An aside

I realize that I am biased, being a primary care physician and all, but a recent article published in Emergency Medicine News really concerned me. As any physician (and most of the public) understands, the health care system is deeply flawed and needs significant repair. However, this author's perspective is NOT the way to go:

Dr. Glauser's Rant

As far as I can tell, this physician would like nothing more than to completely dismantle primary care because we're mostly inept and lazy, leaving all the hard work to ER physicians like himself.

I don't really see the author's point. Does he really feel his job would be easier if primary care was gone? Wouldn't his job be more meaningful and fulfilling if primary care was recognized by the health care system as being valuable and beneficial, and the only patients making it in to the ER were those who were REALLY sick?

From the larger view, does this author's attitude provide any opportunity to work together to make the system better?

Fortunately, there are strong counter arguments, many of which can be accessed here.

The system must be fixed, no doubt. But we need to work together as physicians and as a country to make it better. Perspectives like Dr. Glauser's will kill any effort to do so, and I hope that he will remain the angry, bitter minority.

Which specialty?

A quick apology for how long it has taken to post again. I just got back from a medical service trip to the Dominican Republic, and the last 1 1/2 months have been eaten up with this.

To continue the previous narrative...

When I entered med school, I was determined to serve in a MUA with rural sites highest on my list. I was sure I didn't want to be a surgeon or "interventionalist", but wasn't sure what primary care area was most appealing to me. Pediatrics and Family Medicine (FM) were highest on my list, but I didn't know which to choose.

Over the first 2 years, my community preceptors in Foundations of Clinical Medicine (FCM) were family physicians. I began to realize that the scope of practice FM was really appealing: adults, geriatrics, pediatrics, Ob/Gyn, minor surgery--all could be included in practice. As I spent time on rotations in rural sites such as southside Virginia, the Northern Neck and the Eastern Shore, I began to realize that this scope of practice would fit in wonderfully with the services needed in these areas.

I applied and matched to the Blackstone Family Practice residency program (which no longer exists in the same form) for my post-graduate training. This program was based in a small rural town of about 3,500 people, and we were at least 30-45 minutes from the nearest hostpital. We were asked to provide a broad scope of services, and did not have much access to specialist care: we had to do as much as we were comfortable doing. We also had to provide emergency/urgent care, especially since our volunteer rescue squad wasn't always readily available.

I feel that this training, and working in this community, provided me with a strong foundation in working in MUAs. This reinforced my desire to keep working in a rural MUA, and meant that I had to find a job.

(to be continued...)

Choosing to practice in an underserved community

When I entered medical school, I had decided that I wanted to practice medicine in an underserved area. So what is a medically underserved area (MUA)?

There are many ways MUAs are identified. Mostly they involve considering the number of primary care doctors (Family Medicine, Pediatrics, Internal Medicine) in relation to the area's population. In my case, I was looking at both federal- and state-designated MUAs. I couldn't really see the value in being another doctor working in another well-off community when there were (and are) so many MUAs. Medicine is inherently a service career; I wanted my service to be meaningful.

My interest in working in a MUA developed after I spent a weekend on Virginia's Eastern Shore in 1995, during my senior year in college. I had never really spent much time in a rural area before. The Eastern Shore is only a 30 minute drive across the Chesapeake Bay Bridge from Virginia Beach, but at that time it felt like another world. Poverty, poor health care access and poor health outcomes were endemic. This experience helped me decide that I wanted to make a difference, and service in a MUA seemed the right way to do it.

So I entered medical school committed to practicing in a rural underserved community. Then, I had to figure out what sort of doctor I wanted to be.

(to be continued...)

--mark

So, here it is...

I've recently discovered Richmond, Virginia's extensive local news blog network (collected at RVAnews) and I've spent a lot of time there and other related blogs. My wife also has a couple of blogs b/c she's downright creative and awesome (Galaxy Girl Radio, MonkeyDog Studio). So I guess I've realized how much is out there, and I'm feeling both jealous and a little left out.

So I went ahead and set up this little production. We'll see how it goes.

The big question: if another random person starts another blog that no-one sees, does it really matter? I hope it'll be interesting enough. Just getting started, so I'll add more information soon about why I'm bothering with this.

To explain the name real quick: I'm a family physician working in Richmond, VA at a medical center which exists to provide care to underserved and underprivileged communities. I've spent my medical career to date in medically underserved settings (in the U.S. and abroad). Hopefully I've learned something along the way, and hopefully I can pass along some interesting or useful thoughts/opinions/insights.

I'm kind of amazed no-one had taken this URL yet...

--mark