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Profile of a Rural FP: James Damos, MD
Dr. James Damos and family on vacation in Colorado.
Name: James Damos, MD (Baraboo, WI)
Clinic: University of Wisconsin-Baraboo Family Medicine Rural Training Track and Baraboo Medical Associates affiliated with St.Marys/Dean Venture.
Years an FP: 32
Years a Rural FP: 20
HPSA-designated Community? No, but debatable, because of tourism influx from Wisconsin Dells.
Staff Note: Dr. Damos has indicated he would be willing to speak with any student or resident interested in rural medicine. Please watch for further discussions from Dr. Damos on the new Rural FP blog, coming soon in this Rural FP Community.
What prompted you to become a rural family physician?
I grew up in an urban inner city environment (Waukegan, Illinois near Chicago) but was introduced to rural living through my family who later moved to rural northern Wisconsin when I was in medical school. In addition, my wife's family lived on a farm in Illinois. The style of living that I observed rural people engaging in, which was based more on personal relationships, appealed to me. I once heard one of our faculty members who practices urban say that they don't know how a doctor can be a friend and a patient's doctor at the same time. It is almost a conflict of interest. I understand what they are getting at but that would make rural physicians pretty lonely people. I now practice in a town where people are neighbors and friends, as well as patients. It has worked well for me for the past 32 years. I don't wish to jinx myself but I have never had a suit brought against me so far. Lucky, I guess.
I practiced rural family medicine in a town of 4,500 for 10 years (1977-87) after graduating from my family medicine residency. My daughter, unfortunately, developed a Wilm's tumor of the kidney, which put my life and practice on hold. Because of our tertiary care needs and my need for change at that point, we moved to the urban/teaching university setting at the University of Wisconsin-Madison, where I practiced and taught for 12 years (1987-1999). There, I earned full professor of family medicine, was privileged enough to receive a few awards, and served a few years as program director of the UW-Madison program. Now I am back in rural practice as Program Director of the University of Wisconsin-Baraboo Rural Training Program.
My life is not as much in the limelight as it was when I was at the University of Wisconsin-Madison but it is just as rewarding. I have been in Baraboo now for 10 years. I prefer the rural setting. The family unit, in my view, should be central to the approach of family physicians. The family unit is the essence of family medicine. It is what separates family medicine from every other physician specialty. Our specialty is named "Family Medicine." This is a personal preference, but I feel more like a true family physician who is valued for the style of care I provide in the rural setting compared to the urban setting. Why? Well, let's take a look at some history in medicine.
Until the 1950's, most U.S. physicians were generalist physicians with one year of postgraduate training (rotating internship). After internship, most physicians entered general practice. The model of the country doctor who made house calls was very much accepted by society. Lawsuits were less prominent. Costs of care were lower. Medical care was personal.
In the 1950's and 1960's, the National Institutes of Health (NIH) began to offer research fellowships in order to attract young physicians into academic research. By 1970, medical training began to change. Research fellowships became clinical fellowships, and further evolved into sub-specialty residency positions that were supported by Medicare or hospital funds. Between 1980 and 1990, major physician training increases occurred in emergency medicine (150%), radiology (118%), radiation oncology (78%), gastroenterology (85%), anesthesiology (63%), cardiology (61%) and pulmonary (64%), while family or general practice increased only 17%.
This change in the generalist-specialist ratio has had an impact on medical practice. With the current emphasis on science and technology in medicine, the care of patients has become more depersonalized. I have found this approach more prominent in the urban setting. The media focuses on the sensationalism of transplants and other tertiary scientific miracles. The focus on the family unit by the primary care physician has declined. In my view, part of society’s reaction to this depersonalization of medical care has been the current interest in alternative medicine, increasing negative medical press reports in the media, increased medical litigation when perfect outcomes are not achieved, increased medical errors, and a generalized distrust with the health care system. In addition, costs have gone up, which has lead to mergers and acquisitions of health care organizations and the corporatization of health care. Profit, cost containment, and efficiency appear to be priority themes in health care these days rather than patient satisfaction and healthcare outcomes. This focus on science, cost and profit can clash with the values proclaimed by family physicians as being most important--- continuity of family care, doctor patient relationships, and the bio-psycho-social-spiritual model. The family medicine approach has evolved into being an approach that is poorly compensated compared to our specialty colleagues and undervalued by insurance companies and the government. It is not financial compensation, however, that drives me in family medicine. I tell medical students who are balking at going into primary care because of financial compensation, "How many family physicians do you see without jobs that are poor?"
