Wearing many hats: Unique challenges, rewards of rural health

Sanchez entered Union College in Lincoln, Nebraska, as a nursing student before switching to theology. He still was interested in health care during his senior year but was uncertain whether his path would lead him to ministry or medicine.

“At that time medical schools really started wanting humanities graduates to apply, not just science majors,” said Sanchez, who was pursuing ministry opportunities at the same time he applied to medical schools in 1985. “I had always felt a calling to ministry, so I majored in that. I felt that either way I could be happy. I prayed about it a lot. When I submitted my medical school applications, I decided that whichever door opened first would be the one I would walk through.”

Fortunately for the people of Plainville, Kansas, where Sanchez has practiced for more than three decades, mail from the Loma Linda University School of Medicine arrived first.

Medicine AND ministry

“My deepest desire became evident when I got back to school from Christmas vacation and my acceptance letter was in the mail,” he said. “The joy and elation I felt was high, and at that moment I knew that's where I was going to end up.”

It was less obvious that Sanchez, the son of a Cuban immigrant who grew up in one of California’s most populous counties, would spend his entire career in Rooks County, Kansas, which has a population that is less than 6,000 people and more than 95% white.

“If somebody had told me I was going to live here, I would have laughed at them,” Sanchez said. “We wanted to go someplace where we were needed. We narrowed the search by picking places near family. My wife’s sister married a farmer from this area. The community was very welcoming. People were very thankful and grateful that we were here.”

Sanchez has pursued both his passions. In addition to practicing medicine, he’s an elder in a church he helped start in Hays, Kansas, about 25 miles from home. He preaches once a month.

“It’s very vibrant, active and growing,” he said of the church. “It’s been a dream come true. The spirit, the attitude. The culture is something we really love.”

At a time when many physicians are spurning practice ownership, Sanchez has embraced it. It helped that his father and father-in-law were both accountants.

“I had a tremendous passion for the business end of it,” he said. “During residency, I became good friends with the practice manager and started asking a lot of questions. I was allowed to take a month and focus on learning all about that. Everybody likes being their own boss, but not everybody is able to make a practice profitable or be able to live within the means that the practice provides.”

One man, many roles in rural family medicine

As one of the few physicians in town, Sanchez has supplemented his practice income with other work, including medical director roles with two nursing homes and the county health department, assistant medical director of a hospice, affiliate staff of the Hays hospital and deputy district coroner.

He said wearing many hats is typical in rural family practice.

“Some of it is baptism by fire,” he said. “When I got here, the family practice doc who had been here six years tried to give me chief of staff responsibilities at the hospital, which was like, ‘We probably should let this guy get his feet wet for a year, learn what things are about and then you can do that.’”

More jobs followed. Sanchez and his wife were returning from a Saturday night out when  the district coroner called to ask for assistance with a suicide at a rural farmhouse. When the district coroner later asked if he could make him a deputy, Sanchez declined.

“He said, ‘You’re probably going to have to do it anyway, so you might as well have the title and the compensation,” he said, “so, I got sworn in to do that.”

Sanchez spends the final hours of his Monday and Tuesday afternoons visiting patients in local nursing homes. That schedule allows him to see all his patients in two facilities within a few months.

“I like to go and see them,” he said. “It saves the nursing home a lot of time and energy trying to get them to a doctor’s office. You get to see them in their environment. You can see them in their rooms, which is more private. They’re typically a little more comfortable there.”

A pitch for rural practice

Sanchez has been volunteer faculty for the University of Kansas School of Medicine since 1994. He hopes the students who visit his clinic will consider practicing in a rural community, including his own.

“At this stage of my career, with the sunset somewhere in the offing, I really want to leave Rooks County in a strong position,” he said. “I would say to students and residents that one of the most fulfilling ways to exercise your training and aspirations in medicine is to come to a place like this. In our county we get weekends and the holidays off, so it’s like a suburban practice, but we have more of the breadth of family medicine. We’re going to round, but the hospital is down the hall instead of across town. In rural medicine, there’s a real need in obstetrics and general surgery procedures. If you want to breathe life into your career or practice, this is a great place to do it.”