RE: serving rural communities

Thanks to all the authors.

I would make a few points as a solo independent doctor in a somewhat rural place, though there are far more rural places than western Maine. We must do much better in preparing physicians to practice in rural areas--not just developing clinical skills, though that takes precedence. Medical school put me through useless pediatric surgery and very poor quality obstetrics training. Out here we make decisions that urban and suburban docs never do.

Of course, one has to want to live in a rural area to practice here. That's the easiest part; the ballet may be far away, but most of us prefer the garden. However, if one is not from "here," one may fit in poorly. We must prepare to support physicians to live among folks who might, for example, have poor spelling skills, own a lot of guns, or resent outsiders. Making a home out here, you may be called by a patient at 3 am for antibiotics because they have the flu. If you do not or cannot do as they ask, they may bad mouth you all over town. For female physicians, being the most highly educated woman around may also affect relationships with patients. These are the REAL kinds of things we must deal with if we want to provide good rural health care.

Finally, one has to be prepared to cope, on one's own, with the politics of hospital systems that, even out here, may not let your patients see the only psychiatrist around or access telehealth systems. There are a lot of barriers, and we can do a lot better. Rural areas are often old, poor, and left behind, yet they are the best places to live!