Monday, March 04, 2013

A tale of the vanishing, independent country doctor

After years of training to become a doctor, a select and dwindling amount of physicians who are driven by passion and not money settle in rural towns to selflessly care for their neighbors, family and friends as primary care doctors. Jennifer Kahn of Parade magazine profiled Howard McMahan, M.D., practicing in Ocilla, Ga., where he is at the center of fighting host of health challenges: obesity, drug abuse, depression — and he is the only doctor for miles around.

Wydene Tomberlin,79, gets a hug from McMahan after
giving him
an apple. (Parade photo by Melissa Golden)
A country doctor is on call every night, and needs a range of skills that no city doctor would dream of having: Your patients depend on you for everything from putting a cast on a broken bone to performing surgery, reports Kahn. Still, you like the idea of knowing your patients, knowing their families and serving your community.

McMahan's job has gotten harder over the past two decades in the midst of unemployment and economic hardship. Insurance companies have been chipping away at his earnings, and a growing number of his patients are now battling chronic diseases, reports Kahn. Colleagues have chosen an easier route and gone to work for larger medical centers and hospitals. But he likes knowing his patients by name, despite the financial struggles and pressures created by a changing health-care delivery system.

Over the past 15 years, the number of new general practitioners like McMahan has been significantly declining, as medical students drift away from the field in favor of more lucrative and less demanding specialties. By 2020, the Association of American Medical Colleges projects, the U.S. will have 45,000 fewer primary-care doctors than it needs, with demand expected to rise as more people gain health coverage from federal health reform.

The scarcity is really felt in rural America, home to nearly 20 percent of the nation's population but just 9 percent of its doctors. Doctors who want time with each patient, to listen intently and compassionately, must make an effort, McMahan acknowledges — especially now that computerized medical records have become so complicated, with dozens of menus that a physician must click through during each visit. Many physicians like McMahan begin their day early and often see their last patient at 7 p.m., reports Kahn. Then, it's time for them finish all of their notes and enter them into the electronic system; the challenges and demands of this type of practice take more of a toll with age.

Vacation is often not an option because as Kahn reports, McMahan is always on call; he last took a vacation seven years ago. "I remember running into one of my former med-school professors, and he asked me, 'Why are you not a surgeon?' " he laughs. "It's tough. For the first five or six years, I kept thinking that maybe I should go back and train to do otolaryngology or some other specialty."

Since starting out, he adds, cutbacks by insurance companies have eaten away at the modest profit margin he once relied on, reports Kahn. "For many family doctors, it's nearly impossible to make a living now," he says. "You have to make enough to pay the light bill, and to pay your employees — while still trying to be compassionate and not overcharge patients," Kahn writes. "That's why so many physicians these days are selling their practices." (Read more)

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