This episode features a panel discussion on rural healthcare, sponsored by the Student Association for Rural Health at the University of Iowa College of Public Health. The panelists emphasized the importance of relationships and community and discussed the need for rural primary care providers to be comfortable with being uncomfortable and knowing when to ask for help. They also highlighted the challenges of limited resources in rural hospitals and the need to recognize when a patient needs to be transferred to a different facility. The panelists shared their experiences of practicing medicine in rural communities and the rewards of being a part of the community they serve and encouraged students to consider rural medicine as a way to make a meaningful impact and develop long-lasting relationships. [click here to link to the audio stream]

Speaker 1 (00:00:06):

Hey everybody. Welcome back to From the Front Row. This week we have another panel discussion. I think it’s a great opportunity to learn about the challenges and the opportunities within rural medicine from four rural practicing physicians. They’re going to discuss their experiences working in rural communities and what led them to choose their careers. It’s a great opportunity to learn from practitioners about what they expect for the future of rural medicine. I’m Lauren Lavin, and if it’s a first time with us, welcome. We’re a student run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside the field of public health. Hope you enjoyed today’s episode.

Speaker 2 (00:00:43):

Dr. Dewey, would you mind just saying hello and introducing yourself for us?

Speaker 4 (00:00:48):

Hi, my name is Janelle Dewey. I’m a family physician in Billings, Montana. I am actually a proud graduate of Luther College. I heard somebody talking about Luther College here. Luther College in Decorah, Iowa. Grew up on a ranch in rural Montana. Graduated from Luther and then I went to the University of Iowa College of Medicine and have been back in Montana now for 20 years, practicing in both Billings and I practiced also in Yellowstone Park at the Mammoth Clinic.

Speaker 2 (00:01:13):

Great. Thank you Dr. Dewey. Dr.Kaefring, if you wouldn’t mind introducing yourself.

Speaker 5 (00:01:17):

So, hi. I am Dr. Whitney Kaefring. I practice family medicine with OB down in Muscatine for the University of Iowa. I am from here, went to med school here, did my residency here, and now I work in Muscatine for here. So I’m very familiar with this area, but in a more rural community.

Speaker 2 (00:01:36):

Great. And Dr. Kaefring just got here from Muscatine. Yeah, I–

Speaker 5 (00:01:40):

Came flying in from clinic.

Speaker 2 (00:01:41):

Yeah, so thank you again for coming. Yeah, of course. Dr. Marquardt?

Speaker 6 (00:01:45):

Yeah, Dr. Tom Marquardt. I’m from Decorah, originally from Madison, Wisconsin, and went to Luther College in Decorah. After that I was in podiatry school in Chicago, residency in Chicago and Minneapolis, and then I was in private practice in Milwaukee. We lived there for about 10 years and then moved back to Decorah, joined the Mayo Clinic health system group there in Decorah and currently 0.5 administration and 0.5 clinical. So half my time is in clinic and surgery, and then half my time is more administrative and I currently serve as the CMO for our practice in Decorah.

Speaker 2 (00:02:26):

Okay, thank you, Dr. Marquardt, for driving all the way down here. It’s a trek and made it okay after the rain too.

Speaker 6 (00:02:33):

Yep. Absolutely.

Speaker 2 (00:02:34):

Happy to have you here. Thank you. And Dr. Jorgensen, we’re going to make sure that the audio is working, so why don’t you give it a go.

Speaker 7 (00:02:41):

Hi guys. I’m Shay Jorgensen and I went to Wartburg College, proud graduate of Wartburg with our Luther grads there. And then I went to the University of Iowa for medical school and then I stayed there for my psychiatry residency training. I’ve been out of residency now for three years and I’m working at a certified community behavioral health clinic in Mason City, so northern Iowa. And I’m our Chief Medical Officer here. My days are also pretty varied. I have some administrative roles and then I see patients in our outpatient clinic. And then I’m the psychiatrist on our ACT team, assertive community treatment, where I see people in their homes including justice involved individuals, seeing them in jails. So I’m kind of all over the place during the week.

Speaker 2 (00:03:19):

Great, thank you. And yeah, thank you Dr. Jorgenson also for joining us on Zoom. We’re really happy to have you and just have some different perspectives. So thank you for coming and I just want to confirm one more time, if you can just do a thumbs up. You guys can hear me okay. You heard Dr. Marquardt talk. Okay. Okay, awesome. Thank you. So we’re happy you could all join us. This is our first event in the Carver College of Medicine. The Student Association for Rural Health is a student organization that we started last year in the College of Public Health. We’re doing a lot of different things to kind of engage with different parts of the university now, working with pharmacy, physicians, and everything. So this panel, we would love audience participation, so any questions you have, feel free to raise your hand. I’m going to start off with just a couple prepared questions, but we really want to get to what you’re curious about. So that’s kind of our plan. But for now, we’ll start with just a very general question with all four of our panelists. What does a typical day look like for you? And can you please talk a little bit about how you ended up in a rural area, why you might’ve been attracted to a rural practice, or how you ended up there, a little bit of your story, and Dr. Kaefring, if you’ll start.

Speaker 5 (00:04:30):

Sure. Well, I’m going to do it in backwards order. So I got interested in rural medicine mostly because I’m from Iowa, this is where my whole family is. I’m like, I lost track of the generations, maybe fifth generation from this area. So really when I went into medicine, I knew that I wanted to be the small town doctor in the first place. And so that really drew me to a rural practice in the first place. Really what the majority of the state is, is rural practices. And so I am actually in the rural medicine loan repayment program for the state of Iowa, which is a five-year commitment program with loan repayment for medical school loans. And so my practice, I wanted to do family medicine. I debated between family medicine and pediatrics, and I was like, well, in family medicine I can do all of those things.

(00:05:18):

That’s actually what most of my practice is, is I do a lot of women’s and children’s care in a rural location. I’m with the University of Iowa Family Medicine Department, but in our Muscatine clinic location, which is about a 48 minute drive, not that I’ve timed it, but 48 minutes down to our clinic down there. And so my day, I generally see patients from basically from eight to five a couple of days a week. And then I have a couple of days that I do more paperwork and things, and then I’m also covering our labor and delivery call. So my schedule can be very irregular at times, but so for example, today would be a very typical day. I saw patients from eight to 12, and then from one to four I blocked it so I could come and talk to you guys and seeing everything from, let’s see, the youngest patient today was a nine month old, just like a well child check.

(00:06:06):

And then I also had an 81-year-old who’s on oxygen and needs a power wheelchair and all of that. So kind of a wide variety of things, seeing all sorts of different patients. I’ve been in that practice for about five years. And so I really have a collection of patients or panel of patients that I have long-term relationships with. So it’s oftentimes where I’m not only saying, Hey, let’s talk about this problem, but oh, how’s your mom? Or, oh, how’s this going on? Or, I heard about that accident with your aunt, I’m so sorry. And things like that. So that’s a pretty typical day. And then adding in call, I then zoom up here to do OB coverage as well too.