I grew up in an urban inner city environment (Waukegan, Illinois near Chicago) but was introduced to rural living through my family who later moved to rural northern Wisconsin when I was in medical school. In addition, my wife's family lived on a farm in Illinois. The style of living that I observed rural people engaging in, which was based more on personal relationships, appealed to me. I once heard one of our faculty members who practices urban say that they don't know how a doctor can be a friend and a patient's doctor at the same time. It is almost a conflict of interest. I understand what they are getting at but that would make rural physicians pretty lonely people. I now practice in a town where people are neighbors and friends, as well as patients. It has worked well for me for the past 32 years. I don't wish to jinx myself but I have never had a suit brought against me so far. Lucky, I guess.
I practiced rural family medicine in a town of 4,500 for 10 years (1977-87) after graduating from my family medicine residency. My daughter, unfortunately, developed a Wilm's tumor of the kidney, which put my life and practice on hold. Because of our tertiary care needs and my need for change at that point, we moved to the urban/teaching university setting at the University of Wisconsin-Madison, where I practiced and taught for 12 years (1987-1999). There, I earned full professor of family medicine, was privileged enough to receive a few awards, and served a few years as program director of the UW-Madison program. Now I am back in rural practice as Program Director of the University of Wisconsin-Baraboo Rural Training Program.
My life is not as much in the limelight as it was when I was at the University of Wisconsin-Madison but it is just as rewarding. I have been in Baraboo now for 10 years. I prefer the rural setting. The family unit, in my view, should be central to the approach of family physicians. The family unit is the essence of family medicine. It is what separates family medicine from every other physician specialty. Our specialty is named "Family Medicine." This is a personal preference, but I feel more like a true family physician who is valued for the style of care I provide in the rural setting compared to the urban setting. Why? Well, let's take a look at some history in medicine.
Until the 1950's, most U.S. physicians were generalist physicians with one year of postgraduate training (rotating internship). After internship, most physicians entered general practice. The model of the country doctor who made house calls was very much accepted by society. Lawsuits were less prominent. Costs of care were lower. Medical care was personal.
In the 1950's and 1960's, the National Institutes of Health (NIH) began to offer research fellowships in order to attract young physicians into academic research. By 1970, medical training began to change. Research fellowships became clinical fellowships, and further evolved into sub-specialty residency positions that were supported by Medicare or hospital funds. Between 1980 and 1990, major physician training increases occurred in emergency medicine (150%), radiology (118%), radiation oncology (78%), gastroenterology (85%), anesthesiology (63%), cardiology (61%) and pulmonary (64%), while family or general practice increased only 17%.
This change in the generalist-specialist ratio has had an impact on medical practice. With the current emphasis on science and technology in medicine, the care of patients has become more depersonalized. I have found this approach more prominent in the urban setting. The media focuses on the sensationalism of transplants and other tertiary scientific miracles. The focus on the family unit by the primary care physician has declined. In my view, part of society’s reaction to this depersonalization of medical care has been the current interest in alternative medicine, increasing negative medical press reports in the media, increased medical litigation when perfect outcomes are not achieved, increased medical errors, and a generalized distrust with the health care system. In addition, costs have gone up, which has lead to mergers and acquisitions of health care organizations and the corporatization of health care. Profit, cost containment, and efficiency appear to be priority themes in health care these days rather than patient satisfaction and healthcare outcomes. This focus on science, cost and profit can clash with the values proclaimed by family physicians as being most important--- continuity of family care, doctor patient relationships, and the bio-psycho-social-spiritual model. The family medicine approach has evolved into being an approach that is poorly compensated compared to our specialty colleagues and undervalued by insurance companies and the government. It is not financial compensation, however, that drives me in family medicine. I tell medical students who are balking at going into primary care because of financial compensation, "How many family physicians do you see without jobs that are poor?"
I make a comfortable living. I have been able to enjoy life with my family because of my career in family medicine. In rural practice, however, I have found that I can practice and teach family medicine with a focus on family units better. I can do hospital care, maternity care, and follow my patient through the system from community to hospital to ICU to nursing home and back to community being with them all the way more effectively in the rural setting. Patients like to have their doctor at their side. I know my University colleagues doubt me but I feel outcomes are better when there is maximal continuity and one doctor follows the patient all the way through. This is more possible in a rural setting where there are fewer specialty turf battles. In addition, I am better able to practice maternity care in the rural setting without turf battles and privilege fights. I saw how many obstetricians in the urban setting sometimes served as barriers to family physicians learning the technical skills to provide good obstetrical care to lower risk deliveries. Rural people have babies, too, and I would think it would be ethically immoral for a teacher to withhold training to someone who aspires to serve the rural underserved.
