Approximately 120 out of Georgia’s 159 counties are classified as rural, according to the Georgia Department of Community Health. This presents significant challenges in healthcare access, particularly for older populations with chronic health conditions.
Amrita Jariwala, the first primary care rural health fellow in the Department of Family and Community Medicine at the Medical College of Georgia at Augusta University, described her recent experience working in Sandersville and Tennille, Georgia. “This past year, I was working with the Community Health Center Systems in Sandersville and Tennille, Georgia,” Jariwala said. “I have an extensive background in anesthesia and critical care, but this was a very different experience for me. In these rural places, what I observed is there is an older population. Probably about 80% of the patients I saw were 60 years of age or older.”
Jariwala noted that many patients have multiple chronic illnesses, making access to regular care crucial. “This is what makes these kinds of fellowships so important,” Jariwala said. “Sandersville is about one hour and 20 minutes away from Augusta, and the patients there really appreciated me coming to see them. They needed help.”
The Community Health Center Systems operates in several small cities across Georgia, helping connect patients from even smaller surrounding communities with healthcare providers. Jariwala explained, “While Sandersville is a small town, it is considered quite a big place in that region. Many of the patients I saw were from much smaller neighboring counties and towns.”
After her fellowship, Jariwala started working at Wellstar MCG Health Medical Center in Augusta but said the fellowship influenced her interest in rural medicine. “It was clear that the doctors and the attendings share a bond with their patients in these close-knit communities,” she said. “They know everything about the patients and their families. It is a strong bond.”
Augusta University President Russell T. Keen highlighted the importance of such fellowships for medical training. “These fellowships are a direct investment in the health of Georgians,” Keen said. “They empower our medical residents to sharpen their clinical expertise, broaden their skill sets and drive innovation in patient care, especially in the areas of our state that need it most.
“We are deeply grateful to the governor and the Georgia General Assembly for recognizing the critical importance of these fellowships,” he added. “Their support strengthens Georgia’s health care workforce and affirms their commitment to Augusta University’s mission of advancing health care statewide.”
Julie Dahl-Smith, DO, vice chair of education in the Department of Family and Community Medicine at the Medical College of Georgia, explained that the rural health fellowship provides family medicine physicians with hands-on experience for work in underserved areas. “In these areas, it is very hard for patients to get specialty care,” Dahl-Smith said. “A lot of times with rural health patients, they don’t have transportation, or they must travel two hours away, and they don’t want to take off work, so their condition might worsen. This rural health fellowship gives our students extra tools to see what these patients are facing.”
Dahl-Smith also noted that such programs help retain medical talent within Georgia. “If a fellow does the fellowship in the state, statistics say they’re more likely to stay in the state,” she said. “That is really important because Georgia is so underserved. We need our primary care physicians and there are shortages in all of Georgia’s rural areas. There are some areas that have no physicians whatsoever for miles and miles away. These kinds of fellowships can help attract and retain physicians in Georgia.”
David C. Hess, MD, interim executive vice president of research and innovation and dean of the Medical College of Georgia, recently announced a record number of residents and fellows at the school. “We have consistently trained around 585 residents and fellows each year,” Hess said. “The great news this year is we have our largest group ever – with 611 residents and fellows across our medical school and health system. Residents and fellows are key to attracting and retaining more doctors in Georgia. Graduate medical education programs are how you really create physicians for the state. More residents training here means we have more doctors to practice here.”
Christopher Johnson, MD, who completed a sports medicine fellowship at Augusta University, reflected on his personal experience with limited access to specialized care in rural communities. “When I was younger, I remember my granddad fell and broke his clavicle, but there was not a sports medicine orthopedic doctor in his little town that he lived in, in south Georgia,” Johnson said. “They didn’t even have an X-ray machine at his regional emergency room. So, we had to go to Tallahassee, Florida, all the way across state lines, just to get an orthopedic doctor to help him.
“That experience showed me how there are just not a lot of doctors out in these rural communities,” he said. “But you have these specializations, like people in sports medicine, who are now actually able to go out to these smaller areas, and they’re able to do diagnoses and refer patients to orthopedic surgeons when it’s necessary for bigger procedures.”
Johnson explained that access to ultrasound during his fellowship improved diagnostic efficiency for musculoskeletal issues: “A lot of times, in order to see the pathology of a patient, you need an MRI, which is super expensive, or a CT scan, which is radiation,” he said. “Both cost a lot of money, and it also takes time. You can’t just order an MRI today and get the MRI today. It takes weeks sometimes.” He described how portable ultrasound devices allowed for faster assessments.
Chris Ledford, MD, director of the sports medicine fellowship at Augusta University, pointed out the need for musculoskeletal experts in rural parts of the state. “In family medicine, we prepare our residents to take care of all conditions that a patient might show up with at the office,” Ledford said. “In the primary care sports medicine fellowship, we look to solidify and advance those skills and education that they need to be the experts in nonoperative care of musculoskeletal injuries, as well as the conditions that typically show up in active individuals related to sports injuries, such as concussions.”
Ledford explained that graduates are equipped to bridge gaps in physical and occupational therapy services by connecting patients with needed resources.
Johnson also gained experience working with Augusta University’s athletic teams and local high schools during his fellowship. “I also worked in the community with the men’s and women’s basketball teams at AU and helped out in the training room with all the sports teams, including track and field, golf, the softball team, the baseball team, cheer and dance team and the volleyball team,” he said. “I also helped some of the high school sports teams around town including Cross Creek, Academy of Richmond County, Hephzibah and Glenn Hills high schools.
“Needless to say, this has been a tremendous fellowship,” Johnson added. “I’m really happy to be able to come back to my hometown of Augusta and do my fellowship here. It’s been like a blur of a year, but I’ve learned so much.”
