An article in the Washington Post caught my eye today. It features a young family practice physician who is frustrated with providing medical care in rural Virginia. She grew up in the Washington DC suburbs and went to top-class schools where she excelled. Now she lives in Charlottesville, VA and commutes 46 miles round trip to a rural town where she is the clinic director as part of a three-year contract with the federal government’s National Health Services Corps in exchange for $50,000 to help pay off her education loan debt.
She has an iPhone but no mobile service so cannot access medical resources such as ePocrates (that’s her excuse). The dial-up internet on her desktop computer is slow. Though she trained on electronic medical records, here she is working with manila folders. It takes 40 minutes to go to the grocery store and there is “a lack of dating potential” along with many other complaints.
The article sure makes the physician sound like a whiner. Aren’t we all. First of all, I wouldn’t call living in Charlottesville, VA the rural life. Especially when she’s only a 2-3 hour drive from her home and the city lifestyle she is accustomed to. But that’s just me since I can’t say the same for myself.
At this point, I would give anything to be a 2-3 hour drive from Washington DC, or New York City, or Boston i.e. my cities of comfort or any other city on that scale. Instead, I’m apparently “in the middle of everywhere”. A town which requires me to take at least 2 plane flights and therefore spend many more hours than I would with a direct flight each way to enjoy the cultural activities that capture my interest in the cities I’m comfortable in. This I do as often as I can but its so tiring and worse it’s eating up my paycheck in unexpected ways. For example, I love Thai food. Yes, that’s an interest. There is not a single Thai restaurant to be found in my town meaning that each time I find myself in a proper city I must have Thai food! Now, I’ve learnt to make a decent pad thai and a swell chicken lemongrass curry to satisfy myself when that urge arises. Don’t even suggest I drive. That’s anywhere from 5 – 10 hours in a single direction.
While I did not sign up with the federal government for a loan repayment deal and while technically where I practice is neither rural nor under-served (go figure) I do empathize with this woman’s situation. It’s a bit silly when you think about it to train young physicians to be technologically advanced and then release them into the real world of pen and paper charts. As I now orient two new physicians who have never had to dictate a consult note I can only remind myself that I was in their shoes last year. Each day wondering “How am I going to see all these new patients and dictate their consults making sure I hit all the silly E&M requirements to make sure I’m reimbursed appropriately for the complexity of each case? It would be so much easier and less cumbersome if I could just type these up!”
In my hospital the hospital the turnaround time of tests is slow. Worse, they tell me that this is as good as it gets. But I just came from academia. I know one doesn’t need to wait 3 days to know whether a gram positive cocci in clusters in a blood culture is a coagulase negative staph which could be a contaminant or a Staph aureus which would indicate likely real infection.
My hospital has had such a hard time recruiting infectious disease physicians so everything that could be interpreted as an infectious disease is being turfed to me. I’ve had to be firm and say no. No because these are not the times of old where I could fiddle about without repercussions, where patients were truly grateful for the care they received no matter the outcome, and where doctors could freely be altruistic.
No, I can’t in good faith present myself as “THE infectious disease specialist” to the parents of a sick 15 month old baby. I’m not a pediatrician. I happen to be an internist (adult medicine) who is specialized in infectious disease. The first thing I learnt on my two month pediatrics rotation back in medical school was “children are not little adults”. No, not doing it.
Nor am I going to claim myself to be the expert on the complexities of Hepatitis C management or pulmonary tuberculosis management because the truth is in many training programs today the former is in the realm of gastroenterologists and the later of pulmonologists. I am not an expert in either but could work in conjuction with these other specialists to take care of a patient.
It’s not that I’m selfish with my knowledge or that I don’t want the work. I am scared. I won’t lie. Were I to see that sick baby and the outcome wasn’t good I’m sure some lawyer out there will find it very easy to convince the parents that I had no business making clinical decisions on that baby simply because I am not a pediatric specialist. Nothing about me being the only one with some kind of infectious disease knowledge in the area even if it’s adult-medicine based. Oh no, that I’m sure would be conveniently disregarded. So I choose to stay in my lane where I’m comfortable and where I know how to analyse situations even if I haven’t had prior experience.
My patients are nice enough in general. Honestly, for the most part, I enjoy the time I spend within the hospital walls. I’m at a tertiary level hospital with a wide catchment area. One neat thing is that we will soon be incorporating telemedicine so that some of these rural patients in their horse and buggy (I’m not even joking) can still have access to us without either of us having to drive/ride 3 hours for a medical visit. That could be cool.
Outside the hospital, while I enjoy the 20 minute nature walk to and from work I don’t like having to get into my car to get to a grocery store if I happen to run out of milk, having expensive produce which is boggling since I’m surrounded by farmland, and not having necessities of life such as PLANTAINS!
What I found hilariously sad about the article was that the clinic staff and other physicians were so worried about the personal life of the physician profiled that they begun to set her up on dates with the hope that if she settles down, there would be a higher likelihood of her sticking around for the long-term.
Just a week ago I had a quick meeting with my hospital’s vice president of financial affairs (or some other fancy administrative title) who wanted to know how I was settling in given that it was my one year anniversary. She felt it necessary to let me know that there are online services such as eHarmony or Match through which one can meet people. “I don’t want you to think that you have to be here to pay off your loans, I want you to be here because you want to be”, she said.
Well, sorry to say, the ship already sailed on that one. Not that I have any problems with internet dating services, but the kind of men to be met within my 50 mile radius here in Podunk, USA is very different from those in a cosmopolitan city. Not that being in a major city lands you a catch automatically, but at least one has options to go through, discard, crush on, or lament about. For the record though, my settings have been set to worldwide and as much as I knew that meeting people here would be difficult, I didn’t imagine it would be this bad.
So often, physician colleagues in their attempt to make small talk with me ask “So what do you do with your free time?” They are either amused or disturbed to find out that most of the time when I am not on call, I am not in town. I guess the writing is already on the wall as to where I will be in 3 -5 years.
So, I can totally see how the National Health Services Corps is going to have some issues with retention of newly minted physicians in the rural areas. It is sad I agree that geography in the US dictates so much as to who has access to good medical care. But I can honestly say that when I’m done with my non-NHSC self-imposed public service to the United States I’m not looking back. I am my number one patient. If I am not emotionally or mentally healthy how am I ever going to help other people? Right?
If it makes you feel any better, I have eaten at least one mango (Haitian and Mexican and all sweet and juicy) every other day since April. Just saying, those of us in the big city are are taking advantage of our situation, especially when we read about what you are going through.