Speaker 2 (00:06:41):

Great. Yeah. Thank you. Sounds like a lot of hats that you throughout the week. Definitely. Great, thank you. And we’ll bounce back to zoom. Dr. Dewey, would you mind sharing just a little bit about how you ended up in rural and what a typical day looks like for you?

Speaker 4 (00:06:55):

Absolutely. I mean, I have a little bit of a similar story in then. I grew up in a really rural area of Montana and I knew that I wanted to go back to our rural communities. I think rural areas are very much about community, and so that’s, that really drew me to family medicine. I wanted to be somebody’s doctor. I wanted to be their family’s doctor. I didn’t just want to take care of their knee or their ear, but I really wanted to take care of the whole person and really the whole family. And I really feel so blessed that I chose a career that I still love 20 years later. I love going to work, I love my patients, but it changed a little bit as far as my typical day. I think this is one of the cool things about family medicine too, is sometimes it changes over time and there can be something for everyone in family medicine, whether it be in an academic setting, a rural setting.

(00:07:43):

And for me, I started out doing everything. I did deliveries, we did obstetrical care, I admitted all my patients. I was doing outpatient and doing home visits, which was part of my training at the Montana Family Medicine residency. I still do a lot of home visits and that was really an important part of my practice. But as I am married to a full-time anesthesiologist as well, and so I didn’t end up in a small of community as I thought. I’m in more of a medium sized community in Montana, though we’re all pretty rural here, but my day has changed a little bit as my kids have gotten older, I now have three teenagers. I don’t really find that I can practice the same way and keep the wheels on the bus at home that I used to. So I have given up deliveries. I still do obstetrical care through 32 weeks, but I don’t deliver anymore. It was just too hard with both of us on call, and I don’t do hospital anymore. Our system has gone to more hospitalist medicine at the downtown campus, so I don’t do all of what I do. I’m more outpatient and then do some administrative things as well. But what drew me to rural medicine was really community, and I think that’s what it’s about. And I to this day still absolutely feel like I picked the best specialty for me.

Speaker 2 (00:08:53):

Great. Thank you, Dr. Dewey. I appreciate input. I bounced back to in person Dr. Marquardt.

Speaker 6 (00:08:57):

Yeah, so my path was a little different with kind of a subspecialty chosen right out of the gates. I would echo some of the same things though about community and relationships and those relationships that you can develop in a rural setting versus an urban area. I think too that defining rural medicine is different for everybody. What is rural medicine? I would argue that where we are, there are parts of it that are very rural, but then again, there are parts of it. I mean, we have 30 physician group primary care, family medicine, family medicine that does, we recently hired two OB-GYN docs. We have ENT, urology, podiatry, ortho. We have an onsite pathologist and a radiologist. And to me, when I think of that, that doesn’t feel like rural medicine to me, but it is rural medicine. Again, it’s all relative as to the size.

(00:09:51):

And so the things that I like about it, again, kind of where I started with the community, the relationships that can exist in those settings I think is super important. And kind of what drew me to that rural medicine setting with my responsibilities in practice. And as an administrator, again, it’s 0.5 and 0.5, but there are days when I’m all administration Monday morning to Friday afternoons and Wednesday afternoons I’m in the OR a day a week. And then the balance of time is clinical. And so for me, that mix is exciting. I did more of the administrative switch about half, well towards the end of my career I guess, I dunno, I got maybe 10 years left, something like that. And I’ve been doing administrative stuff for about 10 years. So for me, I like that mix. It is an opportunity to drive a bigger group of individuals collectively to have more of an impact when you’re seeing a patient having an impact with that patient. One-on-one, but when you’re doing administrative stuff, you’re making decisions that will affect the organization, which will affect a community. And to be in the setting where you can have that kind of effect through those administrative things is exciting for me and the stuff that I really enjoy doing.

Speaker 2 (00:11:10):

Yeah. Thank you Dr. Mark, you started to steal a little bit of my thunder. What is rural medicine was a related question, but we’ll get back to it. Dr. Jorgensen, I’m kind of curious with your perspective too, also having a little bit of administrative work. What brought you to rural and and Dr. Marquardt answer kind of connects with you?

Speaker 7 (00:11:27):

Yeah, so similarly, I grew up in this area. I also wanted to do family medicine. That was kind of why I went into medicine was the idea of taking care of a family and getting to know people in the community. And then I found as I went through rotations in medical school, I was just really drawn to mental health. I think that was whatever rotation I was on, I was really interested more in the mental health of people. And so I still thought I would do family medicine and just focus on mental health as a primary part of it, knowing that there’s a huge shortage of psychiatrists, I thought that would be a good way to still rural medicine. I really had no idea what rural psychiatry would even be like if that was even a thing. I was not even sure what that could look like.

(00:12:00):

I never had really considered psychiatry until I did my psychiatry rotation at the university my third year. And then I took care of people that had schizophrenia and severe severe mental illness. And it was really when I was taking care of patients with schizophrenia that I realized that that was what I was really, really interested and passionate about. I just found that they were so interesting and that you could make such just a major impact because if you address mental health, especially severe mental illness, you’re really changing the ability of that person to function within their family, within their community to be able to have employment. Mental health just seemed to shape so much of a person’s life trajectory that that’s when I kind of made the decision that I was going to do psychiatry and I was nervous. I knew I wanted to move back to my hometown area and I wasn’t sure what it could look like to be a psychiatrist when there’s not many psychiatrists around.

(00:12:47):

And so I’ve sort of learned as I’ve been here, I work at Prairie Ridge, which was a community mental health center, now came since I’ve been here, a certified community behavioral health clinic, which is a whole nother conversation in and of itself as mental health changes across the nation. Right now, I’m the only psychiatrist here in this clinic on site, otherwise I supervise nurse practitioners. And that was a big adjustment for me leaving residency, being more on my own and then jumping into a supervisory role, which I really hadn’t intended to do, but happened because of the rural location. And my days are really varied, which I love. So on Tuesdays I have my outpatient clinic where it’s my patients that I see, and I’ve seen many of them now for a couple of years. And I try not to see kids because I’m not a child psychiatrist, but I see some because of the need otherwise we do have a virtual child psychiatrist, we were able to recruit.

(00:13:33):

And so that took a huge amount off my plate to have children be able to see someone else with the true expertise in it. And then Wednesdays are my administrative days, and like I said, mental health is really changing. It’s changing nationally right now with a lot that’s being done. And then state level, there’s a lot of changes with the regions happening, and there’s been a lot of emphasis from our governor and our state legislature this legislative session that’s changing the entire outlook, how mental health will be delivered in our state. So on my administrative days, there’s a lot of political advocacy things and things we’re doing both community level within our region, but also statewide. So that’s been really interesting to be a part of. And then Thursdays, I have a little bit more administrative time and patient care. And then Fridays are when I’m doing act.