Because of the undervaluing of family medicine and primary care in general, society is getting what it has ordered--a complex, broken healthcare system. There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs. I encourage anyone to look up studies by Barbara Starfield, MD, from John Hopkins Medical School who has studied different healthcare systems around the world for years. Not that tertiary care is not important. My daughter's Wilm's tumor care is evidence of the value of scientific advances. I just feel like primary care also has something to offer and is undervalued. Between 1999 and 2003, compensation for primary care physicians went up 9% with their productivity rising 25% indicating that primary care is working harder for the same inflation-adjusted income. Specialist compensation during those same years rose 21%. With fewer students choosing primary care because of these differences in value, which also translates to respect amongst colleagues, we are now re-inventing primary care by organizing teams, doing group visits etc. mostly because there are not enough of us to deliver needed care.
Because of the undervaluing of family medicine and primary care in general, society is getting what it has ordered--a complex, broken healthcare system. There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs. I encourage anyone to look up studies by Barbara Starfield, MD, from John Hopkins Medical School who has studied different healthcare systems around the world for years. Not that tertiary care is not important. My daughter's Wilm's tumor care is evidence of the value of scientific advances. I just feel like primary care also has something to offer and is undervalued. Between 1999 and 2003, compensation for primary care physicians went up 9% with their productivity rising 25% indicating that primary care is working harder for the same inflation-adjusted income. Specialist compensation during those same years rose 21%. With fewer students choosing primary care because of these differences in value, which also translates to respect amongst colleagues, we are now re-inventing primary care by organizing teams, doing group visits etc. mostly because there are not enough of us to deliver needed care.
An example of the difference between urban and rural practice exists in the family conferences I have seen conducted in both settings when a family member is gravely ill. In the urban setting, I frequently saw a subspecialist or two go out to talk with a family outside the Intensive Care Unit (ICU). They would explain to the family members gathered what is happening to their relative. The family then asked what I call the "suspicious questions" like; "Can you explain that to me again?" "Shouldn't we get more opinions?" "What type of doctor are you again?" "I need to call one of our other relatives to get their opinion too."
Or sometimes the family would become angry at the medical staff and ventilate their distrust with the healthcare system at the family conference. I am not saying those things never happen in rural practice. But more often than not, sitting in front of me at a family conference outside the ICU is the patient's daughter whose children I delivered, the son who I see for hypertension, and the three grandchildren who I have immunized, seen for their sprained ankles, and done sports physicals on (maybe having seen them play football from the sidelines as team physician). I have an established track record with the family. They trust me. More often than not, the comment I will get from the family is "Do what you need to do doc, we trust you. You have been good to us." I find this attitude more prominent in the rural environment. Relationships and trust are important in my view in caring for patients.
Or sometimes the family would become angry at the medical staff and ventilate their distrust with the healthcare system at the family conference. I am not saying those things never happen in rural practice. But more often than not, sitting in front of me at a family conference outside the ICU is the patient's daughter whose children I delivered, the son who I see for hypertension, and the three grandchildren who I have immunized, seen for their sprained ankles, and done sports physicals on (maybe having seen them play football from the sidelines as team physician). I have an established track record with the family. They trust me. More often than not, the comment I will get from the family is "Do what you need to do doc, we trust you. You have been good to us." I find this attitude more prominent in the rural environment. Relationships and trust are important in my view in caring for patients.
Community
Baraboo
From our Web page, there is a good description of Baraboo.
Home to 12,000 people, Baraboo is located 45 minutes northwest of Madison in south-central Wisconsin. Baraboo is two hours from Milwaukee and three hours from Chicago and Minneapolis/St. Paul.
The town's many turn-of-the-century homes built on hillsides are reminiscent of New England. St. Clare Hospital is situated atop a hill offering a splendid view of the rolling bluffs surrounding Devil's Lake.
Baraboo's downtown centers on an old-fashioned square, which includes:
Baraboo
From our Web page, there is a good description of Baraboo.
Home to 12,000 people, Baraboo is located 45 minutes northwest of Madison in south-central Wisconsin. Baraboo is two hours from Milwaukee and three hours from Chicago and Minneapolis/St. Paul.
The town's many turn-of-the-century homes built on hillsides are reminiscent of New England. St. Clare Hospital is situated atop a hill offering a splendid view of the rolling bluffs surrounding Devil's Lake.
