PONCA, Neb. | Before she graduated from dental school, Dr. Natalie Leader had agreed to come to Ponca and work with a dentist nearing retirement.
Not yet 30 years old, Leader now owns Ponca Family Dentistry. Her practice is robust and keeps her plenty busy, and she and her husband are putting down roots in the area.
"I don't particularly love living in the city," said Leader, a Wayne, Neb., native and 2012 graduate of the University of Nebraska Medical Center's College of Dentistry. "There's a lot more opportunity sometimes in rural Nebraska."
Leader was the type of person those who launched the Rural Health Opportunities Program 25 years ago had in mind.
A partnership between the University of Nebraska Medical Center and Nebraska's state colleges in Wayne, Chadron and Peru, RHOP, as the program is known, aims to ease the shortage of health care providers in rural areas by guaranteeing chosen high school students from rural Nebraska entrance into medical school.
The students are under no obligation to practice in rural areas once they graduate, but many of them do.
According to UNMC, of the 420 students who have graduated from the program, 65 percent are practicing in Nebraska. Of that percentage, 73 percent are practicing in rural Nebraska, defined as non-urban communities outside of Omaha, Lincoln and South Sioux City.
"We're pretty happy with it," said Dr. Jeff Harrison, assistant dean for admissions and student affairs and family medicine professor at UNMC. "It's done what it was meant to do."
When established in 1990, RHOP took a little different route than other programs that encourage health care providers to practice in rural and other underserved areas. Most other programs targeted students already in medical school. RHOP was the first, and, Harrison said, still the only to target high school seniors.
"Everybody's out there trying to figure out what works," Harrison said.
Those who developed RHOP asked who was most likely to practice in rural areas.
"It goes back to the old data: Who's going to go back and practice in a rural area? Someone from a rural area," Harrison said. "It is kids going back to their roots."
UNMC teamed with Nebraska's three state colleges, which attract the majority of their students from rural areas. Those colleges -- Wayne State in the northeast, Chadron State in the west and Peru State in the southeast -- accept seven to 28 students annually into the program, which includes nine career tracks: medicine, clinical lab science, dental hygiene, dentistry, nursing, pharmacy, physical therapy, physician assistant and radiography. Wayne and Chadron offer spots for all nine tracks. Peru offers only nursing and pharmacy.
Nebraska students who grow up in rural areas -- basically anywhere outside Lincoln, Omaha and its suburbs -- are eligible. Once accepted, they're given full-tuition scholarships at Wayne, Chadron or Peru. The bigger bonus: they're guaranteed a spot in medical school once they complete their undergraduate requirements.
"That's really the main prize is that they have a seat waiting for them at UNMC," said Todd Young, a physics and astronomy professor and RHOP coordinator at Wayne State.
It's a relief knowing that spot is assured, said Mary Alderson, a Wayne State sophomore majoring in chemistry/health science on the premed track.
"That is the thing that makes RHOP worthwhile. You're reassured that what you're doing will pay off," said Alderson a North Bend, Neb., native and graduate of Archbishop Bergan High School in Fremont, Neb., and a sprinter on Wayne State's track and field team.
Both Alderson and Leader said they would have gone into medicine without RHOP, but it was nice to have that early medical school admission in hand when they started college.
As for practicing in a rural area, Leader said that was always her plan and she considered it a "moral agreement" to do so when she was accepted into RHOP. She also took part in a state program independent of RHOP in which she committed to practice in a rural area.
Young said that during interviews with RHOP applicants, faculty members get a good read on who's sincere about someday practicing in a small town, and those are the students who get accepted.
"We basically tell them if you don't seriously consider this, maybe you need to reconsider," Young said.
One of the criticisms of the program, Harrison said, has been that graduates aren't required to practice in a rural area. But there are circumstances that would make it hard. Those who get married while in medical school may follow a spouse to practice in a city or another state. Some specialists wouldn't have enough patients to support a practice in a rural area.
Plus, faculty members are seeking providers who truly want to live in rural areas, Harrison said, rather than someone who's just fulfilling a two-year contract, then immediately leaving.
Alderson, who plans to be a physician, said she intends to settle in a rural area if possible. She grew up working on farmland her family owned and liked the feeling of life in a tight-knit, small town.
"I see myself in rural Nebraska. Just being raised there, I feel that's where I'm most comfortable," she said.
Obviously, students don't have to be in RHOP to practice in a rural area. There are other programs, notably one at the University of Nebraska at Kearney that's nearly identical to RHOP, working toward the same goal.
RHOP aims to get those most likely to return to do so.
"It gives us and all the programs at least a core of people who want to go back to rural areas," Harrison said.
As small towns continue to shrink, the pool of students is getting smaller, Harrison said, making the future more challenging. The number of RHOP graduates returning to rural areas now roughly equals the number of practitioners who are retiring.
And while RHOP hasn't cured the problem of provider shortages in all areas, Harrison said he thinks those shortages would be worse if not for RHOP.
In Ponca, Leader is now a young business owner providing a valuable service to residents of Ponca and the surrounding area. She likely would have settled in a rural area, but RHOP and other programs provided the encouragement and incentives to make it a reality.
She couldn't envision working in a big-city practice.
"I'm very happy where we are," she said.