(00:14:12):

So I’m out in the community working with people with severe mental illness, visiting ’em in their homes, and we cover an eight county area. So sometimes I’m driving 45 to 50 minutes to see a patient and we’ll kind of group the patients together in that cluster. But seeing people in their homes is an entirely, totally different situation than seeing people in your office for 30 minutes. People can show up and present pretty well for 30 minutes when you see ’em in your clinic, and then when you see them at home and you can actually see what their lives look like. I mean, some people I’ve seen have been homeless and I’m seeing them in campgrounds or all kinds of situations that I never even imagined. I grew up here 30 minutes from here and I had no sense of the amount of poverty that people experienced, the level of severe mental illness, substance use disorders, trauma, things that I just really didn’t witness as a kid growing up here. But in this role, I’ve really kind of gained a different idea of what rural medicine can look like, especially through a psychiatry lens in northern Iowa.

Speaker 2 (00:15:09):

Yeah. Thank you, Dr. Jorgenson. I kind of want to stay with you here for just a second. I’m pulling together a little bit what Dr. Kaefring was saying and what you’re saying about wearing a lot of different hats. And Dr. Marquardt is saying the hospital that he’s the CMO for has all these different specialties, which you don’t necessarily think of when you think of rural, but really urban needs are the same as rural needs. People still need these services. And so I’m kind of curious in all of your perspectives, what does make rural health unique and maybe what are some misperceptions or misconceptions that people have? And if anyone wants to jump in, Dr. Jorgen said, I don’t want to put you on the spot, but if you have any thoughts

Speaker 7 (00:15:49):

For me, I mean, in psychiatry, coming from the university, there was like 80 psychiatrists within the hospital setting. And so there was a different specialty area for each niche. Within psychiatry, we had a geriatric psychiatrist, child psychiatrist, we had people that did neuromodulation and ECT. We had people that they focused on treatment resistant depression. I mean the ACT psychiatrist, that’s all she does. She does act all day long every day of the week. And coming here kind of realizing that you kind of wear every hat suddenly. I’m a psychiatrist, so I’m a specialist in that sense, but I’m not a specialist in any certain area of psychiatry and functioning as the psychiatrist that’s going to take care of all of those areas. Of course, I refer if there’s things that I feel need to be referred, but I’m covering a much larger breadth, I think of psychiatry than I would’ve covered if I’d stayed in a more urban area.

(00:16:38):

I also think the community partnerships, at least for me, stepping out of the university setting to this community, I just didn’t have as good of an understanding. I think as a resident in a more urban setting, what kinds of things different partnerships can bring? So I now work really closely with our local jail and probation officers trying to help people stay out of the Carceral system. And that was a partnership that I just didn’t really have an appreciation for before just so many. I could name off a whole bunch of different areas, but the homeless shelter in town, of course, the local hospital, primary care clinics, I’ve just found that I’ve built relationships with a lot of different partners and kind of function in a way that we’re taking care of the community. And you get that sense here. I think everybody that works and lives in northern Iowa in this rural setting has a similar passion that we’re all here to help and we collaborate in lots of different ways. And so my days are spent with all kinds of communication with different organizations as we take care of the same population of people. So to me, at least coming from the university setting to the setting, that was a major difference, was the breadth of what I did. And also this feeling that we are all here working together to support in any way we can, knowing that our resources are more limited, we’re a little bit more creative in how we function. Those are just a few of my thoughts.

Speaker 2 (00:17:56):

Yeah, thank you. And I want to open up to the rest of the panel too. Any thoughts? Does anyone want to jump in?

Speaker 5 (00:18:03):

Oh, sorry, go ahead.

Speaker 4 (00:18:04):

Oh, go ahead. No, go ahead.

Speaker 5 (00:18:06):

I was going to say just kind of what is rural in the first place. I think that there’s a lot of different ways to define a rural area. The federal government has ways to define it, the medical associations have ways to define it. Everybody kind of brings it up. I went to a conference one time where they said, well, any city with a population of under 500,000 is rural. And I’m like, so the entire state of Iowa, including Des Moines and Iowa City and the Quad Cities would all be rural. Like, Hey, I’m not sure I would agree with that coming from that location, but, but I think what really defines it is having those areas where there are people that need to step up and fill those gaps where you’re like, okay, well, we don’t have all of the resources at our fingertips. And so even in places like Decora where you’re like, yeah, you have a bunch of specialists, but you don’t have all the specialists, but even within those specialties, everybody has to kind of say, okay, well, I can do these things because a general podiatrist, I am generally doing all of these things, but you might have to step up or say, well, the next access to the specialist that you need to see might be an hour away, which I can drive an hour, but maybe your car is such that you can’t drive an hour, and so well, doc my doctor, you take care of those things or you do those things I can get here.

(00:19:24):

And so I think with what Dr. Jorgenson was maybe also saying too is you step up, you step in and you fill in those gaps, or you fill in those pieces that need to, and you work together and collaborate with your community so that you can find the people that maybe it’s not me who’s doing it, but I’m finding the people. I’m the one who’s finding the people to help with those things as opposed to just or having other providers or other people who say, well, it’s not my problem, go find somebody else. No, you find those answers. You say, okay, here’s where you should go, or Here’s what we can do or how we can navigate these problems. So I think defining the rural location in that sense is like that’s where you’re having those resource lacks, and then you can find those and step up and fill in those gaps. That would be what I would call a rural area, whether it’s Des Moines or Sine or Decora or Montana.

Speaker 2 (00:20:12):

Yeah. Thank you Dr. Kaefring. I appreciate that. Dr. Dewey, did you want to follow up?

Speaker 4 (00:20:17):

Yeah, I think there’s a misconception sometimes about that family docs in rural areas or any kind of rural provider has to know a little about a lot. And I would argue that we have to know a lot about a lot. I mean, you have to have such a growth mindset and be willing to learn because just like you were saying, there’s not always a specialist to refer to, or if I do even have a neurologist in Billings, Montana, it may be a four or five month wait to get into the neurologist. So I’ve got to learn about a problem. And ultimately the buck stops here in primary care, and so there is no one else. We have to be an advocate for our patients. And I think that’s something that’s a misconception, but also really special about this specialty is that we do know a lot about a lot of different things that we’re constantly learning and constantly growing, which keeps it really interesting, and I think allows us to develop even closer relationships with our patients who gain such trust in us because I think they know that we’re working hard for them.

Speaker 2 (00:21:21):

Thank you, Dr. Want to give you some room if you want Dr. mcc?

