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 final post in the series, Harshal Athalye ’20 talks about his pediatrics clerkship at North Country Hospital in Newport, a small city in the heart of Vermont’s Northeast Kingdom.
What was a typical day like?
On a typical day, I arrived for rounds at the nursery at 8 a.m. to assess newborns and talk to the parents about any complications of the birth, what to expect, when to discharge, and answer any questions. I performed a full newborn physical and assessment. From there we went to clinic around 9 a.m., which included a plethora of complaints from colds, to rashes, to unimmunized children with rashes, emergent acute visits, ER consultations, OBGYN birthing complications, and routine well-child checks. I was able to develop a wide range of skills, including performing well-child checks based on the age of the patient, and learning how to answer questions raised by anxious parents. With ER visits I was able to develop my acute history of present illness question/quick assessment and plans, and with OBGYN I was able to see the birth process, develop an APGAR scoring and see an intubation of a meconium baby.
Did you spend the bulk of your time with one preceptor – what was that like? What did you learn from him or her?
I spent 97 percent of my time with Dr. Bannach. It was an amazing experience to see her work. She has such a calm, optimistic, and healing personality. I learned a lot from her mentorship, but perhaps the one thing I admired the most about Dr. Bannach was the way she handled intricate cases – whether it be children who were unimmunized due to parental decisions, or acute ER visits – with such a calm and thorough manner. Many of the patients we saw had a troubled history, and Dr. Bannach knew the idiosyncrasies of each patient. She truly has a strong relationship with her patients, which goes to show you the power of primary care when coordinated correctly.
What surprised you about working in a rural location like Newport? What were some things you learned or took away that you didn’t expect?
Rural medicine is a beast in and of itself – the plan of attack when it comes to treatment is rarely straightforward. When I first entered rural medicine, I always envisioned it as an isolated sector that took care of small health concerns and transferred any complex cases directly to UVM Medical Center, so I was nervous that I was not going to be able to see intricate cases. I was obviously wrong. Some patients, for a multitude of reasons, seek help only when absolutely necessary, thus, often we found ourselves facing some serious medical conditions.
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?
At the start of the rotation, I thought I had ruled out working in a rural area due to its potential isolation. But one pearl that has stuck with me from Dr. Bannach is that specialists are just a phone call away. Technology continues to close the communication gap for rural medicine, making it feel much less secluded. Though I am unsure of what my future holds in terms of medicine, after working with Dr. Bannach, I am considering rural medicine as a career path.
