On Rural Medicine

I am leaving my beautiful rural community.  I am excited to be back with Patrick and company, to have a car again, to have options beyond deep fried food when eating out and to not have to pack and drive an hour and a half back and forth every weekend.    I however will miss the really nice apartment we have here and the gorgeous scenery that God produced in this little space.

The view from the living room window, where I sit to write.

In the past four weeks, I matched to my program of choice, learned that I didn’t forget all of Internal Medicine, discovered that rural hospitals (at least this one) run surprisingly smoothly and learned that, as they say, in a small town, everyone knows everyone.  I also discovered the cardiac disease capital of Canada (at least, it looks that way).  And despite not going to the gym for four weeks, I got epic workouts climbing “The Biggest Hill of All” on a daily basis.

Evidence of the abundance of fried food and the source of many of the heart attacks I see in emerg... "We sell fried food." Oh wow.

So, as much as I sometimes become frustrated with my school’s obsession passion for rural medicine, I must say I am glad that I have had the chance to work in rural communities for 12 weeks (technically 16, but the first four were epic fails in the rural department and turned out to be suburbs of my hometown).  The whole small community, everyone knows everyone and fewer resources really do make a difference, but there are definite benefits.

And thus, I have concocted a list of the great things about rural medicine, even though I will likely never practice in a rural community (unless God rearranges my plans, career choice and such… And to be honest, I would not be impressed if He did at this point).

  1. You get to live in a small town… Cheaper cost of living (in general until you go really north), less traffic, less pollution, and fewer distractions.
  2. Many rural communities I have been are beautiful (at least in Atlantic Canada).   Waking up every day to the view of the ocean or forest is something that is priceless.
  3. You can often walk places (and because there is no public transportation, you don’t really have a choice).
  4. You can learn a new activity… For instance, the community I did family medicine in was very big into canoeing and kayaking.  I had a few chance to go, but they didn’t work out.  Here, I had an impromptu skiing lesion when I had to navigate my way down “the Biggest Hill of All” in the middle of a freak storm.  At one point, I did a full-on split, and then fell over.  Thankfully no cars were coming (or I may not have been able to type this).
  5. The practices are often less busy and somewhat smaller.  This is not always true.  But, I have noticed on medicine, especially, the pace is so much more relaxed.  Going home at lunch on medicine would never happen in a bigger centre.  Unless you were post-call.  And even then, it is unlikely.
  6. Home call.  Never underestimate the value of sleeping in your own bed.
  7. You have a broader scope of practice.  The GP I did family with covered the local “emergency” (I used quotes because only 25% of the patients were legitimate emergencies), did minor procedures and had his traditional office practice.  The Internal Medicine doctors here cover the ICU and also their own subspecialty.  The Hospitalists here can do some emerg shifts, some deliver babies and still have a community practice.  The variety is fascinating to me.  I can see why people would prefer a community like this, especially if they like that kind of autonomy and those opportunities that are often lost in giant cities.
  8. People are more grateful.  Again, this is a stereotype.  But, people are glad they don’t have to go to town for care.  So, whatever you can do here is often just amazing.  Not always, but sometimes.
  9. You get a lot more follow-up, even as a specialist.  In a small town, people just happen to run into each other, so as you can imagine, people who wind up back in the hospital are likely to be on your service, or their family member is, or there is time enough to actually see them in clinic to make sure they are doing okay.  In big centres, people leave and sometimes you wonder what happened, but they go to a GP on the other side of town who is too busy to give an update.  We had a guy go home one week and get readmitted under us the next for two unrelated problems.  Another person came in to visit someone else and told us that she was feeling much better.
  10. You just plain have more time.  Most physicians out in the periphery are salaried, which means they don’t get paid for volume, they get paid for designated amounts of time.  Thus, people don’t feel obligated to book patients one on top of the other.  You get more time with people.  You can give better care.
  11. As a learner, you get more experience.  Now, volume is an issue.  I could have seen as many people in a week in a city, but because for the first three weeks, I was the only medical student on the service, I had free reign.  I managed the patients on my own, did my own consults and reported back to the doctor.  So much better than clamoring over five other people who wanted to do the same thing.

The peninsula as seen from my bedroom window.

So, rural medicine isn’t all bad… In fact it is really good for many, especially those people who live in those communities.

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2 thoughts on “On Rural Medicine

  1. so I’m guessing Patrick is your hubby? And this 12/16 week stint @ a rural hospital is part of your schooling process? Did Patrick have to stay and keep the home fires burning while you were away for this internship? I’m new to your blog so I’m probably asking you questions you have answered elsewhere .DM

    • I love questions!
      Patrick is my hubby. And he had to stay home for work and such while I have been off galavanting on a few rotations.
      The 12/16 week stint is a part of my schooling process. The last two years of medical school here is called clerkship and in that, we do all of the main medical fields and have some elective time to do other things in medicine that we find interesting. My school considers rural medicine of any kind a main rotation. So, I did 8 weeks of rural family medicine in my third year and just completed four weeks of rural internal medicine/ICU in my fourth year. The other four weeks were two in my first year and two in my second and were a mix of family medicine and public health that were supposed to be rural, but wound up being in a town that is basically a suburb of where I grew up and very not rural. I don’t think I have fully explained that anywhere.
      Take care!

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