Speaker 6 (00:21:24):

Yeah, it’s going to be hard to top any of those. They kind of hit it all. But what drew me to rural medicine, I think, and it’s been mentioned, the relationships. The relationships are huge. The relationships that we have within the communities and the relationships that we have with our patients, there’s a different level of accountability When I am addressing that ankle fracture and I know exactly who it is or that patient’s, neighbor’s, friend, there’s so many connections. And that level of accountability in that smaller rural setting initially can be very intimidating for me. I mean, I had practiced in Milwaukee and had that type of practice, and moving to this more rural setting was at first a little bit anxiety provoking, I guess. But in the end, what you have is you have accountability at a different level and relationships that are going out beyond the professional relationships. And to me, I think there’s huge value to that. And so I don’t know that that’s what drew me there. It’s a realization that I had once we were there, and I really appreciate that aspect of it,

Speaker 5 (00:22:35):

Almost like not a better doctor, but a better human being.

Speaker 6 (00:22:37):

Absolutely. Because of those. Absolutely. For sure.

Speaker 2 (00:22:43):

Great. So I do have a lot more prepared questions, but I want to give our audience the opportunity to jump in with any questions they might have. We have students representing at least two different colleges here. So does anyone have any questions for our panels?

Speaker 8 (00:22:59):

I think I’ve heard you say that to do labor. So one of the things that I recently is that I was like the 50th state, the lease, and you can take care of people.

Speaker 5 (00:23:19):

That’s

Speaker 8 (00:23:21):

Not,

Speaker 5 (00:23:21):

So I’ll see and do, I’ll do the full, sorry, I’m trying, I don’t want to interrupt, but I do the full scope of pregnancy. Maybe I’ll talk about my prenatal care and delivery experience.

Speaker 8 (00:23:31):

Well, really my question is what if somebody Yeah, yeah. Gets to you before they can get to the hospital to actually

Speaker 5 (00:23:45):

You deliver the baby? We’ll call an ambulance. So Muscatine is one of the hospitals, so at least with the state of Iowa, we’ve had a pretty significant number of our labor delivery units closing across the entire state. It’s not an isolated story to Iowa. This is the case along many other states In their rural locations, labor and delivery units are expensive to staff, expensive to maintain, and not very busy and high risk situations. So just costly for a lot of hospitals. The Muscatine Hospital, which is a Trinity or Unity Point Hospital, there did have a labor and delivery unit in Muscatine, but it closed in January of 2020. Unrelated to the pandemic, it closed. So actually, so when I had started at the University of Iowa Family Medicine Clinic down there, at the time that it closed, I was the only prenatal care provider in the entire city of Muscatine, which is the city of about 26,000.

(00:24:42):

So my prenatal care opportunities, my obstetric care opportunities really exploded significantly. As a result of that, I really incorporated that into my practice. We have supplies on site at the clinic so that in the event that somebody shows up in labor, because they just don’t have the option to drive somewhere, and sometimes deliveries can go very quickly. We have the tools there, we have the supplies there to be able to manage that more often what happens is I have patients who have the same worry. They’re like, well, what do I do? How do I get to the hospital if I am in labor? And well, we come up with a plan. We say, okay, you live an hour away. Your car won’t get there. Do you have any family or friends who can get there? Can you call 9 1 1? Can you get an ambulance to get you to the hospital?

(00:25:29):

The closest hospitals from Muscatine that do delivery the University of Iowa or somewhere in the Quad Cities. And so they would have to then decide if they’re doing prenatal care with me at the University of Iowa Family Medicine Clinic. I’m like, you should go to Iowa City because then I’ll deliver you maybe. But that way, but whatever works is what I encourage my patients to do within that, actually, because of that transition and that loss of a labor and delivery unit there, they also then added, I became an I-B-C-L-C, so I’m actually a lactation consultant. In addition, just to support that, which kind of speaks to that creativity or addressing the needs pieces of it, it was like, well, I’m going to take on this role and then I’m going to have people asking me questions about what happens next? What do I do? How do I feed this baby?

(00:26:10):

Oh, can help you with that too. I guess I’m learning these skills too. But definitely we now have grown that. We actually have OBGYNs that come to a Muscatine clinic now, so I work it hand in hand with them. So we have midwives and obs and family medicine that all do prenatal care in that location now. But yeah, it is definitely a problem across the whole state. More of the state of Iowa has family medicine doctors who are doing deliveries rather than OB GYN. So it’s oftentimes the family meds who are doing that prenatal care and deliveries if they are affiliated with hospitals that have a labor and delivery unit. But unfortunately, it is the case where a lot of our pregnant patients are having to travel one, two, sometimes three or more hours just to get even prenatal care, not even just a place to deliver their baby. So it is a problem, a growing problem.

Speaker 2 (00:26:59):

Yeah, back here. We’ll go in the back first.

Speaker 9 (00:27:01):

Okay. I just kind of wanted to follow up on that conversation. In terms of hospitals shutting down, lack of access to care, where do you guys see the future? I mean, there’s people that travel three hours to get chemo or three hours to see an MV at a cardiology clinic, and how can we mitigate that gap? Because not only for family medicine, but even specialty care ortho or whatever.

Speaker 2 (00:27:27):

I just want to be sure. Dr. Doon, Dr. Dewey, did you hear the question?

Speaker 4 (00:27:32):

Okay, yeah. Can you repeat that question one more time? I just cut it out a little bit.

Speaker 2 (00:27:36):

Yeah, sure. I can do my best to repeat it. So just continuing the conversation of lack of access issues, essentially, what do you see as the future and how can we address some of those barriers to access in rural areas? Is that kind of what we try to distill it down?

Speaker 4 (00:27:52):

That’s really happening in Montana a lot. I mean, Montana is so unique in that we’re just such a vast state, and so it’s rural community next to rural community, and we’re just, distance is such an issue. It is not. My parents come down to Billings for care. They drive four hours, drive four hours for medical care to Sydney and Glendive and out in Eastern Montana. You can either go to Bismarck or Fargo or you can come to Billings or you’re going to your really rural small areas. So I think that is an issue. Telehealth is really helping us with doing follow-up. Now, it’s tough to do an exam on telehealth, but it’s really great for follow-up type care, mental health care, following up on blood pressures, that kind of thing. So we’ve really stood up and used a lot of telehealth, especially since Covid also, we’re doing a lot of outreach.

(00:28:38):

So one thing the Billings clinic system is really committed to is taking providers and going to these communities, urology, neurosurgery, neurology. They’re going out into the rural areas, cardiology. I mean, really, almost every specialty we have is going to Sydney and they’re seeing patients one or two days a month. So bringing the care to where people live because they are reluctant or can’t sometimes get to a major medical center. And so it’s really bringing the care to people where they are. And I think that may be some more of the future of medicine is bringing care to people where they live.