Baraboo's downtown centers on an old-fashioned square, which includes:
- The historic Al Ringling Theater, where the Baraboo Theater Guild performs;
- Many excellent places to dine and shop;
- A seasonal farmers' market; and
- Summer concerts on the Square
The surrounding area offers numerous points of interest, including:
- Devil's Lake State Park, which features cross-country skiing, swimming, canoeing, rock climbing, biking, and hiking;
- Devil's Head and Cascade Mountain downhill ski areas;
- Circus World Museum;
- International Crane Foundation; and
- Wisconsin Dells and Lake Wisconsin vacation areas
Patient Population
Patients are primarily from small communities and surrounding area farms. The medical community also serves a Native American population and a growing Hispanic community. During the summer, the Emergency Department serves an influx of tourists from the Lake Delton/Wisconsin Dells area.
Patients are primarily from small communities and surrounding area farms. The medical community also serves a Native American population and a growing Hispanic community. During the summer, the Emergency Department serves an influx of tourists from the Lake Delton/Wisconsin Dells area.
Clinic
Medical Associates Clinic, Baraboo
Medical Associates Clinic is the ambulatory training site of the family medicine Rural Training residency. Staff includes:
Medical Associates Clinic, Baraboo
Medical Associates Clinic is the ambulatory training site of the family medicine Rural Training residency. Staff includes:
- 11 family physicians;
- 3 surgeons;
- 2 pediatricians;
- 2 podiatrists;
- 1 critical care internist;
- 1 orthopedic surgeon;
- 2 physician assistants; and
- 3 nurse practitioners
Medical Associates Clinic is adjacent to the hospital. Family Medicine resident physicians are treated as colleagues in our group practice: they have their own practice, deliver their own continuity obstetrics patients, and take call (with faculty backup) similar to all the other staff physicians.
Critical Care
St. Clare hospital has a four-bed critical care unit (CCU). Family physicians have privileges to care for patients in this unit. Residents learn which patients can be cared for at St. Clare's CCU and which need transfer to a higher center. In addition, residents learn methods of transfer and why (helicopter vs. ambulance) and have the opportunity to accompany the patient on ambulance transfers as the physician in charge.
Obstetrics
Approximately 325 obstetric deliveries occur at St. Clare each year. Residents co-follow obstetric patients with family physician faculty.
Most of the obstetric teaching in Baraboo is by family physicians. A consulting obstetrician comes to Baraboo twice weekly to offer consults.
The annual Advanced Life Support in Obstetrics (ALSO) course is hosted in Baraboo every June for University of Wisconsin family medicine residents. Many of the Baraboo faculty and upper-level residents teach in the course and have served as editors and authors in the course's syllabus.
Additional St.Clare/Baraboo hospital services:
Critical Care
St. Clare hospital has a four-bed critical care unit (CCU). Family physicians have privileges to care for patients in this unit. Residents learn which patients can be cared for at St. Clare's CCU and which need transfer to a higher center. In addition, residents learn methods of transfer and why (helicopter vs. ambulance) and have the opportunity to accompany the patient on ambulance transfers as the physician in charge.
Obstetrics
Approximately 325 obstetric deliveries occur at St. Clare each year. Residents co-follow obstetric patients with family physician faculty.
Most of the obstetric teaching in Baraboo is by family physicians. A consulting obstetrician comes to Baraboo twice weekly to offer consults.
The annual Advanced Life Support in Obstetrics (ALSO) course is hosted in Baraboo every June for University of Wisconsin family medicine residents. Many of the Baraboo faculty and upper-level residents teach in the course and have served as editors and authors in the course's syllabus.
Additional St.Clare/Baraboo hospital services:
- A sleep disorders lab;
- A hemodialysis unit;
- A home health agency
- A recently updated Emergency Department (19,000 patients annually), with adjacent medical imaging and medical intensive care units;
- A new surgery unit and expanded day surgery unit;
- A new radiation oncology unit, opened in 2005;
- A new obstetrics unit, opened in the Fall of 2006; and
- A new 4-bed hospice house recently constructed on the medical campus.
