What do you see in your mind when I tell you I am a small town country doc? A few of you may have called to mind images of a stoic doctor working along side their patients, often humble surroundings. You may even think about images of a horse and buggy with payment in chickens, bread, or other goods. If you are really lucky and grew up in a small town, you may have even had a “country doc” yourself.
Indulge me a moment, I want to teach you a little about medical training before I talk to you about the glories and trials of being a small town country doc. Unfortunately due to the attitudes of traditional medical training, country docs are becoming an endangered species. I want you to walk you through what it takes to become a physician in America. First, you have to go through college and earn either a degree or enough credits to earn early entry and you must get high marks on your MCAT (medical college aptitude test). Most colleges are in cities of some size. Then comes medical school, this will definitely be in a major city. That is four more years spent in a metropolitan area. Finally, you have to choose a residency. Residency training varies depending on what kind of doctor you want to be, from three years for Family Medicine to eight years for Neurosurgery. Traditionally, this training also takes place in a major city. So, now this young driven future doctor has spent the formative years of their early adult life in a city.
While you are in medical school, the future doctors face many challenges and prejudices. I trained ten years ago, but what I hear from students today still confirms that many medical schools have a bias against the training of doctors fit to work in rural America. These specialties would be the primary care specialties: Internal Medicine, Family Medicine, general pediatrics, and General Surgery. (I would like to make an aside here and let you know that Family Medicine is a board certified specialty and is NOT a General Practice doctor.) Even now, at medical meetings I am often quizzed on why I chose family medicine with its long hours and lesser financial payments. Even now, many of the forms I fill out, insurance paperwork I do, or even documenting the numerous phone calls and email request offer no financial payment.
The crisis facing primary care in America is not dissimilar to the aging crisis facing America’s farmers but that is a different soap box.
But, I would like to take a moment to give some thoughts on why I LOVE being a doctor in a small town. I was running tonight and got a “Hey, doc” from a patient. I can leave my kids at the ballpark and not worry overly much cause they know or are related to most everyone there. If I forget a check when I am getting my hair done, they know I am good for it. I am known and liked at church, the grocery store, and even Walmart 30 miles away. My patients are my Facebook friends, my blog readers, and people that I am proud to be involved in their lives. I help them through illness, family crisis, and personal achievements.
But, what about the bad parts about medicine in a small town. Well, I guess some people would not like having so many people know what their every move is, but I have been truly blessed to find a balance between private family time and community involvement. I guess, some would also not like the lack of “things to do” and “cultural enrichment”, but I would say those people have never walked barefoot in the fields and spent a lazy afternoon teaching their kids to catch brim in a pond. There is true achievement in baiting your own hook. I also deal with my patients, wanting to go to a “specialist” in a “city”. At first when I moved home, that bothered me. After all, I had just spent 10 years learning how to treat illness and disease and now I am supposed to send people off to a city because why… But now, I take that in stride too. I can understand that there is a time and a place for me to treat illness, a time and a place to respect patient’s request to seek another opinion, and even a time to tell patient’s that it is in their best interest to seek another opinion. (I have no problem knowing what I do and don’t know and what we can and cannot treat in my hometown)
So, by living in my hometown for the last 7 years, I have learned many life lessons from my patients. I have learned courage and faith in the face of a terminal illness. I have learned humor makes everything better at times and at times nothing is better than crying with the patient and families who have made me a part of their lives. I have learned humility and willingness to seek other opinions. I have learned that a temper and pitching fits never helps patient care or staff relations. I have learned that mutual respect, even when we disagree, is a better policy than trying to always be right.
Most of all I have been blessed to learn patience from a wonder group of patients and health care providers who have been willing to learn from me and teach me at the same time. Short of being a Mom, there is nothing else that I am more proud of than being a “country doc”.