Primary care physicians equipped to practice in rural locations are in dire need across the country. According to the Centers for Disease Control, there’s a “striking gap” in health between rural and urban Americans. The causes are complex, but socioeconomic conditions and access to healthcare play a role. Rural Americans have higher rates of cigarette smoking, high blood pressure, and obesity, according to the CDC. They also have higher rates of poverty, and are less likely to have health insurance. All of this translates into patients who are more at risk for death from preventable causes as compared to their urban counterparts. In this series on the UVM Larner College of Medicine blog, we explore what students experience during rotations in more rural areas, and how it shapes their thinking about their own career paths and the practice of medicine overall.
In this second post in the series, Jennifer Boccia ’20 talks about her family medicine clerkship at Mad River Health Center in Waitsfield, Vt., a small village nestled in the heart of the Green Mountains.
What was a typical day like? What kinds of patient complaints/conditions/procedures did you generally see?
A typical day for me starts at 8 a.m. Depending on the number of patients scheduled and the type of visit, I may see patients first by myself and then come back in with a preceptor, or my preceptor and I might go in at the same time and work together. During my lunch break I typically work on other required assignments for the clerkship – online cases or my community health project. Patient conditions run the gamut from well-visit to acute issues that warrant us calling the ambulance to transport them to the emergency department. One of the most important things is to keep in mind screening and well-care even if someone is here for an acute visit; it may be the only contact they have with the health system for quite some time. It’s also been really interesting to see patients for an acute complaint and then see them again in a week or two for a follow-up and get to know how their condition has progressed and what further workup, if any, is indicated as time goes on.
Seems like you spend a lot of time with one or two preceptors – what was that like? What did you learn from them?
It’s wonderful to have the opportunity to work with different people and get the advantage of their differing backgrounds. It’s not just valuable in terms of physical exam skills; observing the different ways and the different styles of each physician as they talk to patients and get their stories is great. Everyone has a unique style, and the more exposure we get as students to different physicians the easier it is to develop and refine our own personal touch.
What surprised you about working in a rural location like Waitsfield? What were some things you learned or took away that you didn’t expect?
I don’t think I really appreciated what a key role in the community rural health offices play. I live locally and even in such a short time it’s changed how I look at the community around me. If I go to a community event now I look around and see people that I may have seen in the office. I am exquisitely aware of the privilege of holding their health information and being involved in providing their health care. The people I see in the office are neighbors; they work in or own the local businesses that I frequent; they are the relatives of people I know well. It’s a profound feeling to be trusted with the health and well-being of so many people in such a tight-knit community.
Do you have any interest in practicing in a rural location? How has this experience helped to shape your thinking about practicing in rural areas versus larger cities or suburban areas?
I’m fairly confident that I want to work in a rural area. While I appreciate the resources and organization of a larger academic medical center, I know that I want to live and work in rural Vermont. I enjoy the resourcefulness of having to make do with what you have available, and the intimacy of caring for a community that you love and of which you are a part.
