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Profile of a Rural FP: Arlene Brown, MD FAAFP
Photo courtesy of Dianne Stallings, Ruidoso News
Name: Arlene Brown, MD, FAAFP
Clinic: Ruidoso Family Medical Group (Ruidoso, NM)
Years a Rural FP: 25
(Started 1983 as Arlene Brown, MD, Family Practice Associates of Ruidoso, PC)
Critical Access Hospital: Lincoln County Family Medical Center (an 11-bed CAH)
I grew up in a small town in New Mexico. Although not “rural” in the usual sense (my husband still refers to Los Alamos as the ‘furthest west suburb of Chicago’), it was a small town, with a population of approximately 16,000. My parents recognized my interest in science, and my mother predicted from the time I was 8 or 9 years old, that I would be a physician. They pushed us all to take as much science and math as we could, so I completed physics, calculus, chemistry, as well as biology in high school, in preparation for college. After attending college in St. Louis (my father would not allow me to travel further east than the Mississippi for college), I returned to New Mexico to attend medical school in Albuquerque at the University of New Mexico. I promised myself that I would return to New Mexico to practice medicine after training, and went to Wisconsin for a full spectrum family medicine residency. As fate would have it, I met my husband in Milwaukee but, indeed, returned to New Mexico to practice.
Photo courtesy of Dianne Stallings, Ruidoso News
Community
In many respects, we live in a year round “summer camp” environment. Ruidoso is a mountain community in southern New Mexico, elevation 7,000 feet, surrounded by the deserts of southern New Mexico. We are a tourist community, with winter skiing and hiking, horseback racing, fishing and hiking during the summer. The surrounding county is mostly ranching and farming based economy. Many of my families have homesteaded in the area, or are original “land grant” families from the Spanish exploration of New Mexico and dating to the 17th century. We are also adjacent to the Mescalero Apache reservation, so a significant number of my patients are also native American. As a rural county, it is not unusual for families to drive 50 miles of dirt road to access the highway and drive another 100 miles in to be seen for medical care.
In many respects, we live in a year round “summer camp” environment. Ruidoso is a mountain community in southern New Mexico, elevation 7,000 feet, surrounded by the deserts of southern New Mexico. We are a tourist community, with winter skiing and hiking, horseback racing, fishing and hiking during the summer. The surrounding county is mostly ranching and farming based economy. Many of my families have homesteaded in the area, or are original “land grant” families from the Spanish exploration of New Mexico and dating to the 17th century. We are also adjacent to the Mescalero Apache reservation, so a significant number of my patients are also native American. As a rural county, it is not unusual for families to drive 50 miles of dirt road to access the highway and drive another 100 miles in to be seen for medical care.
Practice
When I first started practicing, I did a full spectrum family practice, including maternity care, deliveries, newborn care and extending to end-of-life care, hospice and nursing home care. As the practice has aged (and so have I), I have stopped doing maternity care, but continue to care for patients of all ages. I continue to take 24/7 phone calls from my patients, continue to admit to our local critical access hospital, and continue to do intensive care, surgical assisting, as well as nursing home and hospice care for my patients. As part of my staff requirements, I also take ER call for “unannounced patients” approximately 4 to 6 times per month. We are fortunate in that our ER currently is fully staffed by ER physicians, although when I first started practice that coverage was also a requirement for staff privileges, and over the years that requirement was sometimes as frequent as every other day. I am thankful that we have coverage, and that our family physician staff has grown to 6 so that “call” is less burdensome here.
When I first started practicing, I did a full spectrum family practice, including maternity care, deliveries, newborn care and extending to end-of-life care, hospice and nursing home care. As the practice has aged (and so have I), I have stopped doing maternity care, but continue to care for patients of all ages. I continue to take 24/7 phone calls from my patients, continue to admit to our local critical access hospital, and continue to do intensive care, surgical assisting, as well as nursing home and hospice care for my patients. As part of my staff requirements, I also take ER call for “unannounced patients” approximately 4 to 6 times per month. We are fortunate in that our ER currently is fully staffed by ER physicians, although when I first started practice that coverage was also a requirement for staff privileges, and over the years that requirement was sometimes as frequent as every other day. I am thankful that we have coverage, and that our family physician staff has grown to 6 so that “call” is less burdensome here.
Photo courtesy of Dianne Stallings, Ruidoso News
Typical Day
A typical work day for me consists of being up early for 60-90 minutes of exercise, starting the coffee and breakfast for my family, and being at the office by 6:45 a.m., where I do e-mails, paperwork, and preparation for the day. I call my patients with their test results, starting at 7 a.m., make hospital rounds starting at 7:30 a.m., and start seeing patients around 8 a.m. to 8:30 a.m. I do a combination of previously scheduled appointments, for health maintenance and well child exams, and same-day appointments to accommodate urgencies and emergencies. We make our last appointment at 3 p.m., which gives me time to do walk-ins, calls to patients, and evening rounds. I try to be home by 7p.m., and we have always cooked dinner and had a family meal at dinner time. My husband and I cook together for dinner and spend the time visiting or enjoying the fact that we live in such a beautiful community. We have a home that is 2 miles from my office and the hospital, but is located on 45 acres, with our nearest neighbor almost 1 mile away. We are adjacent to the forest service, so most of our neighbors are elk, deer, wild turkeys, raptors, and occasionally a bear or coyote. Our dogs love chasing bears and pretending to round up the elk, who tolerate their circling and barking. Before our son left for college, he also participated in dinner preparation and a sit down dinner, although he often grumbled about how “boring” it was living out there.
