Friday, February 20, 2009

Virginia General Assembly 2009

A relatively brief note to thank all the people in the Virginia Academy of Family Physicians, the Medical Society of Virginia and any and all organizations that worked so hard this General Assembly session to positively impact the health of the Commonwealth of Virginia.

The biggest victory is the passage of the anti-smoking legislation. Word came late last night that the General Assembly's conference committee passed legislation that would essentially outlaw smoking in any restaurants (with very limited exceptions). This is a huge victory, especially in such a tobacco-focused region and one that last year (when the legislation failed to even make it out of the House of Delegates) seemed nearly impossible.

Other good things: no issues addressing the malpractice cap came up and the proposal to license Naturopathic Physicians (N.D.s) was killed in committee.

Legislation and government are not always friendly and are rarely easy to understand, at least for me. However, the further I go in this career the more I realize that in order to make a major difference in the health of the people of Virginia you cannot approach things one patient at at time. We need to care for our patients, both at the individual level but also by becoming active participants in government in order to affect policy in way that will provide the greatest benefits for Virginia's doctors and patients.

I want to write more about the N.D.s--I'll try to do so soon.

Saturday, February 14, 2009

A country doc(?)

Keysville is a very small town in the northern part of Charlotte County, Virginia. I think the most recent population numbers I saw for the town put the size at somewhere a little south of 1,000 people. The surrounding countryside includes farms, rural homes and some small communities. The county seat, Charlotte Court House, is about 15 to 20 minutes west, and Farmville ( a town of around 7,500 or so) is 20-25 minutesn north. Charlotte County is a strikingly rural part of Virginia, and lacks even one stoplight (there is a blinking caution light, but that's it).

The office where I worked for 4 years was a privately-owned practice which employed the owner physician, a nurse practitioner and me. We were very much a small-town country doctor's office. We had it all: some children and well-child check-ups (though many went to the pediatrician in town), health check-ups and physicals, chronic illnesses without easy access to specialist care, minor emergencies such as lacerations, and the rare life-threatening or critical illness. Patients expected us to do a little bit of everything: partly because they had expected it from the previous doctors and expected us to life up to their precedent and partly because few specialists were within easy reach. We were in a position where we had to broaden our skills, keep up with new developments, and provide care for the community without much in terms of outside support.

I was fortunate that my residency training had provided a lot of preparation for this sort of practice; the location was different, but many of the issues of access and distance and insurance coverage were familiar to me. I think I was lucky overall. I came into a practice where the physician in charge wanted me to be successful and had enough confidence in me to allow me to call my own shots, to stretch my legs without fearing that I would end up unsupported.

The 4 years weren't perfect, but they were good. My wife and I lived near Farmville, and we made a lot of close friends during that time. By the end of the 4 years, though, it seemed that things were developing to a natural transition. Many of our friends had moved on to new jobs and new cities, I was interested in teaching more and in using my Spanish for medical care. I began to cast around for other opportunities, and I learned of a position back at VCU School of Medicine. The facility was a community health center (meaning we could care for uninsured patients through patient assistance and sliding scale programs), it was in an underserved part of south Richmond, and 80% or so of the pediatric patients were Spanish-speaking.

The time seemed right for a change. Making the announcement in Keysville was very, very hard: you get to know people really well in 4 years. It was harder because things moved quickly: I interviewed in Richmond in March, and I started my new job at the Hayes E. Willis health center in August. I still feel somewhat guilty for leaving Keysville: the office there has not been able to replace me nor the nurse practitioner who left soon thereafter. I do believe, though, that this move was right for my wife and I. So, August 2007 I started working with VCU Health Systems.

(to be continued...)

Saturday, February 7, 2009

Finding a job

Believe it or not, employment opportunities in rural Virginia are not always plentiful, and are not always attractive. I knew I wanted to work in a rural site, but my wife and I had no particular interest in working in southwest Virginia--too far from the people and places we knew. We had always planned on working somewhere on the Northern Neck--the long peninsula in Virginia between the Potomac and the Rappahannock Rivers. Unfortunately, once we started looking there, no positions were available.

This was especially frustrating to me, because I had hoped to practice in a community health center (CHC) after graduation. CHC's are established to provide health care to all, even those who lack health insurance. This is done by means of receiving federal financial support and then offering a sliding fee scale to uninsured patients. The Northern Neck had a CHC that I hoped to work in, but it never fell into place. I interviewed at a second CHC near Charlottesville, Virginia and thought that this position would work out. Again, things just never settled in.

I had interviewd at a private practice in December of 2002. Satori Medical Center is an independent family practice in Keysville, Virginia--at the upper end of Charlotte County. This was deeper in southside than I had intended, but it was evident by then that my earlier preferences for employment had not developed as I had hoped they would. I negotiated and signed a contract at Satori to start work August 2003, and was immediately made welcome by the physician owner of the practice (Dr. Teresa Moore), the office's nurse practitioner (Margo Potts) and all the nurses and staff of the practice. This began 4 years of practice in this rural community--4 key formative years to my current career path.

(to be continued...)