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For people living in rural America, finding a family doctor or adequate health care services has never been easy. Says Rian Dundon in a timeline.com report: “Country folk have been bootstrapping their healthcare for generations through the use of hard to reach clinics, rural hospitals, and the traveling doctor. And even in the 1920s, when half of Americans still lived rural, 80 percent of doctors were in cities.” Those taking up medical practice in a rural setting, based on the wide-ranging needs of the populace, were unlikely to be specialists but more likely to be family doctors — a professional choice counter to a growing and overwhelming trend in medicine. Choosing to be a specialist means higher potential income, and as far back as 1960, “85-90 percent of med school grads were choosing to specialize their practice,” says Dundon.
This trend toward specialized fields of medicine continues to this day. Add to it an overall shortage of new doctors, and you have a desperate situation for many of those living in rural America. According to a recent report from the not-for-profit Association of American Medical Colleges, “Of the more than 7,200 federally designated health professional shortage areas, 3 out of 5 are in rural regions.”
The AAMC report states that “rural residents are more likely to die from health issues like cardiovascular disease, unintentional injury, and chronic lung disease than city-dwellers. Rural residents also tend to be diagnosed with cancer at later stages and have worse outcomes.”
The AAMC says that encouraging young doctors to take up rural practice is challenging for a multitude of reasons. “Rural areas offer fewer opportunities for working spouses, and schools in rural communities may have fewer resources. Young doctors also may worry that they will earn less, which is a serious concern for those with major student debt.”
Says Dr. Randall Longenecker, assistant dean for rural and underserved programs at Ohio University Heritage College of Osteopathic Medicine, “The culture that most medical students train in values specialization and diminishes the intellectual challenge or importance of family medicine and rural practice.”
Adds Dundon in his timeline.com piece, “Truth is, efficient healthcare and rustic living had never mixed very well — but the situation has worsened as medical careerism shifted from an emphasis on altruism to profit.”
There was a time once when leading the life of a good old American country doctor was viewed as a heroic endeavor. Stories of their accumulated wisdom to be recounted. Their connection to patients and community to be celebrated. Back in 1992, the physician staffing company Staff Care began an annual process of honoring the self-sacrifice of rural physicians by bestowing a Country Doctor of the Year Award. The last recipient of record I could find was in 2020. The winner was Dr. Kenneth Paul Mauterer of Olla, Louisiana, but I was drawn to the story that ran in the Quincy, Illinois-based newspaper the Herald-Whig on the runner-up for the award, Dr. Rachel Rahman.
When the loss of a doctor threatened to close the obstetrics department of Memorial Hospital in Carthage, 30 miles from Nauvoo, where Rahman lived and practiced, this mother of three, pregnant with her fourth child, volunteered to step in.
“We asked her to commit, 24-7, to help us keep the OB department open,” Pat Howe, obstetrics department director at the Carthage facility, explains in the Herald-Whig report. “She just said ‘OK, I’ll do it,'” treating patients right up to the day before she delivered.
For her efforts, Dr. Rahman was forced to shoulder a 267% increase in the cost of malpractice coverage. Instead of searching elsewhere for a more lucrative position, she chose to expand her practice with a branch office in Carthage, treating patients right up to the day before her own child was delivered at home. She also chose to address the staggering cost of malpractice insurance by finding more affordable office space in Nauvoo, sharing the rent with a local Century 21 Realtor to keep the doors of her new practice open.
According to the Herald-Whig, when one patient came in for their scheduled checkup, “she immediately recognized a rare infection of the bloodstream and rushed him to a specialist … The specialist said ‘I don’t know of a rural doctor in the Midwest who could have found this; who is this Rachel Rahman?'” Answer: the doctor whose skill and actions saved this man’s life.
“One afternoon the town’s electricity service failed,” reports the local paper. “Rahman calmly moved a young patient to the front room — the Century 21 office — near the window and continued her work.” According to my research, Dr. Rahman continues to specialize in family medicine with offices in Springfield, as well as five other locations throughout Illinois.
Another winner of the Country Doctor of the Year Award was Dr. Neil Nelson of Gibson City, a town of about 3,500 in Central Illinois. According to a 2013 USA Today report, Nelson grew up farming, planting corn and soybeans, plowing and tending livestock, and planned that, once he set up his medical practice, he’d divide his time between the two — family medicine and farming. Soon after opening his doors, his medical practice began to grow until it embraced an estimated 5,000 patients covering 50 different ZIP codes including nearby nursing homes, as well as patients as far away as 1,000 miles. At the time of his award, he was on call 24 hours a day and had not taken a vacation in more than 12 years. The award sponsor, Staff Care, included with the award a temporary physician to fill in for the award winner allowing a two-week vacation. “I’m not sure exactly where yet. I’m going to make use of it. I’m not going to waste it,” he tells USA Today. Among the many statements of gratitude in the story, Dr. Nelson is praised by one local for being “a back-to-basics, old-time doctor, like the doctors who used to make house calls.”
According to the AAMC report, to counter the forces against rural practice, at least 40 medical schools have now implemented a rural training track. Some leaders in the medical field are even pushing for rural rotations as part of every medical school’s curriculum. Adds Dr. Susan Anderson, dean of rural medicine at the University of South Dakota Sanford School of Medicine, in rural practice, “you take care of the whole family and in some cases multiple generations of families. Birth, death, trauma, you see your patients through it all. There’s a continuity of care and a kind of gratification that’s very hard to find in any other kind of practice.”