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I’m
walking down the street in Yuma, Colorado, on the way to the phone
company office to arrange a line for the home I’ve just
moved into. Someone I’ve never seen steps out of the door
of a shop and says, “Doc? Your office manager is looking
for you.” So I walk into the store and call my brand new
employee at our brand new medical clinic, where I’d just
left her unpacking brand new supplies. Before I arrive at the
phone company, two more shopkeepers, who haven’t gotten
the message that I’d reached Linda, also hail me.
This was in the days before pagers. In a town this small, such
a device would have been optional anyway, at least within city
limits. My office manager knew the stores on Main Street. And
people were able to identify me because the week before arriving,
my photo had appeared on the front page of the Yuma Pioneer with
the caption “New Doc to Start.” Even if they didn’t
recognize my face, they certainly did my big curly Isro (Jewish
Afro) hairstyle, not a common cut in 1976 in this prairie town.
That afternoon yours truly, raised on Chicago’s Northside
and trained at Cook County Hospital, began to grasp just how different
his life was going to be as a general practitioner in a town of
2000.
I had been thrown directly into the deep end of Yuma, where I
received a two-year, sink-or-swim education in rural practice
and country ways. Since then, I’ve devoted my career to
rural healthcare and my heart to country folk. I’d like
to share with you a few things I’ve learned along the way.
Rural practice is hugely rewarding and challenging. First, there’s
the close connection with your patients, who genuinely appreciate
you and what you do for them. The strength of the patient-doctor
relationship can be a challenge, too, in a world where you can’t
always draw a clear line between patient, neighbor and friend.
Then there’s the opportunity, as a family doc, to do so
much more than your city colleagues do, like emergency-room work;
caring for really sick people in a small intensive-care unit;
and delivering babies, including by Cesarean section. The stakes
are greater than in an urban practice, and they frequently involve
higher adrenalin levels in the doctor and the need to keep up
with a wider range of information and skills.
One of the ways psychologists categorize people is into high-and
low-stimulus folks. High-stimulus people tend to like roller coasters,
vacationing in unfamiliar places, and loud music. Low-stimulus
people would rather ride the tram, spend their vacations at a
place they know, and play music softly. Rural practice, with its
wide range of problems and unpredictable crises, is for high-stimulus
people.
Yet rural life, with its dearth of unfamiliar faces and narrower
palate of restaurants and entertainment, is generally more for
low-stimulus sorts. (As a high-stimulus guy, I made up for what
was missing in Yuma by acquiring a really good sound system and
learning how to cook a wide range of cuisines, most of them spicy.)
So, the ideal recruit to a rural family practice is someone who
desires to blend a higher-stimulus career with a lower-stimulus
lifestyle. It’s a tough bill to fill.
When a community is lucky enough to land one of these very special
doctors who wants to spend their career there, the challenge is
to keep them. When I interviewed for the job in Yuma, one old
guy on the hospital board told me, winking, that they just needed
“to find me some local chickie to place under my wing.”
I actually did find a local chickie, to whom I’ve been married
for 30 years. Though Kathleen and I chose to fly the coop, that
board member’s point still holds. If you want to keep a
doctor, you must do whatever you can to make him and his family
feel a part of the community.
Of equal importance, for both retention and recruitment, is that
the physician feel like part of a professional community. When
I was in Yuma, our professional community consisted of five physicians,
one physician assistant, and one nurse practitioner, distributed
over three towns, each 28 miles apart along Highway 34. During
my tenure in Yuma, I scheduled Denver specialists to travel to
our corner of Colorado and give presentations to the Washington-Yuma
County Medical Society. It helped us to feel connected to the
larger world of medicine and to add faces to the signatures on
reports we received from these consultants.
While in Yuma, I developed and nurtured, via telephone, relationships
with a wide range of specialists in Denver and Sterling, whom
I could count on for support in dealing with my most challenging
patients. In the days before the Internet, I found a librarian
at the CU Medical School whom I could call to ask for literature
searches and she’d send me photocopies of pertinent medical
articles.
Today, thanks to electronic technology, we have a host of ways
to stay connected: online medical references, email, an array
of social media, electronic medical records, digital radiology
systems, and interactive video for doing conferences and even
medical consultations and intensive care monitoring remotely.
Medicine is only one area where the electronics revolution is
contributing to a rural renaissance, making small towns places
where all sorts of people can do high-stimulus occupations while
availing themselves of the peace, beauty, intimacy, safety and
slower pace of the country.
Under the influence of The Whole Earth Catalog, thousands of young
folks of my generation dreamed they would, as John Prine sang,
“Blow up your TV, throw away your paper, go to the country,
build you a home.” Dyed-in-the-wool Chicagoan that I was,
I assumed I’d settle in the Windy City or a similar large
burg. But my life unfolded in ways I could only glimpse that September
afternoon in 1976, as I walked down Main Street under the hard
blue Colorado sky. And, boy howdy (as they say in Yuma), has it
been a fun and interesting ride. Some of it on horseback, even.
Marc Ringel has spent the majority of his career as a family
doctor working in rural communities, including the last 12 years
in Brush, Colorado. He has written extensively, for lay and professional
audiences, about rural health, medical informatics and healing.
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