Typical Day
I usually rise around 6-6:30 AM, check the computer to see if I have anyone in the hospital, eat breakfast, and head to the hospital. I will average 2 patients hospitalized most days sometimes having none and sometimes having 4 or 5 to see. By 9 AM, I am in the office. Because I am the program director of our rural training track in Baraboo, I spend 2-3 half days/ week doing administration for the program (and yes, some evenings documenting for the ACGME). The other 6 half days/week, I see my own patients or precept/staff family medicine residents in clinic. We have 6 residents in Baraboo; two in each year. We are a 1-2 program which means the residents spend their first year in Madison at the University of Wisconsin Department of Family Medicine and the last 2 years in Baraboo in an apprenticeship (with scheduled time away for rotations). I normally get home at night around 6-6:30 PM, just in time to make it to Madison in the winter for the University of Wisconsin basketball games which we have season tickets for. I am on call 2-3 times/month but we also take our own OB call every night unless you sign out to someone else. I still do OB as this is an interest of mine. I share most of my OB patients with residents. I had the opportunity, when I was at the University of Wisconsin-Madison, to become the co-concept originator and first editor of the Advanced Life Support in Obstetrics (ALSO) provider and instructor courses along with my colleague, John Beasley, MD and a national group of family physicians and obstetricians. When I originally organized the course, many of the chapters and cases in that course I modeled after experiences I had had in rural practice. I still teach ALSO every June in Baraboo for the Family Medicine residents around the state of Wisconsin. For me, it is a joy to see obstetricians, nurse midwives, OB nurses, family physicians and others co-teaching and learning from each other in the course. I feel this course has improved maternity care around the world. Many people have shared in the success of this course including the AAFP and Diana Winslow, RN, who has helped to advance the course around the world.
I usually rise around 6-6:30 AM, check the computer to see if I have anyone in the hospital, eat breakfast, and head to the hospital. I will average 2 patients hospitalized most days sometimes having none and sometimes having 4 or 5 to see. By 9 AM, I am in the office. Because I am the program director of our rural training track in Baraboo, I spend 2-3 half days/ week doing administration for the program (and yes, some evenings documenting for the ACGME). The other 6 half days/week, I see my own patients or precept/staff family medicine residents in clinic. We have 6 residents in Baraboo; two in each year. We are a 1-2 program which means the residents spend their first year in Madison at the University of Wisconsin Department of Family Medicine and the last 2 years in Baraboo in an apprenticeship (with scheduled time away for rotations). I normally get home at night around 6-6:30 PM, just in time to make it to Madison in the winter for the University of Wisconsin basketball games which we have season tickets for. I am on call 2-3 times/month but we also take our own OB call every night unless you sign out to someone else. I still do OB as this is an interest of mine. I share most of my OB patients with residents. I had the opportunity, when I was at the University of Wisconsin-Madison, to become the co-concept originator and first editor of the Advanced Life Support in Obstetrics (ALSO) provider and instructor courses along with my colleague, John Beasley, MD and a national group of family physicians and obstetricians. When I originally organized the course, many of the chapters and cases in that course I modeled after experiences I had had in rural practice. I still teach ALSO every June in Baraboo for the Family Medicine residents around the state of Wisconsin. For me, it is a joy to see obstetricians, nurse midwives, OB nurses, family physicians and others co-teaching and learning from each other in the course. I feel this course has improved maternity care around the world. Many people have shared in the success of this course including the AAFP and Diana Winslow, RN, who has helped to advance the course around the world.
Challenges
My challenges as a rural family physician and a rural training track program director are twofold; Clinical and Academic.
Clinical
The greatest clinical challenge I have faced has been trying to provide competent care to my patients in a country where we now have 47 million people who have no health insurance and legions of other people who have inadequate health insurance. I am seeing more and more people who are forgoing screening or needed tests because they just can't afford them. The farm community is especially vulnerable. I also feel that with the fractionation of our healthcare system into "specialty pies", and with the focus on "good science" patients are getting lost in a maze of complexity and they don't understand it. Especially in rural areas, elderly are not going to travel to urban areas to see the dermatologist, rheumatologist, cardiologist, and endocrinologist for their actinic keratoses, osteoarthritis, CHF and hypertension, and diabetes.
When a person walks into a grocery store to buy food, they are a wise consumer of goods. They can look at a can of peas, study the price and the amount of sodium that this can of peas may contain, and compare it with another brand of peas. You throw your choice into your cart and continue shopping. You are a wise consumer. Now let's take a person with a belly ache into the medical supermarket. As they push their cart along the isle, they see CT scan, MRI, CBC, UA, comprehensive metabolic panel, surgeon and gastroenterology consult on the shelf. They have no idea what to purchase for their belly ache. What a primary care physician does is walk along with the patient as they push their shopping cart and guides them as to what they should buy. Primary care most of the time will be able to manage the belly ache with a history, physical exam, and with tests that are on the shelf. If needed for a more specialized problem, primary care may recommend one gastroenterologist or surgeon over another for various reasons. We know a consultant's skill level, personality and practice style, and can match the patient to the appropriate consultant so that we end up with patient satisfaction in the end. Now the patient is more of a wise consumer because they have an advocate. That is what I feel I do for my patients.
