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Profile of a Rural FP: Alan Glaseroff, MD
Alan Glaseroff, MD, teaching at the Behavioral Diabetes Institute in San Diego, CA.
Name: Alan Glaseroff, MD (Arcata, CA)
Clinic: Ann Lindsay, MD and Alan Glaseroff, MD – A Family Practice
Years an FP: 28
Years a Rural FP: 26
HPSA-designated Community? Bordered by many HPSA sites in Humboldt County
Critical Access Designated Hospital? Yes, two in Humboldt County
Staff Note: Dr. Glaseroff has agreed to share his contact information with readers who may wish to reach him: Alan Glaseroff MD, 1318 H St, Arcata, CA 95521 (alang@hdnfmc.com)
What prompted you to become a rural family physician?
My decision to become a family physician happened as a result of a medical school talk at Case Western Reserve University given by a visiting professor, Donald Ransom, MD, (from the Santa Rosa, CA, Family Medicine program). Dr. Ransom told a story about an agitated elderly patient in an ICU who was about to be placed in restraints when his family doc called his wife to come in, climb in the ICU bed and hold him (in lieu of restraints). This approach viewed the patient not as a disease, but rather as a whole person living within an environment that included friends, family, work, recreation, faith, etc. This “biopsychosocial” view of health and illness, which stands in stark contrast to the strictly “medical/pathological” model that characterized medical thinking in the mid-seventies, has remained the cornerstone of my work since that day, and is what attracted me to medicine in the first place. I haven’t been disappointed.
My decision to become a family physician happened as a result of a medical school talk at Case Western Reserve University given by a visiting professor, Donald Ransom, MD, (from the Santa Rosa, CA, Family Medicine program). Dr. Ransom told a story about an agitated elderly patient in an ICU who was about to be placed in restraints when his family doc called his wife to come in, climb in the ICU bed and hold him (in lieu of restraints). This approach viewed the patient not as a disease, but rather as a whole person living within an environment that included friends, family, work, recreation, faith, etc. This “biopsychosocial” view of health and illness, which stands in stark contrast to the strictly “medical/pathological” model that characterized medical thinking in the mid-seventies, has remained the cornerstone of my work since that day, and is what attracted me to medicine in the first place. I haven’t been disappointed.
Alan Glaseroff, MD, with his partner and wife, Ann Lindsay, MD, in front of their Arcata office.
The “rural” decision was more a result of serendipity. My wife and practice partner is from a small town on the East Coast, as am I, although we’re not from the same town. We attended college, medical school (she heard the same Donald Ransom lecture), and residency together, and had established a small practice in San Francisco after finishing training at UCSF, expecting to stay. Our first child (now in medical school at UC Berkeley) was born in 1982, and the difficulties inherent in raising a child in a city that wasn’t “kid-friendly” quickly became apparent. We visited a friend from medical school who was living in Arcata, CA, a small college town in the Redwoods on the coast of northern CA in July 1983, and found ourselves accepting a job at the local community clinic (which we split) following 3 days of hiking and walking along rivers and beaches. The clincher was that the local movie house had a “crying room” so that parents could attend movies without disturbing the other viewers. This followed our being thrown out of the same movie in SF the week prior to our trip for carrying in our sleeping and silent year-old daughter in a shawl. Combine that with public schools that worked, a spectacularly beautiful environment, and affordable housing, and we were sold. We made the right choice, and are committed to staying here for the duration.
Community
Humboldt County is a spectacularly beautiful rural county on the coast in Northern California (275 miles north of San Francisco) that has 130,000 people and is roughly the size of Connecticut. We are known for redwoods trees, a rugged coastline with unspoiled beaches, rivers, and mountains, and our illicit agricultural economy (no jokes please). We are older and poorer than California as a whole. The local economy is depressed, as timber and fishing continue to decline. The population is relatively stable, though young people are often forced to move for work, and are replaced by retirees moving here to enjoy the environment and lifestyle. Education, health care, and government are the major employers. Tourism is also the source of many jobs. As the life of a family physician makes prolonged vacations problematic, we decided to move to an area where the “vacations” could happen in an afternoon or weekend. Humboldt County is perfect in this regard.
Arcata is a college town in Humboldt that has approximately 17,000 people. Humboldt State University brings a level of diversity and culture that greatly enriches the local environment. Arcata is known for its alternative character, is a “nuclear-free zone” and its overall participatory nature. The county itself has more artists per capital than anyplace in the US. There is a thriving local music scene. The public schools are adequate, and excellent charter schools serve those who seek a different school experience.
