» Painful Choices 3: Rural Docs Must Answer a Different Call Spencer Speaks: Here are my thoughts; share yours

By Jim Spencer
SpencerSpeaks.com

December 21, 2007

When he arrived in a rural area to practice medicine, Dr. Mark Deutchman saw his first patient before he finished unloading the moving van.

“They came to get me to help someone who had been hurt in a car wreck,” said Deutchman, a professor of family medicine at the University of Colorado Medical School.

Deutchman directs CU’s program to produce more doctors for the state’s remote counties. He tells students that offering rural health care in Colorado will mirror his experience in White Salmon, Wash., a small town in the Columbia River Gorge 60 miles east of Portland.

“In the city,” Deutchman explains, “you are overwhelmed with the ‘worried well.’ Most people in rural areas come through the door with something wrong. People tend to present later and sicker.

“Your breadth and depth of skills is a lot wider if you are a family physician in (the rural community of) Craig than in Denver.”

Folks like nurse practitioner Becky Hutcheson, who examines and treats patients in the Washington County Clinic in northeastern Colorado, offer real-life affirmation to what Deutchman says and what CU’s Rural Track program battles.

Even with two clinics – the Washington County Clinic and a satellite clinic of the Yuma District Hospital – in the county seat of Akron, there is still no doctor available in the entire county on Thursdays and Fridays.

That represents a crisis in physician interest in small-town living, not a lack of patients.

Hutcheson treats six to eight patients on an average day and up to 15 when things get really busy. The emphasis in a rural medical practice is hands-on. Hutcheson tried running a medical clinic at a Wal-Mart in Greeley.

“I hated every minute,” she said. “It was medicine by flow chart. We were not busy at all. After being independent, having to know when to hold ‘em and when to fold ‘em, that wasn’t for me.”

On the other hand, Deutchman knows rural medicine isn’t for every doctor or perhaps even for most doctors. He admits that there are “frontier counties” in Colorado and across the country “that may never have a physician” and where the work will have to be done by physician assistants and nurse practitioners, such as Hutcheson.

But demand remains for plenty of rural doctors between the city and the frontier.

“You want to find people who have had a rural living experience and want to return to it,” he said.

That means screening the backgrounds of applicants to medical school to make sure each entering class has geographic diversity. It also means “constant exposure” to the good things about rural practice that are needed to overcome the “urban, sub-specialty” bent of the four years med students spend in academic health centers.

“We meet twice a month with (Rural Track) students their first two years,” Deutchman said. “We bring in speakers. We talk about the economics of rural medicine. We talk about scholarships.”

Thy also give “suturing workshops” that teach young students how to sew up cuts and give young medical students the hands-on experience they love.

Deutchman wants his Rural Track participants to know their work will be very hands-on. He also wants them to realize they can still make a living in areas populated with uninsured and underinsured patients. He lets them know that they can have a lot of their educational debt forgiven by agreeing to practice in rural areas.

“Colorado was one of the last states to pass a law for loan repayment for rural physicians,” said Denise Denton, former director of the Colorado Rural Health Care Center. “They just passed it in the last session of the General Assembly.”

The private Colorado Health Foundation also offers a loan repayment programs for rural docs, said Craig Cresawn, the rural health care center’s work force programs director.

With the average medical student graduating more than $100,000 in debt, that’s quite a perk. Yet it comes to nothing if folks don’t understand what they’re getting into.

So Deutchman encourages his third-year and fourth-year Rural Track med students to do their clinical rotations outside of Colorado’s Front Range urban corridor. He encourages them to go instead to the San Luis Valley, the Western Slope or other understaffed rural areas.

He also pairs Rural Track students with rural physicians for a summer of work so they get a taste of the country doctor’s soup-to-nuts life.

It remains a different kind of calling from urban medicine.

“You wear many hats,” Deutchman explained of his 12 years in White Salmon. “You’re the public health department. You work for the fire department. You direct the ambulance service. You are really engaged with the community.”

That connection may be the only hope for solving Colorado’s and America’s rural health care crisis. Medical schools must admit and nurture a certain number of students who understand and enjoy remote living.

“You can survive,” Deutchman said. “That’s a mentality people who practice in rural areas have. You take care of people because they are your neighbors.”