How long will you stay, doctor?
By Dr. Pritam Neupane, MBBS, FACP, FCCP
Pulmonology/Critical Care – Memorial Hospital of Sweetwater County
It is no news that there is perineal shortage of doctors in the rural U.S. While about 20 percent of the U.S. population lives in rural areas, only around 9 percent of the physicians practice in rural areas. Rural medicine poses a number of problems for patients and the doctors who want to practice there.
They suffer due to lack of doctors and particularly due to lack of specialists. Distance and weather conditions pose a unique problem in harsh areas like Wyoming. For the aging population who is in real need for specialist services and centers, the problem truly hits home when you add the risk of driving and the need for assistance for appointments, which frequently turns into multiple visits. People are flown out to higher care centers adding enormous cost to the individuals and the state insurance system. Thus, unfortunately, it is not uncommon to see patients in late stages of diseases getting medical attention for the first time as if we live in some underdeveloped sub-Saharan nation.
Patients also feel that there is a constant flux of doctors like through a revolving door. Patients cannot get true continuity of care and they have to reiterate the same story again and again. It is not the medical history alone but their own story and the bonding that they seek with their doctors/clinicians. They have not been able to say “so and so” is my doctor. It is almost unrealistic now to expect that the doctor will know you, your spouse, your pet and the recent birth or death in your family or what a pleasant summer you had or how good you are at golf or fishing or what kind of elk you shot this season. Although this may not sound important in terms of health or disease, a flimsy doctor-patient relationship has shown to decrease interest in following recommendations and shown to lead to lack of continuity, resulting in poorer health outcomes. It takes time to build trust and to divulge your inner fears to another human being. Gone are the days when you could take the cake you baked next door to the doctor and your kids played together. It is also true that with changing demographics more and more rural dwellers have to deal with what they think are “not invested in the community” type doctors.
Doctors’ side of the story
Rural areas pose a number of problems for the doctors, as well. If the clinician is not born in that area, it is difficult for folks to even consider real rural places. They obviously want to be close to their family and friends and enjoy the amenities of a big city. Hobbies have to be different when you come to a rural place. As far as work is concerned, clinicians could easily get overwhelmed. Lack of proper technology and lack of other specialties usually leads to frustration when you cannot take care of your patient in a timely manner. Clinicians with children often want to be in the best school district. Racial mix, lack of ethnic diversity or lack of a larger airport are common deterrents in recruitment of physicians.
The United States trains far fewer clinicians than other developed nations and relies on international medical graduates (IMGs) and health care workers to fill the gap. About 24 percent of the physicians in the U.S. are IMGs and 19 percent of these graduates are practicing in rural areas compared to 10 percent of osteopathic physicians. IMGs are also filling the specialties that are essential but are not taken up by the U.S. graduates like geriatrics. What this means that it is more and more likely that patients will find international doctors at their local hospitals.
Physicians in general are sensitive and empathetic people. What they do for patients on occasions is much more than what they would do for themselves or their relatives. We fight with the insurance companies, drug companies and with legislatures and authorities for the best of the patient, usually at the expense of our personal time, which one research showed on an average to be about 2 hours a day. We are at the mercy of the patient’s opinion as to how we performed while this has nothing to do with what the health care need of the patient really is. These days, most physicians have no autonomy and we are not even called doctors anymore and are called providers. Still, clinicians take pride in what they do and their source of happiness and satisfaction is still not the money or the debt paid but the improvement in patients’ health and a simple thank you from them. Even though they may be at some place for a short while, most do care about the patients that they encountered and do cherish the opportunity they had to help them.
Folks who perceive that they have been helped by their physicians often fear that they might leave. It is daunting to go over all of it again with another unfamiliar face. However, the rule of nature is that one who comes has to go one day. When they came here, they also came by leaving some other place. But when clinicians are asked, “how long will you stay?” remember that we do realize where you are coming from and no matter how long we stay, we will always remember you and wish the best for you. When in doubt, please give your health care workers a chance and love the ones who make this – what others call an eccentric decision to come to rural America – their home.