Humboldt County is a spectacularly beautiful rural county on the coast in Northern California (275 miles north of San Francisco) that has 130,000 people and is roughly the size of Connecticut. We are known for redwoods trees, a rugged coastline with unspoiled beaches, rivers, and mountains, and our illicit agricultural economy (no jokes please). We are older and poorer than California as a whole. The local economy is depressed, as timber and fishing continue to decline. The population is relatively stable, though young people are often forced to move for work, and are replaced by retirees moving here to enjoy the environment and lifestyle. Education, health care, and government are the major employers. Tourism is also the source of many jobs. As the life of a family physician makes prolonged vacations problematic, we decided to move to an area where the “vacations” could happen in an afternoon or weekend. Humboldt County is perfect in this regard.
Arcata is a college town in Humboldt that has approximately 17,000 people. Humboldt State University brings a level of diversity and culture that greatly enriches the local environment. Arcata is known for its alternative character, is a “nuclear-free zone” and its overall participatory nature. The county itself has more artists per capital than anyplace in the US. There is a thriving local music scene. The public schools are adequate, and excellent charter schools serve those who seek a different school experience.
Clinic
My practice life is split into two major areas: I serve as the Chief Medical Officer for the Humboldt Independent Practice Association, an organization that includes virtually the entire provider community in the county. I have worked in that role since the inception of the organization in 1994. I also work slightly less than half-time in my medical practice (started in 1985), which I share with my wife of 35 years, Ann Lindsay, who is also the County Public Health Officer. Our practice includes five generations of patients, and we follow families from birth (though we no longer perform obstetrics) until death.
In the past 2 years we have succumbed to using hospitalists (with mixed emotions) but did full hospital work before then. My individual practice focuses on patients with complex chronic diseases (especially those with diabetes), while my wife’s patients tend to be younger women and the healthier elderly. I developed Type 1 diabetes in 1983 shortly after moving to Arcata, and as Humboldt lacks a population sufficient to support an endocrinologist, I have found myself increasingly playing that role in the community. Learning to self-manage my diabetes has also led to a focus on patient self-management in all areas. Rural family physicians are frequently cast in the role of “quasi-specialist” as a result of the lack of certain specialties in their locales.
My practice life is split into two major areas: I serve as the Chief Medical Officer for the Humboldt Independent Practice Association, an organization that includes virtually the entire provider community in the county. I have worked in that role since the inception of the organization in 1994. I also work slightly less than half-time in my medical practice (started in 1985), which I share with my wife of 35 years, Ann Lindsay, who is also the County Public Health Officer. Our practice includes five generations of patients, and we follow families from birth (though we no longer perform obstetrics) until death.
In the past 2 years we have succumbed to using hospitalists (with mixed emotions) but did full hospital work before then. My individual practice focuses on patients with complex chronic diseases (especially those with diabetes), while my wife’s patients tend to be younger women and the healthier elderly. I developed Type 1 diabetes in 1983 shortly after moving to Arcata, and as Humboldt lacks a population sufficient to support an endocrinologist, I have found myself increasingly playing that role in the community. Learning to self-manage my diabetes has also led to a focus on patient self-management in all areas. Rural family physicians are frequently cast in the role of “quasi-specialist” as a result of the lack of certain specialties in their locales.
Dr. Glaseroff, with Traci Vote, MA (left) and Krista Johnson (receptionist) in front of the office
My biggest professional satisfaction has come from leading a community-wide effort to integrate care across the county. Starting with the Humboldt Diabetes Project in 2003, Humboldt County has earned a reputation for promoting systems of care for patients with chronic conditions. We have successfully run local collaboratives for diabetes (including a web-based registry that includes >95% of all patients in Humboldt County with diabetes), depression, hypertension, breast medicine, and end-of-life care that have garnered national attention. Currently I serve as Project Co-Director for the Robert Wood Johnson Foundation’s “Aligning Forces for Quality” project in Humboldt County, which was the only rural county of 14 regions selected from many applicants across the U.S. (other communities selected include whole states – Minnesota, Wisconsin, Maine; large metropolitan areas – Detroit, Seattle/Tacoma, Portland Oregon, Memphis, Cleveland, Cincinnati, Kansas City and large regions – western New York (Buffalo), central Pennsylvania (York), and western Michigan (Grand Rapids). AF4Q is an ambitious multi-year project designed to improve care delivery via a strategy that includes performance measurement, public reporting, consumer engagement (patient activation), quality improvement in both the hospital and ambulatory settings, with a focus on reducing health inequities.
IHI National Forum 2007: Faculty for a day-long workshop on the Chronic Care Model: Ed Wagner, MD, Brian Austin, Judith Schaefer, and Katie Coleman of the MacColl Institute, and Alan Glaseroff, MD
My interest and experience in quality improvement and systems has led to many opportunities to serve as faculty to similar efforts around California and the US. This has included teaching at state and national events hosted by the Institute for Health Care Improvement (IHI), both the California and American Academies of Family Physicians, the California Medicare QIO, and numerous collaboratives. I also chair the measures committee for the statewide Pay-for-Performance initiative, led by the Integrated Healthcare Association, as well as serve on their executive and steering committees.
