New Doctors Often Find Rural Medicine a Bitter Pill to Swallow : Health Care: U.S. pays for schooling, then assigns graduates to physician-short areas. Many leave embittered and disillusioned.

Over the last 20 years, the federal government has strewn more than 17,000 fresh-faced doctors across places they hardly would venture on their own--the country’s most remote and impoverished corners, from Downeast Maine to the desert Southwest.

The idea is to seed the hinterlands with a cadre of physicians who will stay there and flourish, who will work and rear families and become cornerstones of their adopted hamlets.

Sometimes that happens. Usually it does not.

In the view of many, this well-intentioned experiment, called the National Health Service Corps, has been less than a success. Some even call it a failure.

Usually, the transplanted doctors seem to flee the villages as soon as their obligations to the government are fulfilled. Often, they are embittered, used up and burned out. Some call their experience so bad that it kills their lifelong goals of being rural doctors.

Plunging young physicians from big-city teaching hospitals into one-doctor clinics is almost guaranteed to shock their professional sensibilities. But most of those who come away hating the experience blame the grinding workloads and the politics of small-town medicine.

Most of all, they speak of the unyielding bureaucracy of the corps itself.

The doctors share responsibility, of course. Some admit to a certain lack of tact when second-guessing old-time general practitioners. Others acknowledge trouble catching on to the ways of small-town living.

But over and over, one phrase arises when corps doctors describe how they feel the bureaucracy treated them--like “indentured servants.”

Typically, young men and women agree to serve in the corps in exchange for medical school scholarships. For each year of tuition paid, the physician must spend one year in a clinic seeing mostly charity patients in one of 1,900 U.S. counties judged to be short of doctors.

When they finish residency training, they must select from a short list of places where the corps decides they are needed most--often, the doctors say, with little apparent regard for where they want to go.

“There seems to be a type of chattel attitude: ‘You belong to us, and we can put you anywhere we want to,’ ” said Dr. Ron J. Anderson, chairman of the Texas state Board of Health. “They just drop these guys in without any survival skills.”

Dr. Donald L. Weaver has heard these complaints and more. For almost four years, he has run the corps from a block-long federal office building in suburban Washington. He agrees that the $119-million-a-year program has had its problems, especially in the late 1980s, when it reached its peak field strength of 3,127.

“Are there negative stories?” Weaver asked. “Yes, and that’s one of the reasons we call ourselves the ‘new’ National Health Service Corps. The corps has been a plus for rural America. It could be better, and this new corps will make it better.”

Among other things, the corps is emphasizing a loan-repayment program that gives new doctors $25,000 a year in addition to their clinic salaries, which average between $60,000 and $90,000 annually, competitive with starting pay for other family doctors. The corps also is trying to be more flexible in placing people, telling prospects more about the jobs they are likely to get and improving contact with doctors once they get into the field, Weaver said.

The corps came close to fading away during the Ronald Reagan years; the number of scholarships granted fell from 6,400 in 1980 to less than 50 in 1988. But the George Bush Administration revived the program three years ago.

The corps’ field strength, about 1,200, could reach 4,000 by the year 2000. Weaver contends that as the corps grows it will learn to be more humane--and provide the rural poor with more permanent doctors.

Perhaps the chief complaint of the skeptics is the corps’ difficulty in sending people where they will be happy.

Doctors married to each other complain that the corps shows little interest in finding spots where they can fulfill their obligations together. Some who want city assignments end up in rural backwaters. Others who seek jobs in their home states land a continent away.

Dr. Antonio Dajer of New York City, who served from 1987 to 1991, wanted to use his Spanish in an inner-city clinic. Instead, he first was sent to an Indian reservation in Shiprock, N.M., and later to rural Pulaski, N.Y.

“The corps has a military mentality: ‘We paid your medical school, and we own you now,’ ” he said. “Whenever you meet anyone from the corps, the horror stories pour out.”

Like several other former corps doctors, Dr. Michael Fine of Providence, R.I., said he ran into hostility from the local medical community.

Fine, who served from 1986 to 1989 in Hancock County, Tenn., said some resident doctors had huge caseloads, sometimes seeing 80 patients a day. They viewed corps doctors as a financial threat and used political pressure to rein them in, he said. Fine said he was ordered by headquarters to stop delivering babies because he was cutting into local doctors’ business, a complaint Weaver labeled hard to believe.

“The local medical Establishment fears (that) these enthusiastic, committed people will stay and compete,” Fine said.

While serving from 1987 to 1990 across the state in Tiptonville, Tenn., Dr. Renee Ruth Lamm struggled with the killing schedule of being the sole doctor in two clinics 10 miles apart.

“I had people flagging me down on the road when I drove home at night,” she recalled. “It was eating me alive. I was just fried.”

All through school, Lamm dreamed of becoming a country doctor. Now, she is a psychiatrist near Myrtle Beach, S.C., and, like many former corps physicians, soured against rural health care and out of it entirely.

“If I had not gone into the corps, I would be in family practice in the Southeast in a small place,” she said.

The idea that the corps actually drives away people who otherwise would have gone into rural practice is especially troubling to some.

“It’s been a failure,” said Dr. John Verby of the University of Minnesota. “Doctors who go into the corps are less likely to stay in rural health than other physicians. The corps experience turns them off to rural health.”

The corps long has estimated that about a third of its doctors stay in doctor-needy rural places. However, a recent study by Dr. Donald Pathman of the University of North Carolina, himself a former corps physician, found that eight years after they finished their obligations, just 12% of corps doctors had stayed. By comparison, 39% of doctors who found their way to the same rural clinics on their own still were there.

“My experience is that people seem to leave, and they leave with bad feelings,” Pathman said.

Dr. Robert Jackson, now a rheumatologist at the osteopathic college in Kirksville, Mo., is not among them. He called his assignment between 1987 and 1991 at a clinic in Ellington, Mo., “a very nice fit.”

Dr. Gary Wiltz, too, has worked out just as the corps intended. He arrived 10 years ago for his assignment in Franklin, La., and soon abandoned his plan to become a kidney specialist.

“The people of the community won me over,” he said. “You get back as much as you give, and I felt I was making a difference. That was the overriding thing that kept me in this community.”