Rural Family Medicine

[Guest MDHopeful04]

Hi,

 

I'm still a premed, but am very interested in pursuing a career in Rural Familiy Medicine. I have been reading quite a bit, trying to learn about the type of lifestyle a physician would have in a rural community, however, most articles focus on the shortage of physicians in these locations.

 

I was wondering if those of you who are currently practising or doing your residency in a rural area could share your experiences?

 

*How was the rural training at your university (also please specify the university)?

 

*What attracted you to such a community?

 

*What kinds of frustrations do you experience?

 

*How has your experience been rewarding?

 

Should I be admitted to med school, I would truly like to help these small communities, but would like to have a realistic idea of what such a decision would entail.

 

Thanks so much for your help and advice.

 

MDHopeful04

[Guest marbledust]

I don't think anybody who regularly visits this board is currently practicing or in the midst of a rural family med residency. I am sure there are some people who have done a clerkship who could probably offer more than I can.

 

I met a first year resident in the Calgary rural program at Christmas time and she was absolutely loving the program. The biggest attraction of this program (and I am assumming other rural programs) is the residents have a great deal of autonomy. The opportunities to learn and do things are very impressive because there aren't a lot of other physicians/residents/medical students around. You learn a lot and you learn very quickly.

 

As for frustrations - the Calgary program is new and is still evolving. As with any new program, there are organizational and administrative problems and frustrations. You also have to be portable and flexible, willing and able to uproot yourself and move during the program. For some people this is one of the attractions of the program, for others it would be very tiresome.

 

Other benefits include being able to get away from the "rat race" of the city. As someone who grew up in small town Alberta, I swore I would only ever live in a big city. But as I have gotten older, I have come to appeciate that living and practicing in a small town is a very apealling idea. Less shopping, movies, etc, but more opportunities to do things outside.

 

Of course, I have to say that the residents that are only in the first year of the program probably feel differently about a rural practice than rural docs who have been doing it for a long time. I know my family doctor from when I was young is over 60, is insanely busy, routinely seeing up to 50 patients a day, and works horrific hours between his practice and the hospital. Training in rural practice and actually doing it are quite different. I realize it is a personal choice to work that many hours, but being a rural family doc is a tough job.

 

I am curious if either of the two rural programs in Alberta will actually result in the graduates working in rural areas or if they will end up going back to the cities to practice. They are new programs, so its too early to know. Anybody have any idea about this issue in other provinces.

[Guest macMDstudent]

I have started my clerkship now and have done a brief rural family medicine elective. I will be doing my family medicine clerkship in a rural location starting in 3 weeks and I am keen to get it started. I may have more insight than most med students to rural practice as I have good friends who have been practicing rural family medicine for over 10 years now.

 

From what I have heard, seen and experienced:

 

1. Rural docs have to have a very wide scope of practice. They do everything from minor surgical procedures (lumps and bumps); to doing surgical assists with the local surgeon; doing ob/gyn including deliveries; managing their patients in-hospital when they require an admission; doing ER shifts (required to keep hospital privileges); palliative care and geriatrics; and of course regular family practice in their office. Some have done extra training and are GP-anesthetists so they do surgical anesthesia a couple of mornings a week as well.

 

2. Generally they love what they do, although it can be long hours and difficult to integrate a "regular" family life in between overnight ER shifts, baby deliveries and keeping regular office hours. Most of the docs I know have given up delivering babies for this reason. Most that I know work between 50-60 hours per week (but you could literally work as much as you wanted).

 

3. It can be hard to feel like "jack of all trades and master of none." Although the family docs I know are incredibly skilled, it is frustrating to them when they run into cases they can't manage and need referral to specialists. This can often take months for the appointment and they are left trying to do the best they can with the person in the meantime.

 

4. Lack of access to diagnostic testing. When you have to work in a rural ER, you may find that the x-ray department is not open all the time! Where I was it was Mon-Fri 9-5. If emergencies came in, the x-ray techs could be called in, but that takes time! There is not often CT scanners or even blood tests that are considered routine at tertiary care centres. For example, I ordered a troponin on a chest pain patient only to be told they don't have that available yet; it is the standard at the university hospital. This means that these docs need to have finely tuned clinical skills.

 

5. As a medical student, I loved being in a small community hospital as the only "learner" as marbledust wrote. There was no line-up of residents and other clerks when somebody needed a procedure done. For example suturing, arterial blood gases, casting fractures, reducing dislocations etc. If I wanted to, they let me do it (with supervision, of course!). I was one-on-one with the doc and part of every case. When code blues happened, I was asked to do the compressions. At a tertiary care centre, the clerk is in the back row on the opposite side of the room during a code.

 

6. I don't know a lot about the rural programmes yet, but from my understanding is that you have to be prepared to do rotations all over the place. Whereas if you do the regular urban family practice residency, quite often you can do a rural elective for a period of time and all the core rotations will be in the university hospitals. However, in the rural program you may each rotation in a different location, which means every month or two you may have to move and live in the resident accommodation. This is what I think would be difficult for anybody with a family of their own. Either you have to often live apart from your family or you have to keep moving them each rotation. A single person may enjoy this change of venue and get a better idea of practice in different locations.

 

I still think family medicine is a great career choice for people who want to balance personal life with professional life. Certainly there are problems with aspects of family medicine but everything has its pro's and cons. As far as learning in a community hospital versus a tertiary hospital, again there is pros and cons. You just won't see the intense medicine in a rural setting, but on the other hand from a learning point of view it is an incredible experience as it is very "hands-on." Lastly, I am always amazed at how much the rural family docs I have worked with know. They are an incredible resource that should be tapped! Best of all, they are generally keen to teach and share their knowledge.