These roles are not typical for a rural doc, but demonstrate that rural physicians can play an important role in the transformation of American healthcare.
These roles are not typical for a rural doc, but demonstrate that rural physicians can play an important role in the transformation of American healthcare.
Son, Bruce Glaseroff, with his girlfriend, Danielle Flores
Typical Day
I can’t remember when I had a "typical day." When I’m in Humboldt, I generally split the day between seeing patients in my office and working at the IPA. I generally get up around 6 a.m., exercise and eat breakfast. I then go to one of my two jobs, as I alternate mornings and afternoons at each job. Most lunchtimes are spent meeting with colleagues, meeting with my care support and medical management teams at the IPA, or catching up with charting and e-mail. As our chronic care work has led us to collaborate with other non-provider stakeholders, I generally have other meetings during my non-clinical time.
I can’t remember when I had a "typical day." When I’m in Humboldt, I generally split the day between seeing patients in my office and working at the IPA. I generally get up around 6 a.m., exercise and eat breakfast. I then go to one of my two jobs, as I alternate mornings and afternoons at each job. Most lunchtimes are spent meeting with colleagues, meeting with my care support and medical management teams at the IPA, or catching up with charting and e-mail. As our chronic care work has led us to collaborate with other non-provider stakeholders, I generally have other meetings during my non-clinical time.
Alan playing slide on Stratocaster at the Jambalaya Club in Arcata with Frank Anderson and friends
I am usually home by 6:30 p.m., and alternate cooking with my wife and practice partner. Our kids are grown, and living in the San Francisco Bay Area. When they were young, my wife and I split the practice and didn’t have other jobs so that one of us could be home to greet the schoolbus when they were dropped off. I frequently have work to do at night (I save the creative work – writing articles or developing talks and curriculum for home, as there are too many distractions during the day). My wife and I take almost all of our own call (except when on vacation), as we no longer do the inpatient work. Allowing our patients to call or e-mail directly to us has greatly aided “the continuous healing relationships” that are the core of family medicine.
The BackSeat Drivers, with Alan on guitar, wife Ann Lindsay, MD, on base, Frank Anderson, RN, on harmonica, and Vice Dean Craig Klein on piano.
We are not “workaholics,” despite appearances. We are both in an acoustic blues band (Backseat Drivers). We hike, bike, cross-country ski, and golf together. We have great friends with whom we share meals and good times. As we live in a fabulous environment, we have nature close at hand..
Daughter, Rebecca Lindsay, (2nd year medical school at Berkeley/UCSF Joint Medical Program) with fiance, Ian Hoffman, MD, (finishing FM Residency at UCSF Santa Rosa)
Having a true life and work partner is the single most rewarding part of my life. My daughter is now in her second year of medical school, and is engaged to a third-year resident in family medicine (my daughter plans to become a family physician as well). I think observing our family successfully integrate life and work has been the inspiration for our daughter’s life plan. We have hopes that she and her husband will choose to live in Humboldt as well (maybe even take over our practice).
Challenges
Specialty back-up is somewhat unreliable, especially in the era of “voluntary hospital call” for critical specialties. This has led to patient transfers to tertiary centers hundreds of miles away for fairly routine cases. Also, university centers tend to view rural physicians as an “inferior species” and frequently require patients to return for routine follow-up rather than simply communicate with us ( thus demonstrating little understanding of the difficulties patients face when traveling to see them).
Specialty back-up is somewhat unreliable, especially in the era of “voluntary hospital call” for critical specialties. This has led to patient transfers to tertiary centers hundreds of miles away for fairly routine cases. Also, university centers tend to view rural physicians as an “inferior species” and frequently require patients to return for routine follow-up rather than simply communicate with us ( thus demonstrating little understanding of the difficulties patients face when traveling to see them).
Rewards
Relationships over time are the greatest benefit of rural family practice. While anonymity is sacrificed, it is over-rated as compared to the joy of being well-known and respected.
Relationships over time are the greatest benefit of rural family practice. While anonymity is sacrificed, it is over-rated as compared to the joy of being well-known and respected.
Advice
It would depend on the rural community. Frontier medicine often requires a strong background in procedures (including c-sections, appendectomies, and tonsillectomies). My rural practice is not that different from an urban practice, as it focuses mainly on chronic illness and complex care.
It would depend on the rural community. Frontier medicine often requires a strong background in procedures (including c-sections, appendectomies, and tonsillectomies). My rural practice is not that different from an urban practice, as it focuses mainly on chronic illness and complex care.
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