as key.

“First of all, I think parents and community members know more about it,” Clemons said, “They have almost come to expect it, in a way.” 

This all translates to benefits to students. Students who take dual-credit courses are more likely to finish college on time. They can save on student debt.

But not all Mississippi students are benefiting equally, Fink said. Thr research center’s report found that Black students in Mississippi and across the country were less likely to pursue dual-credit opportunities. 

“The challenge like we see in essentially every state is that who’s in dual enrollment is not really reflective of who’s in high school,” Fink said.

Without more study, it’s hard to say specifically why this disparity exists in Mississippi, but Fink said research has generally shown it stems from elitist beliefs about who qualifies for dual-credit courses. Test score requirements can be another factor, along with underresourced school districts. 

“The conventional thinking is (that) dual enrollment is just … another gifted-and-talented program?” Fink said. “It has all this baggage that is racialized … versus, are we thinking about these as opportunities for any high school student?”

Another factor may be the cost of dual-credit courses, which is not uniform throughout the state. Depending on where they live, some students may pay more for dual-credit courses depending on the agreements their school districts have struck with local community colleges and universities. 

This isn’t just an equity issue for students — it affects the institutions, too. 

“You know, we’ve seen that dual-credit at the community college level can be a double-edged sword,” Smith said. “We lose students who oftentimes … want to stay as long as they can, but there are only so many hours they can take at a community college. 

Dual-credit courses, which are often offered at a free or reduced price, can also result in less revenue to the college. 

“Dual credit does come at a financial price for some community colleges, because of the deeply discounted rates that they offer it,” Smith said. “The more students that you have taking dual-credit courses, the more the colleges can lose.” 

State officials are also working to turn the double-edged sword into a win-win for students and institutions. 

One promising direction is career-technical education. Right now, the vast majority of dual credit students enroll in academic courses, such as general education classes like Composition 1 or 2 that they will need for any kind of college degree. 

“CTE is far more expensive to teach,” Clemons said.

Smith hopes that state officials can work to offer more dual-credit career-technical classes. 

“If a student knows they want to enroll in career-tech in one of our community colleges, let’s load them up,” Smith said. “Those students are more likely to enter the workforce quicker. If you want to take the career-tech path, that’s your ultimate goal.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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