Speaker 6 (00:29:16):

And I would kind of dovetail on that. It is going to be recruitment and getting you guys to go there. And I’ll go back to the previous question about rural medicine and what drew you there and why do you like that? It kind of gave our answers on that. But living in these various communities personally is awesome. These are great communities. They’re wonderful communities to live in, whether it’s decor or Montana or Muscatine or Mason City, there’s a real draw to those communities. The school systems are good. Typically, the quality of life is good. The cost of living is not bad. There are reasons to be in these areas versus being in rural, excuse me, in urban settings. And so for us, a lot of it has been bringing the care to the patients or bringing the patients to the care, that kind of thing.

(00:30:11):

I mean, we’ve been working very, very hard to recruit. And I guess one other point when you talk about rural, we have a small little outreach office in Ocean, Iowa. Ocean is, I dunno, 120 people or something. It’s a very small community. And we were down in their community center at a meeting presenting and they said, we just don’t like to drive to Decora. It’s too urban. And again, it kind of made us chuckle. It’s like, really? And people in Decora don’t like to drive to Rochester, Minnesota to Mayo Clinic because parking is terrible and traffic is terrible. And so everyone’s paradigm is a little bit different as to what’s tolerable. But I think to Dr. Dewey’s point, I mean, bringing that care to the patient is really what they want to do. So we have an outreach clinic in auction. We have a nurse practitioner that’s down there. We have physical therapists that are bringing the care to the patient, is the way that we manage it in the future, but we need providers to want to be in those communities and they’re great communities to be in. So come and practice in ’em.

Speaker 7 (00:31:21):

And I’ll also add to Carrie Lincoln Meyer’s question. And along with this too, we’ve been able to partner in some ways really successfully. So for our patient population with substance use disorders, HIV and hepatitis C are things that we screen for anybody that has IV drug use. And we’ve had many patients that have screened positive for Hep C. And up until about maybe a year and a half ago, it was always really frustrating. I would test a patient, they would test positive, and I would say, go to Des Moines, go to Iowa City. We have one infectious disease doctor in town, but she’s not taking new patients. And these are patients that have very limited resources and many of them are still using substances. So you’re knowingly sending this patient out to the community with Hep C and saying, good luck getting to Iowa City three hours away.

(00:32:07):

And so one of the really neat partnerships that’s been awesome for us as we partnered with the infectious disease doctors at the University of Iowa to have outreach to our patients. So if we have them, we will still do the testing and screening here, and then if they test positive, we can hook them up through telemedicine. We have them come to our clinic like a regular appointment so that we can still do the revivals here. And for them, they know nothing different other than they’re coming to Prairie Ridge, but then they get put on a screen with an infectious disease doctor. And then we work with the infectious disease doctor to order the appropriate labs so that we can start Hep C treatment. And so for some of our patients that are in our residential substance use treatment program, they’re here for 28 days. So if we screen them in the first week, they can get started on Hep C treatment within the second week.

(00:32:47):

And we’ve had many patients now that have been cured of hepatitis C through this partnership, which otherwise I would care to bet most of them would not have been treated. So really cool tangible outcomes through partnerships. Another example of that is methadone. If you guys are familiar with methadone, it has to be dosed at least for the beginning few months. Every single day someone has to come into a dosing station, be observed taking their dose of methadone. And the state of Iowa has actually done some new policymaking with our C-C-B-H-C saying that every patient needs to have methadone access within 60 miles of their residence. We’ve got some rural places in Iowa, 60 miles. It means we have to have methadone in a lot of places that we don’t have methadone right now. Methadone’s also really highly regulated. And so when we looked at doing this ourselves, it was daunting the expense of a safe and the timing of the dosing and the staff needed for dosing.

(00:33:35):

We just didn’t feel that we could feasibly do it. So we’ve partnered with a methadone program out of Des Moines and we’ve renovated a space here so they can have their staff come down and they’ve done some training. Anyways, long story short, we are very close to opening our methadone program here because patients otherwise in our community that need methadone or traveling to Waterloo, which is an hour and a half away, or Des Moines two hours away every day for a dose of methadone, I mean, they’re spending most of their day driving to get a dose of methadone to drive back to our community. So we’ve really worked hard to try to decrease some of these barriers to access for patients who need them in our area.

Speaker 2 (00:34:14):

Great, thank you. And do you want to jump in?

Speaker 5 (00:34:16):

Yeah, I was going to kind of add on that all of these are really, we’re really engaging creativity and thinking outside of the box and trying to look at, okay, maybe we need to look at different ways in which we deliver healthcare, where it’s not just a clinic from eight to five and then you’re done. It’s like, okay, maybe we need to, as providers have more flexibility to go other places or to practice medicine in a different way than maybe it’s traditionally been done. Just because always been done that way needs to be thought through. We need to make sure that we’re doing things safely. The other thing I think that has sometimes a limiting factor is having an identified space or identified support staff. If we are doing these remote visits or telemedicine visits, which I think with Dr. Jorgenson’s talk about that was you have somebody who can be onsite. So you have to have that community connection. And so I think working with public health departments or working with the local resources to say, Hey, who in the community can help provide this resource or help in this way so that we have not only the providers getting to that area, but the nurses, the clinic, the support staff, the people who can be on the ground running these things so that we have the ability or space to make it happen for the patients.

Speaker 2 (00:35:28):

Great. Thank you. And I just want to poke this a little bit too, and stay along with the access theme. So we’re talking about a lot of initiatives where it’s a lot of strain on you as the providers if you’re going up to these other areas administratively or just even time-wise. And so I’m curious, as far as concerns about sustainability, are there any concerns about being able to sustain these initiatives? Is it something that is out in your mind at all, or is this, I’m just kind of curious if you want to speak a little bit about your ability to do outreach. Do you receive reimbursement for it? Is it something you do for service in your free time along those lines?

Speaker 6 (00:36:14):

Yeah, I’ll go first. I think the sustainability is, that’s a valid point. You wouldn’t want to go there if you can’t sustain it. So I think we kind of do that homework on the front end. If we’re going to do this, is it going to be something that we can continue to do? I think, not to dive into this too deep, but I mean AI is a big thing and it’s affecting all of us, and it will continue to affect us and family medicine docs on the panel. So I have to be careful what I say. I was at a lecture, it’s like in five years there’s going to be an app that replaces a family practice doc. It’s like, that seems a little crazy, but I don’t know that it’ll go that far. But I think there will be other creative ways that we will be able to sustain it through things like that. Not replacing family doc with ai, but different ways to practice medicine. I think,

Speaker 5 (00:37:13):

I’m not offended. I think you’re not wrong in that we have general recommendations and things that AI can very easily screen a chart and say, Hey, you qualify for these things. But it’s that in-person conversation that human connect,

Speaker 6 (00:37:27):

That’ll be harder to replace

Speaker 5 (00:37:29):

That I don’t think a robot can do. That’s right. I agree. Yeah, so

Speaker 4 (00:37:34):

You can’t replace that. But patients don’t follow algorithms until patients follow an algorithm. I don’t know that the robot can do what we do. And I mean medical students come in, they’re like, wait a second, they came in for a sore throat, and all of a sudden we’re taking, we’re hand delivering ’em to the psych center because they’re suicidal. And that’s really what they came in for. I mean, patients are so complex that it is an interesting thought though, where we use AI a lot now actually is helping to make our jobs easier in DAX nuance or using them to help with our chart completion and those sorts of things. I mean, but I hope we don’t get replaced by ai, but the patients are just so complex. I don’t know how it would work.

