There is a shortage of rural physicians in the U.S. My specialty, medical oncology, is but one of many specialties where the shortage is especially glaring. In oncology, I think there is perhaps a fear of practicing outside the walls of a large tertiary center and leaving behind the established framework and boundaries between the doctor and patient. I know it was a fear of mine when I moved to a rural community to practice nearly four years ago.
While there are many challenges to practicing in a resource-limited area, there are also hidden rewards. The boundaries may be softer, but I find they are still well-respected by the vast majority of my patients. With the softer boundaries also come surprising rewards. I wanted to share some of the rewards I have experienced from practicing in a small community:
1. We see the huge impact our care has on our patients by seeing them with their families and in the community. In a large urban/metro practice, when we see our patients who are cured, months to years out from their chemotherapy, it makes our day. The bright light of a survivor several years out, at their 6-month follow-up, renews and rejuvenates us as we see our other patients who may not be doing as well. But after they leave the clinic, those survivors are then out of sight, out of mind, until their next 6-month visit.
However, in a small community, I might glimpse one of my patients out walking their dog, or with their family at a restaurant, or simply out at the grocery store. Or a recent example that hit me deeply, seeing them pick up their children from school. Wow, I thought. I did that. I saved that person. Which saved that family. To glimpse a moment in their daily life and realize the impact you have had. There is no other word than humbling.
It occurred to me that this is what medicine must have been like decades ago. The doctor is part of the community, and is seen around town in other roles, not just an aloof person in a white coat working in an ivory tower. I enjoy being part of the community — I don’t mind being seen in my sweats in the grocery store, my kids trailing behind me — in other words, as a real person. When I look around the audience at one of my kid’s school events, I recognize my connection to some of the other families by having had the privilege to care for one of their loved ones. It’s not intrusive at all. It’s a sense of connection that has, I think, been nearly lost in modern medicine.
2. People come together as a team to make things happen for the patients. In a resource-challenged area, sometimes the health care team has to be creative to think of ways to accomplish the necessary care. I have found working with a small team to be incredibly receptive as we work together to often think outside the box to figure out how to take care of the patient.
There is not as much “red tape” as with large health care systems bogged down by policies made by people far removed from the actual patient care. Or if there is red tape, I can find the right person to meet with and explain what might need to be changed in order to deliver the needed patient care, and I am listened to. There are actual 2-way conversations between the providers and administrators.
3. A five-minute commute to work. Enough said.
Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.
Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is out 11/9/23 and available for preorder now in paperback and on Kindle.
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