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Profile of a Rural FP: Jen Brull, MD
Dr. Jen Brull, along with her husband and three children at the Kansas Academy of Family Physicians (KAFP) 2010 President's Dinner.
Name: Jen Brull, MD (Plainville, KS)
Clinic: Prairie Star Family Practice, PA
Years an FP: Nine
Years a Rural FP: Nine
HPSA-designated Community? Yes
Critical Access Designated Hospital? Yes
Staff Note: Dr. Brull has agreed to share her contact information with readers who may wish to reach her: mrsbrull@gmail.com.
What prompted you to become a rural family physician?
I grew up in a town of about 250 in northwestern Kansas and had a family physician as my doctor from birth. Dr. Dick Ohmart was also a family friend, so I was influenced by him in many ways throughout my early years. I came back "home" as a medical student and resident to precept with Dr. Dick, which only strengthened my decision to practice family medicine. In residency, I was mentored by Dr. Mike Engelken, a faculty member who had roots in rural family medicine. His experiences of being a family doctor in a smaller community fascinated me.
Plainville Turkey Trot -- Dr. Brull and family preparing to participate in the annual fund raiser for the hospital.
Community
I practice in Plainville, KS, a town of about 2,200 people. With my colleagues, I serve a county population (Rooks) of about 5,000. The county seat is located 12 miles north of Plainville in Stockton and does not have a full-time physician currently. There is a critical access hospital, Rooks County Health Center (RCHC) in Plainville. The hospital and clinic in Plainville were relocated to a new facility in 2008 after the original facility, built in the 1950's, was determined not to meet fire codes.
I practice in Plainville, KS, a town of about 2,200 people. With my colleagues, I serve a county population (Rooks) of about 5,000. The county seat is located 12 miles north of Plainville in Stockton and does not have a full-time physician currently. There is a critical access hospital, Rooks County Health Center (RCHC) in Plainville. The hospital and clinic in Plainville were relocated to a new facility in 2008 after the original facility, built in the 1950's, was determined not to meet fire codes.
Practice/Clinic
I am a solo practice family medicine physician and founded Prairie Star Family Practice, PA in April 2002 before I opened my practice in Plainville in July of 2002. There are two other full-time family physicians in Rooks County, and we collaborate extensively. I provide full spectrum family medicine, including obstetrics, emergency room coverage, inpatient care, and nursing home rounds. I offer extensive women's health services, including colposcopy. I see patients regardless of age, race or ability to pay.
I am a solo practice family medicine physician and founded Prairie Star Family Practice, PA in April 2002 before I opened my practice in Plainville in July of 2002. There are two other full-time family physicians in Rooks County, and we collaborate extensively. I provide full spectrum family medicine, including obstetrics, emergency room coverage, inpatient care, and nursing home rounds. I offer extensive women's health services, including colposcopy. I see patients regardless of age, race or ability to pay.
Dr. Brull with a newly delivered patient.
Typical Day
I would say there are two types of "typical day" for me. The first is a typical day when I am seeing patients in my clinic. I tend to arrive at the office/hospital (they are adjacent) about 7:30 or 8:00 am to round on hospital patients. Office hours start at 9:00 am and the morning tends to finish about 12:30 pm. Usually a meeting occupies the lunch hour – either a clinic staff meeting, a hospital medical staff, a "lunch and learn" for our community or a conference call for an outside activity. The afternoon hours for clinic start about 2:00 pm and finish up around 5:00 pm. I usually see 25 to 30 patients per day, but on busy days, we can see upwards of 40. My clinic utilizes an EHR, which has greatly reduced the amount of time I spend "cleaning up" at the end of the day, so usually I am on my way home by 5:30 pm if I am not on call. On call days, I cover the emergency room which may involve trips over to the hospital side during the day as people come to the ER, and usually involves staying late to cover the busier ER hours in the evening. The second "typical" day for me involves travel. I am involved in several statewide and national organizations which require travel for meetings. On these days, I tend to leave quite early (5:00 or 6:00 am is not uncommon!) to drive across the state. Since I have a family, I prefer to make the trip in one day if feasible, so a late arrival home isn't uncommon either. Although the days are long, I feel like participating is important because it gives rural family physicians a voice in what is happening across the state.
I would say there are two types of "typical day" for me. The first is a typical day when I am seeing patients in my clinic. I tend to arrive at the office/hospital (they are adjacent) about 7:30 or 8:00 am to round on hospital patients. Office hours start at 9:00 am and the morning tends to finish about 12:30 pm. Usually a meeting occupies the lunch hour – either a clinic staff meeting, a hospital medical staff, a "lunch and learn" for our community or a conference call for an outside activity. The afternoon hours for clinic start about 2:00 pm and finish up around 5:00 pm. I usually see 25 to 30 patients per day, but on busy days, we can see upwards of 40. My clinic utilizes an EHR, which has greatly reduced the amount of time I spend "cleaning up" at the end of the day, so usually I am on my way home by 5:30 pm if I am not on call. On call days, I cover the emergency room which may involve trips over to the hospital side during the day as people come to the ER, and usually involves staying late to cover the busier ER hours in the evening. The second "typical" day for me involves travel. I am involved in several statewide and national organizations which require travel for meetings. On these days, I tend to leave quite early (5:00 or 6:00 am is not uncommon!) to drive across the state. Since I have a family, I prefer to make the trip in one day if feasible, so a late arrival home isn't uncommon either. Although the days are long, I feel like participating is important because it gives rural family physicians a voice in what is happening across the state.