Speaker 6 (00:38:20):

I don’t think you can see us, Dr. Dewey, but we’re nodding with you in agreement here.

Speaker 5 (00:38:27):

I think that also gets to the sustainability piece of it too, is looking at ways to fill in the gaps so that we aren’t getting burned out with these sort of initiatives so that we do have the time to, if it does take two hours to drive to the outreach clinic that we’re doing, and then we have two hours worth of charting after the clinic is done, and then we have another two hour drive back home, if we now have a robot that can do our charting well, that saves us two hours in that entire situation. And so then it adds a whole lot of value to some of the services that actually gives us a little bit more opportunity to get creative or to say, okay, maybe right now I can’t do all of these things because I have to do all of this other paperwork pieces of it. But if that paperwork piece can be done by a robot, then maybe it does in fact give me the time, the mental energy and the ability to increase services or to offer some of these other pieces and do it in a sustainable way as opposed to hitting the ground running and then burning myself out trying to serve all of these things without a change in the system.

Speaker 9 (00:39:31):

So on a related note, you’ve all mentioned how many hats you all wear and how much extra work you have to do to advocate and really take care of your patients. So I was wondering, what does the work life balance look like? Are you able to take care of yourselves and your families and regaining that energy?

Speaker 7 (00:39:52):

I’ll start maybe. So when I started, I’d say six months into being here, one of my really close mentors, a psychiatrist at the university, I’d reached out to her and I just said, I can’t do this. I got here. And it was so overwhelming when I saw how much need there was and such, so many things that I just saw. This isn’t doing, this isn’t being done well, this can’t go on like this and we’re not addressing this thing. And I was trying to tackle I think everything all at once because I just saw the need and she gave me the most valuable advice I think that allowed me to stay here and continue was to pick your priorities, pick what do you really need to focus on? What’s going to make the biggest difference now? What’s actually attainable and where do you want to focus?

(00:40:35):

And to everything else say, I totally agree, we need to work on that and now is not the time or we’ll get to that. And so I found myself using that phrase a lot and really finding like, okay, so what are we going to first do to help this clinic function successfully? And starting with some smaller things. And then as things got improved, things got easier with time, and then we were able to take on bigger projects. And for me, what’s I think preventing me and I think for my career will prevent me from burnout is the ability to see the changes we’ve made in the impact it has on patients and our community. I’ve only been here three years and I’m not beating my own drum, but I can see a major impact of the things that have changed within our clinic that’s had lots of impact on a population of patients.

(00:41:19):

And then things we’ve changed with community connections to get people out of jail that have high mental health needs. I mean, there’s just a lot of ways that we’ve been able to address things in a really positive way. And so I think if I didn’t have the mindset that I wanted to make change projects and I wanted things to go differently and I’m willing to address them, I think I would be burned out. I think if all I did was show up, go to work, see my patients and go home, I would work in a system that I felt like was ill-equipped to take care of patient problems. And I think I probably would’ve left this position already. But I think for me personally, I had the mindset of I want to make a big change in this community and I want to be able to have things be done to the best level they can be.

(00:42:00):

I want Prairie Ridge to be a place that people go to seek out for care, not because they live here and have to, but because we deliver excellent mental health services and we’re able to treat our population in a way as well as the University of Iowa or Mayo Clinic. And I think having that mission and being able to do small projects at a time and seeing successes in those has absolutely kept me engaged. We have two little boys and I only work 32 hours a week, so that was another big thing. When I chose to take a position as I knew I wanted to work. I do my Mondays that I’m technically not working. It’s a day sometimes I used to catch up, but a lot of times I used to stay home with the kids. And I think for me that was a priority.

(00:42:38):

And even when I interviewed Dr. Marquardt interviewed me and I looked at going to Decorah and I was very, very verbose in my interviews and saying, family comes first for me. That’s my absolute priority that I know that if I don’t put my family first that I’m not going to last in this career. Especially I think when seeing mental health patients, it can be mentally really draining. So for me, I’ve always kind of prioritized my own time, my time with my kids. We have a small little acreage. Those things really had to take a priority for me to feel like I could sustain this work.

Speaker 2 (00:43:11):

Great. Thank you. Thank you for the question. Anyone else want to add on to work-life balance?

Speaker 6 (00:43:17):

Yeah, I think you have to be careful about that. We do wear a lot of hats and when you put that hat on matters, and so for me, I think there were a few opportunities along the way where I was tapped like, Hey, would you be interested? And it wasn’t the right time, right? So be careful about that. Protecting that time is very important in our efforts to recruit. Now we’re seeing a lot more of that kind of on the front end like, Hey, I’ve got to have work-life balance like Dr. Dosen had mentioned. And so I think having that awareness is really important. The work week for our primary care providers consists of what’s called non visit care time. And that non visit care time is, so they work a 32 and eight. So 32 hours of patient contact hours and eight hours of non visit care time and non visit care time can be sprinkled throughout the week in any manner in which they want a pause in the morning or a pause at lunch or a long lunch or a day or however that can be done. So the organization I think is trying to make steps forward to make sure that there’s balance in the day to protect that work-life balance, because that’s huge. Because physician burnout is huge and can’t stick our head in the sand and act like it’s not there because it’s there and you have to be real careful about it, I guess. So

Speaker 4 (00:44:37):

I think that’s a really good point. I would say the old school family docs who did it all and were on call 24 hours a day, seven days a week and didn’t take vacation people, people don’t necessarily want that lifestyle anymore. I would say a lot of us that even came out, I started 20 years ago, I feel like sometimes a dying breed. I feel like I’ll be on call forever. A lot of patients have my cell phone number. And I’m not saying that having those boundaries is wrong. I don’t think it’s necessarily wrong to have those boundaries, but we’ve found in our practice too that yes, students coming out or residents coming out looking for a practice have different expectations. And again, it isn’t wrong because it is preventing burnout. And we’re trying to, we’re really, as an organization at Billing’s Clinic right now, we’re working on this.

