Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The country doctor is alive and well

Richard Young, MD
Physician
June 3, 2014
Share
Tweet
Share

In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby — the kindly, accessible, but straight-talking television doctor — is dead.” If he believes that, Dr. Oz needs to get out of New York.

At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty schmaltzy and that it implied Welby could make a living on long conversations with two patients per day, which has never been a reality in primary care, not even then.

Perhaps a better nostalgic model of family medicine is Dr. Ernest Ceriani, a rural Colorado general practitioner and the subject of an extensive photo essay in Life Magazine in 1948. In the essay, Ceriani delivers babies, makes house calls, reads x-rays, splints fractures, tends to elderly patients, flushes out waxy ears, cares for patients after a heart attack, amputates a gangrenous leg, and is called away from a Saturday morning at a trout stream to care for a little girl who has been kicked in the head by a horse. He repairs the facial laceration, but has to tell her parents to take their daughter to Denver for surgery to remove the eye that was damaged beyond repair.

The writer of the article concluded, “His income for covering a dozen [medical] fields is less than a city doctor makes by specializing in just one, but Ceriani is compensated by the affection of his patients and neighbors, by the high place he has earned in his community and by the fact that he is his own boss. For him, this is enough.” Clearly, fair pay for comprehensive primary care is not a new issue. We see this issue threaten our field with every medical school graduating class.

But the country doctor is still alive. Dr. Ceriani’s spirit lives on in my family medicine residency and others. I am on the faculty of the John Peter Smith (JPS) Family Medicine Residency in Fort Worth, TX. We are the largest family medicine program in the country, and in spite of our location in the fourth-largest metropolitan area in the country, we have trained more rural family physicians than any other program in America.

We were one of the participants in a program called Preparing the Personal Physician for Practice (P4), which was an experiment in family medicine residency curriculum that started in 2007. We were allowed to revamp our curriculum in the way we felt best prepared young family physicians for future practice. Our curricular innovation comes in two layers:

  1. We allow residents to stay for a fourth year of training to do just about anything they want (within reason).
  2. We take their vocational passion, delivering babies, for example, and try to make the training experience as longitudinal as possible. We increase the residents’ exposure to maternity care throughout all four years of training, not just in a fourth-year fellowship. By far, our most popular extra training request has been a combination of maternity care and rural or global rotations. Sports medicine and geriatrics are also commonly sought, and we’ve had a few residents create experiences in hospital care, general surgery, and emergency medicine.

The final data are just now being collected, but preliminary results show that of the people who chose the maternity care track, 80 percent deliver babies in practice, and of those, all do their own C-sections. They average 106 deliveries per year.

And they’re not just watered down obstetricians. They do so much more than maternity care. They address numerous needs in their communities.  Ninety percent of them care for newborns and children in the hospital. All of them see elderly patients. Eighty percent feel comfortable providing end-of-life care. Eighty percent care for hospitalized adults. All of them place IUDs and perform endometrial biopsies. About a third do colonoscopies and EGDs.

Our graduates provide these services in a variety of underserved settings such as a remote jungle valley in Papua, New Guinea, the African savannah, and small towns across Texas and many other states. Because they provide comprehensive care to complex patients and they are able to provide a full basket of procedures, their local health care infrastructure is strengthened.

A great example of this phenomenon is Randy Lee, MD, a graduate from the pre-P4 days who has served his rural hometown of Hamilton, TX, for nearly 20 years. When he first arrived in Hamilton, the county hospital ER saw less than 100 patients per month, had an average daily inpatient census of less than five, and was about to close. Now Dr. Lee has seven family physician partners that have helped increase the hospital’s capacity. Besides ambulatory care, they provide hospital care, ER coverage, colonoscopies, EGDs, and other minor surgeries. The ER now sees 600 patients per month, and the daily inpatient census ranges from 15 to 30. The hospital operates in the black and community support is strong.

Although the CMS fee schedule allows Dr. Oz to make more in a two-hour surgery than family physicians make in an entire day, the spirit of altruism and service is still strong enough to carry many of our graduates to fulfilling careers in underserved populations. If primary care physicians are ever paid fairly for providing comprehensive care to complex patients, our ability at JPS to train even more young family physicians to serve vulnerable populations will grow, and so will family physicians’ visibility and accessibility.

And maybe then, enough Americans will have an accessible and trusted comprehensive generalist physician, so that the parochial opinions of Dr. Oz will forever fade from our collective memories.

Richard Young is a family physician who blogs at American Health Scare. This article originally appeared in Primary Care Progress.

ADVERTISEMENT

Prev

What Apple's Healthkit and Health app mean for physicians

June 3, 2014 Kevin 10
…
Next

Are safe harbors the answer to fixing medical malpractice?

June 4, 2014 Kevin 6
…

Tagged as: Primary Care

Post navigation

< Previous Post
What Apple's Healthkit and Health app mean for physicians
Next Post >
Are safe harbors the answer to fixing medical malpractice?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Richard Young, MD

  • When medical protocol meets family concerns

    Richard Young, MD
  • Patients in Sweden received fewer post-op opioids. Why is that?

    Richard Young, MD
  • Medicine is too complex for computers to keep up with or understand

    Richard Young, MD

More in Physician

  • When errors of nature are treated as medical negligence

    Howard Smith, MD
  • The hidden chains holding doctors back

    Neil Baum, MD
  • 9 proven ways to gain cooperation in health care without commanding

    Patrick Hudson, MD
  • Why physicians deserve more than an oxygen mask

    Jessie Mahoney, MD
  • More than a meeting: Finding education, inspiration, and community in internal medicine [PODCAST]

    American College of Physicians & The Podcast by KevinMD
  • Why recovery after illness demands dignity, not suspicion

    Trisza Leann Ray, DO
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 13 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How conflicts of interest are eroding trust in U.S. health agencies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why young doctors in South Korea feel broken before they even begin

      Anonymous | Education
    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The country doctor is alive and well
13 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...