Approximately 90% of what patients see me for in the office I can handle. Not every disease or encounter in medicine is a medical zebra (like we are drilled to believe in the academic centers). But when I can't handle a problem and I feel the patient needs consultation, I can point them in the right direction. I am a strong advocate of the "medical home" concept. Enacting the medical home concept will be one of family medicines biggest challenges to accomplish. In my view, it will definitely benefit society if it is done right and the style of practice attracts students into primary care. We are starting the medical home project in our practice and I feel it will benefit patient care.
My challenges as a rural family physician and a rural training track program director are twofold; Clinical and Academic.
Clinical
The greatest clinical challenge I have faced has been trying to provide competent care to my patients in a country where we now have 47 million people who have no health insurance and legions of other people who have inadequate health insurance. I am seeing more and more people who are forgoing screening or needed tests because they just can't afford them. The farm community is especially vulnerable. I also feel that with the fractionation of our healthcare system into "specialty pies", and with the focus on "good science" patients are getting lost in a maze of complexity and they don't understand it. Especially in rural areas, elderly are not going to travel to urban areas to see the dermatologist, rheumatologist, cardiologist, and endocrinologist for their actinic keratoses, osteoarthritis, CHF and hypertension, and diabetes.
When a person walks into a grocery store to buy food, they are a wise consumer of goods. They can look at a can of peas, study the price and the amount of sodium that this can of peas may contain, and compare it with another brand of peas. You throw your choice into your cart and continue shopping. You are a wise consumer. Now let's take a person with a belly ache into the medical supermarket. As they push their cart along the isle, they see CT scan, MRI, CBC, UA, comprehensive metabolic panel, surgeon and gastroenterology consult on the shelf. They have no idea what to purchase for their belly ache. What a primary care physician does is walk along with the patient as they push their shopping cart and guides them as to what they should buy. Primary care most of the time will be able to manage the belly ache with a history, physical exam, and with tests that are on the shelf. If needed for a more specialized problem, primary care may recommend one gastroenterologist or surgeon over another for various reasons. We know a consultant's skill level, personality and practice style, and can match the patient to the appropriate consultant so that we end up with patient satisfaction in the end. Now the patient is more of a wise consumer because they have an advocate. That is what I feel I do for my patients.
Approximately 90% of what patients see me for in the office I can handle. Not every disease or encounter in medicine is a medical zebra (like we are drilled to believe in the academic centers). But when I can't handle a problem and I feel the patient needs consultation, I can point them in the right direction. I am a strong advocate of the "medical home" concept. Enacting the medical home concept will be one of family medicines biggest challenges to accomplish. In my view, it will definitely benefit society if it is done right and the style of practice attracts students into primary care. We are starting the medical home project in our practice and I feel it will benefit patient care.
Baraboo Rural Training Residents Party
Academic
Running a 6 resident rural training program is exceedingly rewarding but is becoming more cumbersome. When I think of the ACGME now, I think of the phrase, "I am from the IRS and I'm here to help." It seems like residency training is becoming burdened with more and more documentation and vindictive reviews (RRC reviews, institutional reviews, internal reviews etc. etc.) similar to the way nursing homes are vindictively scrutinized with minimal resources to do their jobs. Documentation for a six resident smaller program is just as much as documentation for a 42 resident urban program. We received 5 years of accreditation with our last review in 2008. We have always received maximum accreditation in our reviews for the last 13 years. In preparing for this most recent review, the 30-40 page Program Information Form (PIF) template that the program director is supposed to fill out changed several times while we were waiting for our program to be scheduled for its review. I had to write this PIF three times as they would not accept the older form I already had filled out. I would not have been able to do this without the support of my wife, Linda, who serves as our education coordinator here in Baraboo. She has been a tremendous inspiration and support through our 39 years of marriage and deserves just as much credit for any successes I have had as I do.
Funding for training does not reach the rural environment as one would expect and compensation for funding is low in primary care. I consequently cannot hire the staff in Baraboo to do the needed paperwork that is required for documentation. I have overcome the ACGME barrier by engaging our community in residency education. Our community had difficulty attracting any physicians to rural practice in the past. They paid recruiters thousands of dollars with minimal returns. Since the residency started in Baraboo, the medical staff has grown, the hospital has grown, and we have actually kept 4 of our family medicine graduates in town. It is like growing them in our own back yard garden. The community has recognized this and we have been able to secure some grants and other support from a very supportive hospital in Baraboo. In addition, the University of Wisconsin Department of Family Medicine has provided us with administrative support and our Baraboo residents participate in much of the curriculum in Madison as well as Baraboo. Our rural training program has been a true success story and has been a joint project between the University of Wisconsin Department of Family Medicine, our Southern Wisconsin AHEC, St.Clare Hospital in Baraboo, St.Marys/Dean Venture, and the community of Baraboo.
