Rural doctor does it all, or most of it, and says urban patients' care is fragmented by specialists

The trials and tribulations a rural doctor faces every day make those who volunteer for the job stand out among the crowd. In the midst of physician shortages, economic disparity and little monetary and administrative support, these doctors have heeded the “calling” to work in rural medicine, Stephanie Desmon reports for the Baltimore Sun.

In Oakland, Md., Dr. Ken Buczynski (Sun photo by Amy Davis) is the saving grace of the 1,856 people who live in the town about 200 miles west of Baltimore. Since applying to medical school, Buczynski has felt a calling to serve the rural poor, but the sacrifices of such a life are acutely felt. In “the hamster-wheel life of the country doctor in Garrett County,” pop. 30,000, at the western end of Maryland, Buczynski works 14-hour days that include everything from baby deliveries to skin biopsies.

Buczynski’s experience puts him in a distinctive position to judge the shape of the health-care system. He says patients' care is being fragmented "by seeing an endocrinologist for their diabetes and thyroid and the cardiologist for their high cholesterol, their gynecologist for their Pap smear. When you start seeing all those doctors, often times the left hand doesn't know what the right hand is doing. In our community that patient with those problems is likely coming to their primary care doctor 90-plus percent of the time ... and if specialty care is required, we help patients get that. I think that's a good model."

As Congress debates health reform, some see Buczynski’s approach as successful bedrock for the system. Don Battista, the CEO of Garrett County Memorial Hospital, says urban patients who rely on unnecessary and costly visits to specialists are worse off than rural patients. A family doctor forced to customize care in underserved areas usually has better results. "For the first time, people are realizing that more intensive, more specialty care may not give you better outcomes," says Dr. Roger Rosenblatt, vice dean of family medicine at the University of Washington.

The skills rural doctors are quickly forced to learn can be a tempting benefit to the job. “It doesn't get boring," Buczynski tells Desmon of his work. "If I were in suburban Baltimore, seeing patients with hypercholesterolemia, hyperlipidemia between the ages of 55 and 75 all day, I'd go nuts." But the thrill of such a job is heavily weighted by the sacrifices: family, money, free time and a social life all suffer. “To go to a recruiting fair and say, 'Come to rural America where everyone will know your car, your business, your house, what kind of chicken you buy at Wal-Mart, and you'll take call 168 hours at a time and there's no mall for an hour and a half,' … When you start talking about those things, it's a real detractor to a lot of physicians," Buczynski says.

The solution, Rosenblatt says, is not simple. "We have these extraordinary doctors but they're sort of dying on the vine,” he said. We have to make this a profession people can do and enjoy and have something else besides medicine." (Read more)