When the patient came to see the family medicine practitioner, he was already suffering the devastating effects of poorly controlled diabetes.

A recent layoff had made even his heavily discounted medications unaffordable. Now, only his forties, he was blind in one eye, his kidneys were functioning at 50 percent, and both his feet would likely have to be amputated – all of which could have been prevented with early care.

“It’s a very, very sad thing,” Ashkin said.

Cases like this are growing in rural North Carolina, where the need for doctors is critical.

To help, UNC Family Medicine has begun a new medical training program at Prospect Hill Community Health Center in Caswell County, 30 miles north of Chapel Hill. Ashkin, the program director and others hope it will become a model for meeting the needs of the state’s underserved areas.

Disappearing doctors

It’s a typical afternoon at Prospect Hill.

Patients and staff zigzag hurriedly between exam rooms and hallways, past laughing nurses and screaming babies, all while down the corridor, a dozen and a half more people sit in the lobby.

The facility was built to serve Caswell County’s lower-income residents, many without medical insurance.

The new building opened last year. Along with the standard exam rooms, it has its own lab, a dental clinic, an in-house social worker, nutritionist and pharmacy. Cost-wise, a visitor can get a full checkup starting at about $25.

“We see the entire range of patients,” Ashkin said. “We do newborn babies, adolescents, adults with complex medical problems. We also do prenatal care here… So it’s the entire range.”

Many patients speak Spanish only.

The Prospect Hill area is typical of many rural parts of the state, Ashkin said, where health care is often unaffordable or unavailable. “Unfortunately, a lot of primary care doctors are older,” Ashkin said. “And we’re not even coming close to replacing them.”

“The average in North Carolina is nine (physicians) per 10,000 patients, and in Caswell County, it’s 3.4 per 10,000,” he continued. “So, it’s half of the average in North Carolina, and North Carolina is low in general.”

As a result, many people delay care until the prognosis can only be bad.

“They wind up at the emergency room. They have bad outcomes. They do poorly, and it’s very expensive for the system,” Ashkin said.

It’s something Emily Volk, a triage nurse at the center, said she sees too often.

“That’s probably the hardest part,” she said.

That’s what community health centers like hers want to change.

The cutting edge

Enter Dr. Christina Drostin, one of the center’s new residents in training. She’s seven months pregnant, but isn’t slowing down on her rounds.

Drostin’s part of the new program Ashkin and UNC Family Medicine hope may dramatically change the outlook for North Carolina’s rural areas, and possibly, for states with similar challenges across the country.

Last year, Prospect Hill became the first health center to test what UNC School of Medicine calls “The Underserved Track.” The idea: to train two recent medical school graduates specializing in family medicine in a rural setting, where the need for them is greatest.

If it works, the plan is to expand the program, and send more residents-in-training to more needy areas of the state, said Donna Parker, a communications director with UNC Family Medicine.

“UNC is on the cutting edge of these kind of programs,” Parker said. “UNC starts things, and others follow.”

Today, Drostin’s visiting three of her regular patients, a grandmother, Jeseni; her 1-year old grandson, Alexander; and his aunt, Ana.

She goes over forms in Spanish with Jeseni. Both residents selected for training had to be fluent. Many of the staff here are bilingual, with Spanish speakers representing about a third of Prospect Hill’s patients.

Ana, who has come to Prospect Hill “pretty much since she was born,” said she always feels welcome.

“They’re all so nice here,” she said. “Really friendly.”

People in need

One problem attracting new doctors to family medicine is that salaries are often lower than other areas of practice. But Drostin said volunteering in poorer areas of Latin America during high school sparked a passion for community work.

“We attract students interested in working with the underserved, because that’s one of the main missions of UNC. You’re working with patients who really need help,” Ashkin said. “And a lot of people go into family medicine because they want to see that what they’re doing is helping people in need.”

When they see that, he said, they want to stay, he said.

If Drostin’s any indication, he’s right – she said she plans to work in community centers long after her 2-year stint at Prospect Hill ends.

“I can still afford to pay my loans,” Drostin said. “And maybe I won’t be driving as fancy a car, or live in as fancy of a house, but I’ll be fine. I don’t know of any poor doctors in this country.”

For her, the work more than makes up the difference.