(00:45:22):

How do we create a job that’s really sustainable for the long haul, something that someone will want to do for 30 years. We want people to stay in medicine for a full career and stay with our organization. So how do we create a job? And I really think the burnout comes not in seeing patients. For me, that feeds my soul. That is really what brings me joy in medicine. What creates the burnout is endless paperwork and prior auths and the documentation in the, I know, I see you nodding too. I mean, this is the sole killer in medicine. And so it’s how can we use AI to help get that work done or use a team care model where we’re using our advanced practice providers and different things to help us all get the work done so that it’s sustainable. I think it’s essential, especially in rural areas, that we don’t burn out providers that really do want to be in it for the long haul and take care of patients long term. So

Speaker 5 (00:46:20):

I think I would add,

Speaker 4 (00:46:22):

Oh, I was just going to say also, I really feel like too work-life balance is going to be, as much as I think I’ve gotten better about it will probably be something I strive that I struggle with my whole life.

Speaker 5 (00:46:36):

And I think I would add to that, yes, as a fellow family medicine doc, yes, that is exactly the part that’s the burnout piece. It’s not the patients, it’s all the paperwork. I find that one of the ways that I navigate it is also to be upfront with my patients about it. So I will say, Hey, yeah, I would love to deliver your baby. I also have a husband and two children who are my priority. And so if it works, I will be there. I will show up and I will catch your baby. But my husband and my kids are the ones that are my first need. And so they need me. And then most of the time I say, Hey, this is what you can expect. Or I’ll even say, Hey, I’m going to be gone next week. So if you call and need something, it might take a little bit for somebody to get back to you on it.

(00:47:23):

So be patient. And most of the time, especially if I’m open with them and they respect that, they’re like, oh yeah, you need vacation too. You need a break. You work. And so they’re very understanding and respectful of that. Okay. Usually I’m like, no, I’m not on vacation. I’m working on labor and delivery, but it’s fine. Different sorts of things, but just not only that, but having that connection or relationship with your patient, which feeds your soul, but then just opening it up with them and saying, Hey, listen, I’m a human being too, and I really want to do all of these things. I want to do everything I can for you to help you. I can’t do that if I am so exhausted and burnt out that I am just burning the candle at both ends. And so give me patience. Yeah, my trip thing says, give me two days.

(00:48:02):

It might take me four. I’m sorry, I will get back to you, but just be patient with me. Know that I will give you just as much time and attention, and I’ll be honest with patients about that and say, this might take me a little bit longer to complete because there’s so many things that are being asked of me, but it’s important to me to understand where I’m coming from. I’m not trying to ignore you. I’m not trying to say I don’t care. I do care. I just need to take a little bit more time to do it.

Speaker 2 (00:48:28):

Great. Thank you. I think we’re going to have time for maybe two more questions. So do we have any more questions?

Speaker 8 (00:48:34):

Hi. Thank you guys for coming to talk to us. This is really interesting. Great perspective. I was wondering what’s your guys’ relationship and collaboration with local public health, where you’re at and how do you think that differs in role settings versus settings practitioners?

Speaker 2 (00:48:54):

Did we hear the question? Okay. Whoever wants to jump in.

Speaker 5 (00:49:00):

So I don’t know about you guys, but I work pretty closely. I actually have a couple of different contacts at the Muscatine Public Health Department that I reach out to. They have a lot of really awesome services that they offer because I have a pretty decent pediatric population. We have a lot of kiddos who are in need of developmental screening or developmental support or things like that. Or at-risk families who are needing a little bit of assistance with navigating early childhood development situations. The public health department at Muscatine has a program called First Five, and I don’t know if it’s in other counties too. It might be, but I’ll refer to them a lot. Or we also have the Free Medical Clinic OB program. The Muscatine Public Health Program will help get, if somebody shows up and they do free pregnancy testing and they’re like, surprise, you’re pregnant.

(00:49:44):

Oh, you don’t have any insurance? Okay, well, we have a program that the family medicine department at the University of Iowa runs. And so then I’m their contacted Muscatine so that if they have somebody who shows up in that situation, and then the same with other testing and treatment and things that maybe there’s a resource limited option where if they come to our clinic to do it, they’ll get billed for it. Just the nature of healthcare. But hey, the public health department has these same things that you can go and do and get screening and things like that. So at least from my perspective, wherever, if I’m in Muscatine forever, that’s what I’m planning to utilize that. I’m sure that that’s probably similar in some of the other places too. But I think the public health department is amazing and has a lot of really great resources to be utilized from an healthcare perspective.

Speaker 2 (00:50:30):

Anyone else would like to add in? Next question. Yeah, another

Speaker 8 (00:50:37):

Question here. Okay. I have a question from a provider perspective. So I’m here because I grew up in rural Iowa, also have an interest in rural care disparities there. So a fast story. My last day of rural, of my family medicine rotation and my hometown of Iowa Falls, Iowa in the direction of Mason City. My provider did regular colonoscopies, very routine screenings. Our patients come in for their first colonoscopy, so you don’t expect to have anything going on. If patients have a history of severe IVD, you’re going to send them on. He’s not going to take on those patients. But still, we had a 60-year-old woman for her first colonoscopy and we went in and essentially a polyp was removed and there was pretty extensive bleeding. And it turns out, long story short, there were two clips and the entire hospital and one didn’t deploy correctly and the second deployed, but was not enough to stop the bleeding.

(00:51:31):

So patient is essentially having a minor hemorrhage, minor major hemorrhage here, and the physician did a phenomenal job. He was so calm. We actually had a conversation later that day walking through the halls and he’s like, you saw me on one of my worst days and I was I in entire practice. And I was like, well, respectfully, you were so calm. And I admire that, and that’s something I hope to carry forward. So when he did the things he could, we tended the hemoglobin and had blood ready, all the things you would expect, but ultimately we had to just put her on an ambulance and transport her to aims and case higher acuity was needed. They called the GI surgeons and had everybody on board. But that comes down to, it was brought up earlier, limitation of resources or Dr. Jergensen, you were saying you took on child psych patients to try to increase care the best you can. And I think as someone going into healthcare as a provider, it’s just an interesting question where to find that balance, how do you balance the limitation of resources trying to increase access of care and care for these patients with barriers with considering the potentially complex cases that you’re going to face? How do you navigate these difficult situations? And we’re okay trying to do both things and I think we all do the best we can, but I would be curious to hear how you would speak to people pursuing that potentially.

Speaker 6 (00:53:02):

Yeah, there’s a lot there, Miguel. There’s a lot of story. I mean, having the right provider, a lot of things come to mind. So our colonoscopies, our general surgeons do our colonoscopies, but we have one family doc who does his own colonoscopies. So I think it starts with having the skill sets and the confidence to do that. Not suggesting that the doctor you were with didn’t right. I’m sure that he did. And then if you’re going to enter into that kind of surgical environment, making sure that you can manage the complications that are going to come your way and don’t even open the door if you can’t manage the complications, which I’m sure he did and he did just fine. So those are things that I think of. And then of course, just making sure that the facility that you’re in has those supplies and things, and I’m sure that that was done as well.

