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Profile of a Rural FP: Lynn Fisher, MD
Back Row: Lance Fisher (brother), Dr. Lynn Fisher, Marvin Fisher (father) and Lee Fisher (brother)
Front Row: Lane Fisher (nephew), Kay Fisher (mother) and Jordan Fisher (niece)
Front Row: Lane Fisher (nephew), Kay Fisher (mother) and Jordan Fisher (niece)
Name: Lynn Fisher, MD (Plainville, KS)
Clinic: LifeLine Family Medicine/Plainville Medical Clinic
Years an FP: 4
Years a Rural FP: 4
HPSA-designated Community? Yes
Critical Access Designated Hospital? Yes
What prompted you to become a rural family physician?
During my sophomore year of high school, a series of events caused me to consider the health care field. Both of my grandmothers passed away that year: one suddenly from a heart attack and one after spending four years in the local nursing home with Alzheimer’s. Also, my best friend’s father died after battling lung cancer. Also, I enjoyed the sciences. I first considered pharmacy as a career choice. However, during my sophomore year of college, I decided that I could impact the health of people I would serve more by becoming a physician. I also credit a good friend and high school classmate who was headed toward the same path.
In medical school, I always felt that I would choose primary care. I became involved in the Family Medicine Interest Group early on, but I did consider pediatrics and medicine-pediatrics as career choices during my clinical years. As a fourth year medical student, I asked my Family Medicine advisors to send me to wherever I needed to go to get the best possible rural family medicine experience. The place? Quinter, with Michael Machen, MD, as my preceptor. During that month, I saw the full spectrum of Family Medicine: the ER, colonoscopies, vaginal and surgical deliveries, hospital care, nursing home care, while seeing patients of all ages in the clinic. After that month, I decided that I wanted to practice full spectrum Family Medicine. After landing at North Colorado Family Medicine for residency, which, at the time, focused on preparing physicians for rural practice, I then returned to Kansas for practice. Eventually, I ended up at Rooks County Health Center (RCHC), where I am able to utilize all of my training skills: ER, OB, endoscopy, hospital clinic and nursing home care.
During my sophomore year of high school, a series of events caused me to consider the health care field. Both of my grandmothers passed away that year: one suddenly from a heart attack and one after spending four years in the local nursing home with Alzheimer’s. Also, my best friend’s father died after battling lung cancer. Also, I enjoyed the sciences. I first considered pharmacy as a career choice. However, during my sophomore year of college, I decided that I could impact the health of people I would serve more by becoming a physician. I also credit a good friend and high school classmate who was headed toward the same path.
In medical school, I always felt that I would choose primary care. I became involved in the Family Medicine Interest Group early on, but I did consider pediatrics and medicine-pediatrics as career choices during my clinical years. As a fourth year medical student, I asked my Family Medicine advisors to send me to wherever I needed to go to get the best possible rural family medicine experience. The place? Quinter, with Michael Machen, MD, as my preceptor. During that month, I saw the full spectrum of Family Medicine: the ER, colonoscopies, vaginal and surgical deliveries, hospital care, nursing home care, while seeing patients of all ages in the clinic. After that month, I decided that I wanted to practice full spectrum Family Medicine. After landing at North Colorado Family Medicine for residency, which, at the time, focused on preparing physicians for rural practice, I then returned to Kansas for practice. Eventually, I ended up at Rooks County Health Center (RCHC), where I am able to utilize all of my training skills: ER, OB, endoscopy, hospital clinic and nursing home care.
Community
The community that I practice in serves approximately 6,000 people. The hospital and main medical clinic are located in Plainville, KS, which has a population of 1,900. There are also satellite clinics in Stockton, population 1,600, and Palco, population 300. There are two nursing homes in the county. The school districts and hospital are the largest employers. Agriculture and oil are also prominent.
The community that I practice in serves approximately 6,000 people. The hospital and main medical clinic are located in Plainville, KS, which has a population of 1,900. There are also satellite clinics in Stockton, population 1,600, and Palco, population 300. There are two nursing homes in the county. The school districts and hospital are the largest employers. Agriculture and oil are also prominent.