Running a 6 resident rural training program is exceedingly rewarding but is becoming more cumbersome. When I think of the ACGME now, I think of the phrase, "I am from the IRS and I'm here to help." It seems like residency training is becoming burdened with more and more documentation and vindictive reviews (RRC reviews, institutional reviews, internal reviews etc. etc.) similar to the way nursing homes are vindictively scrutinized with minimal resources to do their jobs. Documentation for a six resident smaller program is just as much as documentation for a 42 resident urban program. We received 5 years of accreditation with our last review in 2008. We have always received maximum accreditation in our reviews for the last 13 years. In preparing for this most recent review, the 30-40 page Program Information Form (PIF) template that the program director is supposed to fill out changed several times while we were waiting for our program to be scheduled for its review. I had to write this PIF three times as they would not accept the older form I already had filled out. I would not have been able to do this without the support of my wife, Linda, who serves as our education coordinator here in Baraboo. She has been a tremendous inspiration and support through our 39 years of marriage and deserves just as much credit for any successes I have had as I do.
Funding for training does not reach the rural environment as one would expect and compensation for funding is low in primary care. I consequently cannot hire the staff in Baraboo to do the needed paperwork that is required for documentation. I have overcome the ACGME barrier by engaging our community in residency education. Our community had difficulty attracting any physicians to rural practice in the past. They paid recruiters thousands of dollars with minimal returns. Since the residency started in Baraboo, the medical staff has grown, the hospital has grown, and we have actually kept 4 of our family medicine graduates in town. It is like growing them in our own back yard garden. The community has recognized this and we have been able to secure some grants and other support from a very supportive hospital in Baraboo. In addition, the University of Wisconsin Department of Family Medicine has provided us with administrative support and our Baraboo residents participate in much of the curriculum in Madison as well as Baraboo. Our rural training program has been a true success story and has been a joint project between the University of Wisconsin Department of Family Medicine, our Southern Wisconsin AHEC, St.Clare Hospital in Baraboo, St.Marys/Dean Venture, and the community of Baraboo.
Rewards
My biggest reward is that rural family medicine has allowed me to live a comfortable life with my family. My daughter, Jenny, is now 31 years old having made it through her Wilm's tumor and is now married and working as a school psychologist. She has an interest in autism and does therapy with autistic children. She is very dedicated. My son, Tim, is also dedicated and is a newspaper journalist in Baraboo. He is receiving all kinds of awards for investigative journalism in our area. My wife, Linda, is still my best friend and support. She serves as our education coordinator here in Baraboo for the residency. We have always tried to judge ourselves by what sort of contributions we can give to society. I am very proud of our family.
I was fortunate enough to have been nominated by my patients to receive family physician of the year for the state of Wisconsin in 2006. The health insurance industry, Medicare, Medicaid etc. may not value my services as much as they do my procedure oriented specialty colleagues, but my patients apparently value my work and that is what matters the most to me. Most family physicians will tell you they receive their biggest rewards from their patients (relationships). Patients really do appreciate a true family medicine approach to care.
To give an example of rural patients and how they interact with the doctor, I once saw a farmer who came in to see me because of a hand infection. His right dominant hand palm was all swollen, red, and he had a fever. When I asked him how long he had had this infection, he told me a week. He had his hand wrapped in a rag. I asked him the obvious question of why he had not sought care sooner. He told me he had a police scanner and apparently, at that time, the police knew when I was going to the hospital to deliver a baby after hours. He told me, "Doc, you have worked hard this week delivering babies. You needed your sleep." These types of experiences are still happening in rural America. The student just has to seek them out.
Another reward I have been privileged to experience is following patients from cradle to grave. Being a family physician means you don't exclude patients from your practice because of age, gender, or presenting problem. As a family physician in a rural community, you become physician, teacher, friend, neighbor, and hopefully a true life role model for the citizens you live with. The longer you are in practice, the more you will see what I am talking about. I don't feel sub-specialists can experience the same bond between their community and themselves as a rural family physician can.
My biggest reward is that rural family medicine has allowed me to live a comfortable life with my family. My daughter, Jenny, is now 31 years old having made it through her Wilm's tumor and is now married and working as a school psychologist. She has an interest in autism and does therapy with autistic children. She is very dedicated. My son, Tim, is also dedicated and is a newspaper journalist in Baraboo. He is receiving all kinds of awards for investigative journalism in our area. My wife, Linda, is still my best friend and support. She serves as our education coordinator here in Baraboo for the residency. We have always tried to judge ourselves by what sort of contributions we can give to society. I am very proud of our family.