A typical work day for me consists of being up early for 60-90 minutes of exercise, starting the coffee and breakfast for my family, and being at the office by 6:45 a.m., where I do e-mails, paperwork, and preparation for the day. I call my patients with their test results, starting at 7 a.m., make hospital rounds starting at 7:30 a.m., and start seeing patients around 8 a.m. to 8:30 a.m. I do a combination of previously scheduled appointments, for health maintenance and well child exams, and same-day appointments to accommodate urgencies and emergencies. We make our last appointment at 3 p.m., which gives me time to do walk-ins, calls to patients, and evening rounds. I try to be home by 7p.m., and we have always cooked dinner and had a family meal at dinner time. My husband and I cook together for dinner and spend the time visiting or enjoying the fact that we live in such a beautiful community. We have a home that is 2 miles from my office and the hospital, but is located on 45 acres, with our nearest neighbor almost 1 mile away. We are adjacent to the forest service, so most of our neighbors are elk, deer, wild turkeys, raptors, and occasionally a bear or coyote. Our dogs love chasing bears and pretending to round up the elk, who tolerate their circling and barking. Before our son left for college, he also participated in dinner preparation and a sit down dinner, although he often grumbled about how “boring” it was living out there.
Photo courtesy of Dianne Stallings, Ruidoso News
Challenges and Rewards
The biggest challenge I have faced over the years is the relative social isolation, as well as the poor economics of rural care. When I first arrived in Ruidoso, I was the second residency trained family physician, and the first left the community for health reasons shortly after I arrived. In medical school we are taught that in order to be objective, we should not socialize with our patients. This is particularly hard when your children play soccer or attend school with your patients, their friends are your patients, or their teachers are patients. I have had to learn to be Mrs. Vordermann at school and social events, and Dr. Brown in the office. Much of my social support has come from the AAFP and the state chapter, as other family physicians face the same challenges and concerns.
The second part of the challenge has actually been a great source of pride for me. As a family physician, I care for my community as well as my patients and their families. I have had the opportunity to work in the community to improve the health care being delivered here, as well as the access of all of my patients to health care. Over the years, I have been able to help start a volunteer staffed clinic to provide prenatal and family planning services to uninsured patients. That was subsequently taken over by the Public Health Office, and has grown to a full service public health clinic. In helping to start the clinic, we discovered that our county has a 40 percent medically indigent population, so, working with the County Commission, I was able to work to form a Health and Wellness Board, and to work for the creation of an indigent fund to help pay for health care services for our patients. At the onset of my practice there was a huge problem with domestic violence, and a relative lack of nearby available services, so my husband and I partnered with several other clinicians to help start a domestic violence service that is now free standing and provides shelter, counseling and legal assistance to victims throughout the county.
Over the years, I have had the opportunity to teach medical students and residents through my office, and I am continually encouraged about our future as I see those young physicians develop into excellent physicians.
The biggest challenge I have faced over the years is the relative social isolation, as well as the poor economics of rural care. When I first arrived in Ruidoso, I was the second residency trained family physician, and the first left the community for health reasons shortly after I arrived. In medical school we are taught that in order to be objective, we should not socialize with our patients. This is particularly hard when your children play soccer or attend school with your patients, their friends are your patients, or their teachers are patients. I have had to learn to be Mrs. Vordermann at school and social events, and Dr. Brown in the office. Much of my social support has come from the AAFP and the state chapter, as other family physicians face the same challenges and concerns.
The second part of the challenge has actually been a great source of pride for me. As a family physician, I care for my community as well as my patients and their families. I have had the opportunity to work in the community to improve the health care being delivered here, as well as the access of all of my patients to health care. Over the years, I have been able to help start a volunteer staffed clinic to provide prenatal and family planning services to uninsured patients. That was subsequently taken over by the Public Health Office, and has grown to a full service public health clinic. In helping to start the clinic, we discovered that our county has a 40 percent medically indigent population, so, working with the County Commission, I was able to work to form a Health and Wellness Board, and to work for the creation of an indigent fund to help pay for health care services for our patients. At the onset of my practice there was a huge problem with domestic violence, and a relative lack of nearby available services, so my husband and I partnered with several other clinicians to help start a domestic violence service that is now free standing and provides shelter, counseling and legal assistance to victims throughout the county.
Over the years, I have had the opportunity to teach medical students and residents through my office, and I am continually encouraged about our future as I see those young physicians develop into excellent physicians.
Photo courtesy of Dianne Stallings, Ruidoso News
As a resident of the community, I have worked to improve the quality of life here, as well. Since settling here in Ruidoso, my husband and I have helped in bringing a classical music station to town (we previously had a single radio station, playing only country music, and now have a full selection of stations), a music festival, and we have seen the creation of a community college as well as the opening of a first class theater that brings in nationally and internationally acclaimed performances such as the Moscow Ballet, the Prague Philharmonic, Dave Brubeck and so forth.
Advice
The most important advice I could give anyone interested in pursuing rural family medicine is: Just do it! Don’t be afraid to be involved. It is very rewarding and very challenging. As a rural family physician, you can, indeed, make a difference in a patient’s life, a family’s life and the community’s quality of life.
The most important advice I could give anyone interested in pursuing rural family medicine is: Just do it! Don’t be afraid to be involved. It is very rewarding and very challenging. As a rural family physician, you can, indeed, make a difference in a patient’s life, a family’s life and the community’s quality of life.
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