There is one message totalling 94 lines in this issue.
Topics of the day:
1. RURALMED Digest - 13 Feb 1997 to 15 Feb 1997 -Reply
----------------------------------------------------------------------
Date: Mon, 17 Feb 1997 16:28:25 -0600
From: "Robert M.D. Bowman" <rcbowman@atsu.edu>
Subject: RURALMED Digest - 13 Feb 1997 to 15 Feb 1997 -Reply
Regarding: Rural Drop outs - those that can't, teach, etc.
I hope to list some information that both supports and refutes this
statement.
Yes, some rural faculty are drop outs and unsuitable. The timing of a
person's life is critical here. I have not done a formal study but just about
every rural physician that has left his or her practice for non-rural
situations goes through a 6 - 18 month period of resentment, isolation,
separation, depression, etc. Some go through this while in rural practice,
if you don't believe this then read Hilfikers "Healing the Wounds". If you
don't go through at least some of this then you really didn't have much of
a rural practice.
Unfortunately this resentment tends to "seep" out at vulnerable situations
such as meetings, student presentations, recruitment talks, etc. My
thoughts are that rural practice gave me a position, a place, a reason to
exist, a bond with the community, a feeling of making a difference.
Separation from this was very traumatic.
Another reason for the ineffectiveness of rural faculty is the lack of
significant investment in them. Rural faculty have no rural budgets and
little time to do rural program development or initiation. My evidence for
this is more than circumstantial. In a study of US FP residency programs
the top correlation with the per cent rural graduates was the per cent of
rural faculty. Yet when these were loaded into a regression model with
rural curricular factors and program factors, rural faculty did not make a
difference. My interpretation of this is that rural faculty have no power
over their lives. My study of rural faculty nationwide confirms how little
time there is for rural programs. AAFP claims that establishing FP
Departments has been the major contributor to improving primary care in
medical schools, yet no one seems to jump on the bandwagon for rural
positions such as asst deans, chairs of rural, rural division directors, and
most of these positions are part time and have no coordinators, etc.
Until there is rural infrastructure, there will be no rural medical education. Wally Swetko is the sole rural faculty in the US with a 1 million annual budget, preceptors in every legislative district, and influential graduates in high places, including associations and medical schools.
After a few years of healing I was more balanced, but still ineffective. I
would move forward in good rural directions, only to fall back to square
one with 2-4 weeks of inpatient rounds, vacations, projects, heavy clinic
or teaching loads etc. I was fortunate and got a rural faculty
development grant funded, and this led to a coordinator to keep the home
fires burning whey I was out directing rural fellowships, preparing rural
faculty development programs, directing student preceptorships, and
doing the routine faculty items such as teaching, going to conferences,
seeing patients, directing rural managed care programs, learning about
research and then doing rural research, making rural visits, developing
rural networks, continuing interdisciplinary contacts, working with the
state folks, etc.; I feel that I have made significant contributions at the
local, state, and national level. Not as many as I could have made if I was
100% rural with only these tasks, but I am still a physician as well as a
teacher with lots of interests and duties.
Perhaps I could have made significant contributions in another small town
not facing economic disaster, but I practiced long enough to benefit from
the best training that I ever had. I also had time enough and stress
enough to identify my weaknesses such as my good nature and my lack
of business abilities. One personal pet peeve I have is that I see many
rural physicians unwilling or unable to help new rural physicians. Have
you done all that you could to help new rural physicians in these weak
areas? Do you have a local health system structure that supports
different types of rural physicians? Now that I ventilated, back to the
main point:
The point is that every person has effective times and less than effective
times. Every person has different reasons for being in rural practice or
leaving it. Just as rural physicians often face periods of being alone with
little support, rural faculty go through those times. We can both blame
many folks, especially the government, but I prefer to identify, recruit, and
motivate the 800 former rural family physicians who are currently in
teaching positions to be more effective at rural medical education.
I also find that I cannot continue unless I interact with rural physicians in
practice, they provide the relevance and the motivation to continue the
struggle, one that is centuries old and more complex with each decade.
A few years ago, the rural preceptorship in Nebraska would have died
except that rural physicians (acting through the state association) told
the medical school that if they cut out the rural preceptorship, they could
kiss rural referrals good-bye. It is only a guess but I suspect rural faculty
tipped them off.
The fact is that we need each other, more than we are willing to admit,
being the major egotists that most physicians are.
Robert C. Bowman, M.D.
This is one of the best short essays on the issue that I have ever seen. Thank you for this. I'm very active in rural practice and involved with trying to build up rural medicine teaching in Alberta. I can relate to what you have said here. Proves once again how important everybody is in this business.
Jim Thompson MD
Sundre, AB, Canada.