(00:53:58):

But I mean those are things that I guess you think of along the way, but it probably speaks to a lot of the other things that we’ve talked about and that is trying to bring that care vocal. I mean, it’s pretty important to do that and that’s what was happening in that particular situation. And I think making sure that they have the resources is, it’s paramount for sure, but bad things will happen and you have to have that bailout plan, whether it’s an ambulance ride or a helicopter ride or whatever. And that I think again speaks to the partnerships and the relationships. I’m sure that there were relationships and pathways that were created for that kind of safety net, if you will, to exist. That would be, I guess, thoughts that I would’ve hearing that story.

Speaker 4 (00:54:47):

I think the relationships are so, so important and having those relationships in place. I mean at the main campus, a lot of our surgeons and especially the surgical specialists have good relationships with outlying primary care providers because you have to be able to communicate well. You have to have a level of trust that both goes both ways. I mean, from a family doc perspective, I think there’s a certain personality type that will go into rural medicine where you have to be a little bit uncomfortable with being uncomfortable. I’m sorry. You have to be comfortable with being a little uncomfortable, but you also have to know when to say when. I think that’s recognizing bad things, recognizing a really sick kid, recognizing a sick adult. I don’t always feel like I have to know everything about everything, but I better know when to recognize early on when someone’s sick or there’s a complication and sooner rather than later be able to get them to the right level of care.

(00:55:46):

And so I think rural primary care providers become very good at that. I mean, the best primary care providers are good at their comfortable with taking care of a lot of different things, but they also know when to say when and to ask for help. And they’ve developed relationships with their bigger medical center so they can get people where they need to be. I mean, when I was in Yellowstone, I remember GI bleeder walking in the clinic and he’s bleeding out. I mean, I was sweating waiting for the helicopter to get there. I mean, it’s rural Yellowstone mammoth clinic and yeah, I was counting the minutes. It felt like forever. And I think that rural primary care providers are some of the most amazing physicians on the planet. Like I said, I’m in a little bit bigger community in Montana, work very closely with some of the people who are way out there and they’re amazing.

Speaker 5 (00:56:44):

I would say you can never plan for everything. Even in the big institutions where they have everything possible, you can still have things go wrong that are going to be, oh, that’s new. We’ve never seen that before. Even at the massive tertiary care centers where you send all of the special situations. I think in a more rural setting, will you see that with as much frequency? Probably not. But you still can have those situations where like an acute GI bleed, you’re like, there are complications, are they common? No. But is it something where it’s just this perfect storm of events? There are literally two clips in the entire hospital. I mean, that could happen. That does happen in rural hospitals with blood. They don’t have as much as blood that they might need for a massive transfusion protocol and things like that. I think that it comes down to thinking through all of the things that you possibly can. And then just as Dr. Do Said is being aware of knowing what your limits are and saying, okay, we’ve done everything we can for this situation and now there are no more resources here to help. We need help. Whether that’s calling a helicopter or transferring to a different facility, things like that. But I think having some of it comes down to experience, but just having the experience to be able to recognize this is not something that I can continue to manage here. I just don’t have all of the resources I need, unfortunately.

Speaker 2 (00:58:14):

All right. And we are a few minutes over time. I want to give space. Dr. Jordans and Dr. Dewey, thank you so much for joining us. If you need to hop off, feel free, and I don’t want to hold you prisoner or anything, but I do have one final question if I can. I was just wondering, we have first year, second year, and third year medical students, future public health professionals, future pharmacists, future healthcare administrators. What’s your elevator pitch to students? Why rural? You’ve got 30 seconds

Speaker 6 (00:58:46):

Sounds like an assignment. That’s awesome. No, rural medicine is super rewarding. It’s high risk, high reward, and it’s a place where you can develop relationships that are very long lasting and very meaningful and hold you at a level of accountability that I think we all want to be held at, right? We didn’t get here by just being kind of okay and kind of good. We all got here because we’ve worked hard and we want to do good work and we want to be accountable for all that work. And in a rural setting, you have the opportunity to do that and have meaningful relationships professionally and personally. And rural medicine I think is awesome and you should all consider it.

Speaker 4 (00:59:30):

I mean, I personally think it doesn’t get any better than this. I mean, it really doesn’t doing exactly what I set out to do, which is being a part of my community. I go to my kids’ track meets and no less than three or four kids will come up and give me a hug or say Hi. Hi, Dr. Dewey. My kids do four H. We’re a part of the community. This is what my family loves. We’re a part of the community in which we practice. My patients are my friends, they’re my neighbors, they’re my community members. We’re all in it together and I’m their physician. And I really think that is something special. And I think it is an honor, it’s a privilege and I am thankful for it every day. So yeah, I strongly encourage it. I think you wouldn’t regret it.

Speaker 5 (01:00:20):

I guess my elevator pitch would be we all went into medicine really, or into public medicine, public health pharmacy because we wanted to serve our community in some way, in a way that not everybody could. And so by going into rural healthcare, you are a person in the community providing care for another person in your community. And so it really emphasizes, it’s not just a medical connection, but it is a community connection. It’s more than just a medical practice, it’s a community care. So

Speaker 7 (01:00:55):

I dunno how to follow that. I would echo everything everybody said, although I would say for me personally, my patients are not coming up to me and saying, it’s so good to see you. They’re like, oh God, there she is. But I would say for me, it’s just the tremendous amount of impact you can make. I think everyone in medicine, whatever field of medicine that is obviously is making an impact. But I do think that when you’re in a more rural area, you relied upon in a different way. And people appreciate us so much in residency, people said, thank you, appreciate your help. But I mean here it’s a different sense of the impact that you’re providing in the sense of hope that you’re instilling in people. And I think the community and the patients are aware that you’ve made an intentional decision to be there and serve them. And I think that level of appreciation and the ability of a change and impact you can have is really different in a rural area.

Speaker 2 (01:01:52):

Great. Okay. Well, on behalf of the College of Medicine, College of Pharmacy, College of Public Health, thank you all panelists for coming. We really, really, really appreciate you coming and sharing your perspectives or experiences. I learned a lot. I think we all did. And thank you all for coming and we hope to bring you back and have more events in, and we hope to see you all soon. Thank you all for your service and everything you do. Thank you. Thank you guys.

Speaker 1 (01:02:28):

That’s it for episode this week. Big thank you to all of the panelists and for the Student Association of Rural Health for sharing this panel discussion with us today. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcast and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cphgradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.