I was fortunate enough to have been nominated by my patients to receive family physician of the year for the state of Wisconsin in 2006. The health insurance industry, Medicare, Medicaid etc. may not value my services as much as they do my procedure oriented specialty colleagues, but my patients apparently value my work and that is what matters the most to me. Most family physicians will tell you they receive their biggest rewards from their patients (relationships). Patients really do appreciate a true family medicine approach to care.
To give an example of rural patients and how they interact with the doctor, I once saw a farmer who came in to see me because of a hand infection. His right dominant hand palm was all swollen, red, and he had a fever. When I asked him how long he had had this infection, he told me a week. He had his hand wrapped in a rag. I asked him the obvious question of why he had not sought care sooner. He told me he had a police scanner and apparently, at that time, the police knew when I was going to the hospital to deliver a baby after hours. He told me, "Doc, you have worked hard this week delivering babies. You needed your sleep." These types of experiences are still happening in rural America. The student just has to seek them out.
Another reward I have been privileged to experience is following patients from cradle to grave. Being a family physician means you don't exclude patients from your practice because of age, gender, or presenting problem. As a family physician in a rural community, you become physician, teacher, friend, neighbor, and hopefully a true life role model for the citizens you live with. The longer you are in practice, the more you will see what I am talking about. I don't feel sub-specialists can experience the same bond between their community and themselves as a rural family physician can.
Advice
If you are interested in really making a difference in life by serving an underserved population and being able to provide full-spectrum family medical care in an environment where most physicians work together in harmony, then go rural. The right rural practice, however, is key. A group practice preferably in an area where there is a mixture of family physicians, internists, pediatricians, and general surgeons is ideal from my view point. Yes, they can all get along together when the main focus is care of the patient and the group is smaller and a mixture of specialties all in one building. I also live by the rule; "bigger is not always better." You will find that all the negative myths one hears about rural practice are false when you choose the right town and right practice. Medical students always tell me that they are surprised how subspecialists in ivory towers always feel like they are the experts on rural practice. These negative myths are often dispelled when medical students rotate with us in Baraboo.
I live on a lake, have a nice home, go out to dinner in my boat, drive my boat to the golf course on the lake, live near a ski hill, teach residents and medical students, give community talks, deliver babies, do hospital care including ICU work, see nursing home patients, and I am fairly well known in town. I feel our consulting specialists who come to Baraboo are supportive of my skills and challenges in rural practice. I don't feel like I am in a glass bubble. Personally, I enjoy seeing a patient at a restaurant who I know was very sick at one time and I helped pull them through their illness. They will often introduce me to the rest of their family. I enjoy seeing the twins I delivered when I am waited upon by their mom at a local restaurant and she pulls the twin pictures out. My children observed this as they were growing up and were proud of what Dad did even though I occasionally missed some of the important family events because of a delivery or other emergency. I am now starting to deliver some of the patients I actually delivered if you can believe that. Rural practice to me is true "Doc Hollywood" if you saw the movie. My family enjoyed the rural lifestyle which is built on relationships with people.
If you are interested in really making a difference in life by serving an underserved population and being able to provide full-spectrum family medical care in an environment where most physicians work together in harmony, then go rural. The right rural practice, however, is key. A group practice preferably in an area where there is a mixture of family physicians, internists, pediatricians, and general surgeons is ideal from my view point. Yes, they can all get along together when the main focus is care of the patient and the group is smaller and a mixture of specialties all in one building. I also live by the rule; "bigger is not always better." You will find that all the negative myths one hears about rural practice are false when you choose the right town and right practice. Medical students always tell me that they are surprised how subspecialists in ivory towers always feel like they are the experts on rural practice. These negative myths are often dispelled when medical students rotate with us in Baraboo.
I live on a lake, have a nice home, go out to dinner in my boat, drive my boat to the golf course on the lake, live near a ski hill, teach residents and medical students, give community talks, deliver babies, do hospital care including ICU work, see nursing home patients, and I am fairly well known in town. I feel our consulting specialists who come to Baraboo are supportive of my skills and challenges in rural practice. I don't feel like I am in a glass bubble. Personally, I enjoy seeing a patient at a restaurant who I know was very sick at one time and I helped pull them through their illness. They will often introduce me to the rest of their family. I enjoy seeing the twins I delivered when I am waited upon by their mom at a local restaurant and she pulls the twin pictures out. My children observed this as they were growing up and were proud of what Dad did even though I occasionally missed some of the important family events because of a delivery or other emergency. I am now starting to deliver some of the patients I actually delivered if you can believe that. Rural practice to me is true "Doc Hollywood" if you saw the movie. My family enjoyed the rural lifestyle which is built on relationships with people.
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