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I learned to say "no," or "later," which is another form of the word "no." Robert Boyer, MD, rural doc
I think it is difficult for young physicians who have not worked in a rural setting, and some older doctors who have (But have only seen one way of doing it), to understand that it is not "Family" or "Practice" but rather the effective integration of the two. There are many models for creating protected time for personal and family space in any setting, especially rural, and the only physicians who make it long-term in any setting are those who either ignore/neglect family or practice, or those who find incredible fulfillment by learning to integrate their lives. -- Randy Longenecker łA Reflective Practitioner in a Rural Setting˛ 2001
"Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance." Rosenblatt and Moscovice, 1982
Students and residents need help with important personal questions. They often find it difficult balancing personal, family, professional, and other needs. They are oriented to short-term goals yet they themselves must defer gratification for months or years.
Deficiencies students have in this area include the lack of delegation skills, poor time management, and the inability to say no. Students do not yet understand that the patterns they set now will stay with them for years. Perceptive preceptors can offer advice and help clarify goals and priorities.
Rural preceptors should illustrate the various supports that they use. Referral resources, the advice of peers, church membership, community organizations, and family support are all a major part of many rural practices.
Spouses should be involved in certain aspects of training pertinent to career advising and practice choice. Spouses should be included in career fairs, recruitment activities, and practice management seminars.
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