Christmas, with the joint office staff from all three practices.
Challenges
I am fortunate that I have wonderful colleagues in Plainville. We work hard to cover each other so that no one gets "burned out" or overstressed. Even with that, there are times when I forgo a trip or miss a child's event because of work. The distance to a bigger city is sometimes a challenge – both medically when patients are critically ill, and socially when I would like to have a great meal. I think any challenges/disadvantages of rural practice are easily overwhelmed by the benefits of living in such a great place where my patients are also my friends and neighbors.
I am fortunate that I have wonderful colleagues in Plainville. We work hard to cover each other so that no one gets "burned out" or overstressed. Even with that, there are times when I forgo a trip or miss a child's event because of work. The distance to a bigger city is sometimes a challenge – both medically when patients are critically ill, and socially when I would like to have a great meal. I think any challenges/disadvantages of rural practice are easily overwhelmed by the benefits of living in such a great place where my patients are also my friends and neighbors.
Dr. Brull, along with medical students she has mentored at the KAFP President's Dinner.
Rewards
Easily, my greatest reward is providing medical care to people I care about personally. I am an invested member of my community and feel connected to others in a way that goes deeper than the doctor-patient relationship. When a patient congratulates me on the grand champion ribbon my son received on wood-working at the county fair, or ribs me for getting a speeding ticket, I know they care about me, too.
A second benefit is the ability to be independent of others. I am my own boss (which can be good and bad!). One of the things that I have made a priority is to teach medical students. I have a student about half the year out in Plainville and have formed some very close, lasting friendships and mentoring relationships with the students I have precepted. Teaching benefits go both ways – I get to show students how interesting and exciting rural family medicine can be, and they get to show me new/cool things they have learned in the university setting. Serving as a preceptor is energizing for me and teaching in a rural setting, remote from the university, means that students get a lot more hands-on learning, which tends to make for a unique and exciting experience for them. One of the students I precepted is joining us in practice in Rooks County next summer – truly the ultimate benefit to come out of mentoring!
Easily, my greatest reward is providing medical care to people I care about personally. I am an invested member of my community and feel connected to others in a way that goes deeper than the doctor-patient relationship. When a patient congratulates me on the grand champion ribbon my son received on wood-working at the county fair, or ribs me for getting a speeding ticket, I know they care about me, too.
A second benefit is the ability to be independent of others. I am my own boss (which can be good and bad!). One of the things that I have made a priority is to teach medical students. I have a student about half the year out in Plainville and have formed some very close, lasting friendships and mentoring relationships with the students I have precepted. Teaching benefits go both ways – I get to show students how interesting and exciting rural family medicine can be, and they get to show me new/cool things they have learned in the university setting. Serving as a preceptor is energizing for me and teaching in a rural setting, remote from the university, means that students get a lot more hands-on learning, which tends to make for a unique and exciting experience for them. One of the students I precepted is joining us in practice in Rooks County next summer – truly the ultimate benefit to come out of mentoring!
Have you been actively involved in developing a patient-centered medical home (PCMH) in your practice?
I have been looking at the PCMH model for several years and have taken the MHIQ test. I have worked on various components as time permits (developed a web site for our practice, implemented patient portal in our EHR, currently conducting a patient satisfaction survey) but have not had time to put the whole thing together or apply for NCQA certification. The barrier that stands in my way is not having enough time or resources to put all the pieces together. All of the components I have implemented have been well-received by patients, so I am planning to continue to work on further projects.
I have been looking at the PCMH model for several years and have taken the MHIQ test. I have worked on various components as time permits (developed a web site for our practice, implemented patient portal in our EHR, currently conducting a patient satisfaction survey) but have not had time to put the whole thing together or apply for NCQA certification. The barrier that stands in my way is not having enough time or resources to put all the pieces together. All of the components I have implemented have been well-received by patients, so I am planning to continue to work on further projects.
Dr. Brull along with her mentor, Mike Engelken, MD, two of her nurses, and the rest of the Fun Run group at the KAFP annual meeting.
What advice would you offer to someone interested in pursuing a career in rural family medicine?
First and most important: look for a rural site that will also provide you with a mentor! When I came to Plainville, Dr. Dan Sanchez had been there for seven years. He spent an uncountable amount of time helping me clinically (looking at x-rays, talking through difficult patient encounters, backing me up on traumas) and professionally (developing practice management spreadsheets, interpreting collections data, understanding cash flow in the practice). Without his help, I would have felt lost at sea! If there is not a willing mentor in the rural town, make sure you have someone close enough to communicate frequently.
First and most important: look for a rural site that will also provide you with a mentor! When I came to Plainville, Dr. Dan Sanchez had been there for seven years. He spent an uncountable amount of time helping me clinically (looking at x-rays, talking through difficult patient encounters, backing me up on traumas) and professionally (developing practice management spreadsheets, interpreting collections data, understanding cash flow in the practice). Without his help, I would have felt lost at sea! If there is not a willing mentor in the rural town, make sure you have someone close enough to communicate frequently.
Profile of a Rural FP