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...)