Is Medicine a Higher Calling?

Dr. Bob Boyer, a rural physician in Kingman KS for decades and the first AAFP doc of the year, answers this question far better than I when he talks to medical students and residents at the AAFP Student Resident meeting in Kansas City each year. He outlines 4 obstacles to rural practice, many if not all have been illustrated by previous list serve examples:

The 4 Obstacles that (non-rural) people with tell you
1. You will never know enough.
2. You can make so much more in other specialties.
3. You will never get a vacation.
4. You will never have respect.

Bob uses stories from rural practice to illustrate the fallacies of each point. Even more important he illustrates the key concept that people do what they need to do and they make choices. Up front he talks about learning to delegate and learning to say "no", or later which is a form of the word "no". He has correctly perceived that people who try to do beyond their calling will not stay in rural practice. He also has some stories about how much fun he has had in rural practice.

1. You will never know enough.

Medicine is about learning for a lifetime. Rural medicine is a specialty of breadth, not depth.

2. You can make so much more in other specialties.

What others make is irrelevant. We make enough, others make far too much. He challenges students and residents at his presentation stating, "Those of you who chose medicine to make money, please get up and leave now. I consider you a contaminant of the profession." By the way students and residents who attend his presentation spontaneously comment on evaluations that his presentation reminded them why they got into medicine in the first place. This is indeed a sad comment on what happens to socialize students away from what they desire during 7 years of training. Selection vs Socialization

3. You will never get a vacation.

Bob always took time to ski and do other activities. He points out various examples of rural physicians who were mayors, fire chiefs, small appliance repair people, senior tri-atheletes, etc. Again illustrating the point that you make choices.

4. You will never have respect.

In his best story The Blizzard by Robert Boyer he discusses a harrowing delivery and how he and the nurse and the patient and her husband and a distant consultant worked together. He notes that not only did he gain respect, but he respected the others as well. He makes references to Taylor Caldwell's book about Luke the Physician (Dear and Glorious Physician), and how special it is to deliver the kind of care that you should, regardless of billing codes and call, and other bureaucratic nonsense.

Rural medicine is a two way street, you get what you put in to it. I just don't get that feeling about practicing in other areas. It is too easy to be separate. When I was in rural practice, nearly 3 years it was great, then the last year it was impossible. We lost over 2000 people from the county in a shore time and went from 5 to 2 practitioners. After a couple of years of depression from the loss of bond with rural patients and community and a few years of stumbling around in academics, I do rural medical education half time and practice semi-inner city half time.

I do believe that medicine is a higher calling, with service to the under-served the highest calling of all. The sad situation is that we are even discussing this. Service is becoming a lost value of medicine as a profession and academic medicine is much to blame. Without service as a primary motivation for medicine, the profession crumbles from within as we select the wrong people, train them disconnected with patients, and distort what values they had when they were admitted.

It is my hope as an academic physician working from within, that we can awaken academic medicine and renew it. I also support those who have taken another route by creating rural primary care medical schools that will address the needs of rural people while academic centers are waking up.

If we are successful, then students will be asking the question, why in the world would I want to specialize, rather than why should I choose rural family medicine.

No matter which career of service that you choose, you will not be dismayed if you are truly committed. If you lose your motivation or it gets stolen from you, then you better find a means of renewal or move on to a less demanding situation.

Email: rbowman@unmc.edu
http://www.unmc.edu/Community/ruralmeded

Boyer Links and Presentations, including Streaming Video

Rural Student Interest Groups

Questions By Students and Other Info about Programs

Students Face Obstacles

I have found the American Academy of Family Practice's (AAFP) video called "The Path Less Traveled" quite useful for med students early in their careers, to promote interest in rural generalist practice. It would be suitable for pre-med students who are debating about career choices. It is a bit propagandist for family medicine, but that is excusable. (17 mins long)
Joe Stenger http://www.aafp.org/rural/pathvideo/