The Local Hospital Closed. These Doctors Didn't Give Up.

Larry Beresford

Disclosures

September 23, 2019

If They See It, They Will Come

If doctors haven't been exposed to a rural practice, they can't know if they'd love it or not, Becher argues. "I'm not jaded or miserable or burned out, at least not today." However, that is because she learned the hard way to set reasonable limits on the job and to prioritize her own well-being by ensuring that she found time to exercise, eat right, and take vacations. "I had to put the brakes on things to make my life more realistic," she says.

The community Becher serves requires that she pay attention to addressing the social determinants of health affecting her patients. "If you don't think you have to put a lot of effort into managing these critical factors, you're not paying attention," she says.

"I see things here that you learn in medical school and answer on boards but never expect to see in the real world, such as parasitology because of water contamination. I see the end-stage version of a lot of diseases because people came to my office instead of going to the hospital—things that might have been prevented if treated earlier." Some of the patients aren't willing to go to the city for the hospital's more technical care, she says. "They say, 'Do what you can, doctor. Then I'm going home.'"

Lofton says his rural medical practice feels like a calling. Last year he didn't take any vacation for 11 months and felt okay for the first 10 of them, he explains while on a call from the Colorado mountains, where he's vacationing with his family.

"I have an NP who can run the practice. This week my staff are calling and texting me first thing in the morning, and another doctor in town agreed to see my patients if needed in my absence."

AAFP President Cullen notes that "at AAFP we see family medicine as the answer to rural health issues. We just need the right people going to medical school." He is an advocate for family medicine and primary care, not just in Valdez but nationally, and sees the urgency to solve rural hospital closures.

In just a few years, advances in technology such as telemedicine mean that it will be possible to do much more care in the small rural hospital, decreasing their outcome differentials with bigger hospitals. "For example, we'll utilize teleradiology with more portable radiology machines and access to radiologists who can read the results in real time. But the trick is that you also need somebody with some surgical and other hands-on skills based in the community."

Once a hospital closes, Cullen says, it's hard to bring it back. "You lose the culture of physicians, the skilled pool of nursing staff and administration. There could be a renaissance of rural healthcare coming. But not if the hospitals are gone."

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