Dr. Lynn Fisher (center, standing) and staff
Clinic
The clinic that I practice at is located adjacent to the hospital. In September 2008, RCHC will move to a brand new building and location. I have a unique practice situation in which I own my physician practice, but cooperate with 2 other local physicians who each own their own practice, and together we provide care at the Plainville Medical Clinic.
I see patients in the clinic every day of the week. My practice is fairly well balanced between seeing patients for management of their chronic illnesses such as diabetes, hypertension or COPD and acute care visits. I also see a balance of age ranges in the clinic. I am responsible for ER care once a week on average. During that 24-hour period, I see any patient presenting to the ER and if they need admission to the hospital, I manage the care until the following morning. I do provide OB care, including surgical OB for my patients and for a partner who currently does not provide surgical OB care. I also do endoscopy in my practice and so once to twice a month I will do EGDS or colonoscopies. Other services that I provide include cardiac stress testing, simple fracture care and simple skin lesion removal. Once a month I do nursing home rounds at one of the two local nursing home facilities. Finally, I occasionally assist the general surgeons with the surgery of my patients if done at RCHC.
Within the past year, I accepted the responsibilities of serving as the medical director for the First Care Clinic in Hays, KS. This clinic exists to serve those in Ellis County and the surrounding counties, which includes Rooks, by providing care to those with and without insurance. It is in the process of becoming a community health care center. I supervise a nurse practitioner who provides the majority of care, but I do provide some limited patient care as well. We also provide nursing home care to several local nursing homes.
The clinic that I practice at is located adjacent to the hospital. In September 2008, RCHC will move to a brand new building and location. I have a unique practice situation in which I own my physician practice, but cooperate with 2 other local physicians who each own their own practice, and together we provide care at the Plainville Medical Clinic.
I see patients in the clinic every day of the week. My practice is fairly well balanced between seeing patients for management of their chronic illnesses such as diabetes, hypertension or COPD and acute care visits. I also see a balance of age ranges in the clinic. I am responsible for ER care once a week on average. During that 24-hour period, I see any patient presenting to the ER and if they need admission to the hospital, I manage the care until the following morning. I do provide OB care, including surgical OB for my patients and for a partner who currently does not provide surgical OB care. I also do endoscopy in my practice and so once to twice a month I will do EGDS or colonoscopies. Other services that I provide include cardiac stress testing, simple fracture care and simple skin lesion removal. Once a month I do nursing home rounds at one of the two local nursing home facilities. Finally, I occasionally assist the general surgeons with the surgery of my patients if done at RCHC.
Within the past year, I accepted the responsibilities of serving as the medical director for the First Care Clinic in Hays, KS. This clinic exists to serve those in Ellis County and the surrounding counties, which includes Rooks, by providing care to those with and without insurance. It is in the process of becoming a community health care center. I supervise a nurse practitioner who provides the majority of care, but I do provide some limited patient care as well. We also provide nursing home care to several local nursing homes.
Typical Day
My day usually starts around 6 to 6:30 a.m., and arrival at the hospital depends on whether or not I am on ER call. ER call starts at 7 a.m. Otherwise, I do hospital rounds prior to the start of clinic patients at 9 a.m. Occasionally, there may be hospital committee meetings before clinic as well. I see patients in the morning and afternoons Monday through Thursdays until 5 p.m. Monday call days run longer with an evening walk-in clinic. On Friday mornings, I may schedule endoscopies (EGDs and colonoscopies) or see patients. Typically, I am off on Friday afternoons unless it is my ER call day. With the gas crunch, I commute with several office staff and we typically leave soon after my last patient. In the evenings after dinner, I will attempt to finish paperwork from patient care on our clinic’s electronic health records system and workout at one of the local health clubs. If the weather permits, I may try to golf. During the school year, I have choir practice one night a week and sing on another night with a music ministry group called Crossroads. I also try to attend as many sporting events of my niece's high school and my nephew's middle school in the evenings.
