I hear it all the time. Young resident physicians are taught it. It infects our failed attempts to staff rural hospitals. (Among other things.) It’s this. ‘If you’re well trained in a teaching center, and you go to a small rural hospital, you’ll lose your skills. Better to stay in the big center. Let less qualified people work in ‘the hinterlands.’ It won’t matter that much out there. They’ll be fine. And they’ll have telemedicine, or NPs or PAs to help them, or helicopters to call. You’ll be bored, and your mind will turn to mush. To which I respond with a resounding, “Rubbish!” Let me tell you about my week in a small hospital in the rural South. I’ll just list a few things I saw. (And a few I saw with my PA.) STEMI (a heart attack for the layperson), high voltage (14,000 V) electric shock sent to burn center, profound sepsis from urinary obstruction with blood pressure of 60, copperhead bite (turned out to be a dry strike but it counts), respiratory failure requiring intubation, another forearm burn from industrial glue, intractable seizure, suicidal patients, hypotensive dehydrated patients in kidney failure, human bite, severe dog bite requiring extensive repair. And these are just the very interesting cases, and do not take into account the many patients with serious problems requiring admission or transfer that were just more commonplace issues of chest pain, abdominal pain, respiratory issues or others. Anyone who believes that their skills in medical care will deteriorate outside a teaching center has probably not spent much time, well, outside a teaching center. Rural America deserves the same high-quality care as everyone else. So let’s stop frightening physicians by warning them away from some of the greatest adventures, busiest shifts and sickest patients of their professional lives. Go rural, young doctor! Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan. Source