My day usually starts around 6 to 6:30 a.m., and arrival at the hospital depends on whether or not I am on ER call. ER call starts at 7 a.m. Otherwise, I do hospital rounds prior to the start of clinic patients at 9 a.m. Occasionally, there may be hospital committee meetings before clinic as well. I see patients in the morning and afternoons Monday through Thursdays until 5 p.m. Monday call days run longer with an evening walk-in clinic. On Friday mornings, I may schedule endoscopies (EGDs and colonoscopies) or see patients. Typically, I am off on Friday afternoons unless it is my ER call day. With the gas crunch, I commute with several office staff and we typically leave soon after my last patient. In the evenings after dinner, I will attempt to finish paperwork from patient care on our clinic’s electronic health records system and workout at one of the local health clubs. If the weather permits, I may try to golf. During the school year, I have choir practice one night a week and sing on another night with a music ministry group called Crossroads. I also try to attend as many sporting events of my niece's high school and my nephew's middle school in the evenings.
Challenges
I feel fairly lucky because I know that my practice area is not as remote as some of my colleagues. An area that creates challenges is lack of resources and specialty physicians. If I need a patient to see a rheumatologist, endocrinologist, or a pain medicine specialist, my patients will travel 3 hours one way. Luckily, nephrology and gastroenterology have outreach clinics on a monthly basis in a town 25 miles away, but in urgent situations, patients again will travel 2 to 3 hours. Our anesthesia services for OB live 45-60 minutes away from our hospital. Diabetic educators are not local. We do not have any type of community wellness center. These issues are not easily addressed. I tend to try to begin treatment to the best of my ability based on previous patient experiences with the specialists or after phone consults. Sometimes a neighboring critical care access hospital may offer a specialty service that we don’t, and I will send my patients there, for example, to see a certified diabetes educator (CDE).
I feel fairly lucky because I know that my practice area is not as remote as some of my colleagues. An area that creates challenges is lack of resources and specialty physicians. If I need a patient to see a rheumatologist, endocrinologist, or a pain medicine specialist, my patients will travel 3 hours one way. Luckily, nephrology and gastroenterology have outreach clinics on a monthly basis in a town 25 miles away, but in urgent situations, patients again will travel 2 to 3 hours. Our anesthesia services for OB live 45-60 minutes away from our hospital. Diabetic educators are not local. We do not have any type of community wellness center. These issues are not easily addressed. I tend to try to begin treatment to the best of my ability based on previous patient experiences with the specialists or after phone consults. Sometimes a neighboring critical care access hospital may offer a specialty service that we don’t, and I will send my patients there, for example, to see a certified diabetes educator (CDE).
Dr. Lynn Fisher (center row, 2nd from left) and staff
Rewards
There are several rewards to being a rural family physician. I currently think my biggest reward is that I am able to practice the type of family medicine I want without worrying about any political backlash. My hospital and practice partners encourage me to develop the skills that I wish to use, and if there is any area of family medicine that I don’t like, I don’t have to offer that service. Also, I have flexibility with my schedule and work hours. My partners and I cover so that we can maintain margin in our lives. Finally, I know that many people are so appreciative of the services we provide for our community and sometimes the actions that we provide in the local ER during an emergency have meant the difference between life and death.
There are several rewards to being a rural family physician. I currently think my biggest reward is that I am able to practice the type of family medicine I want without worrying about any political backlash. My hospital and practice partners encourage me to develop the skills that I wish to use, and if there is any area of family medicine that I don’t like, I don’t have to offer that service. Also, I have flexibility with my schedule and work hours. My partners and I cover so that we can maintain margin in our lives. Finally, I know that many people are so appreciative of the services we provide for our community and sometimes the actions that we provide in the local ER during an emergency have meant the difference between life and death.
Advice
I would encourage any medical student or resident to do a rural clerkship/rotation to understand what the time commitments may be and to see what an asset to the community the rural physician is. Rural communities work hard to make sure that their physicians have adequate time away for family and fun. I do not feel that overall I work any more hours in a week than some of my city colleagues.
I would encourage any medical student or resident to do a rural clerkship/rotation to understand what the time commitments may be and to see what an asset to the community the rural physician is. Rural communities work hard to make sure that their physicians have adequate time away for family and fun. I do not feel that overall I work any more hours in a week than some of my city colleagues.
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