Rural Family Medicine is My Future

This essay was written for the Michigan State University College of Human Medicine's Integrated Medical School and Family Medicine Residency Program (TIP), a transitional fourth year medical school experience that continues into residency.

by Veronica K. Arbuckle-Bernstein

They say the best predictor for determining where someone will ultimately end up practicing medicine is where they were raised. I grew up in the suburbs of Southern California, yet I do not see myself returning there. I am a small town girl at heart and have known for years that my future in medicine would be in a rural family practice.  In fact, it is the commitment to and focus on primary care, along with the opportunity for rural training that brought me to MSU from California initially.

In my undergraduate education I earned degrees in biochemistry and psychology because I love the interplay of the biopsychosocial model. The relationships that one is able to build in family medicine enables a physician to better address the psychosocial aspect of care. Family medicine is one of the specialties that embodies an overall approach to health care, embracing nutrition, exercise, psychiatric consideration, preventative health, and support services. Another aspect attractive to me is the variety available within family medicine. I do not want to be restricted to taking care of one age group or one body system. I wish to be able to do obstetrics to geriatrics, and everything in between. Likewise, I desire to work in a variety of settings including clinic, long-term care facilities, and academics. I excel by keeping myself challenged and living outside of a routine - it keeps things fresh and fun, which will ultimately benefit my patients if I can remain engaged and not burn out.

I cannot say precisely what first drew me to rural medicine. Perhaps the greatest impacts on me were the winters I spent with my family in the mountains of Northern California. My parents owned acreage in the remote town of Wildwood. We had a mobile home on the land and when we arrived every winter the pipes were frozen, so we were without running water for a couple days while my father worked to unfreeze them. That meant my siblings and I had to take freezing cold creek baths, use the outdoors as our restroom, and cook by campfire. I gained an appreciation for what is means to “live off the land.” That is the place I learned to hunt and fish. During the holidays we would trek into the woods and cut down our own Christmas tree. Everything about the experience was unique and special to me. Every year was an adventure.

While it was my undergraduate education and my own personal upbringing that first directed me toward rural family medicine, it was my experience on the Family Medicine Clerkship that truly solidified my choice to pursue this path. I had the pleasure of working at the Mason residency location, which demonstrated some of the challenges and joys to practicing in a rural setting. Rural medicine physicians have to rely on their clinical assessment and physical exam skills more than one might in an area where sophisticated diagnostic tools are more readily accessible. Sending patients to specialists may also not be easily accomplished, and as a primary care doctor in a rural setting I will have more of an opportunity to be a jack-of-all-trades, so to speak.

The Sparrow/MSU Family Medicine Residency in Lansing is well-suited for my career goals. The medical community in and around the Lansing area cares for a diverse group of populations, including homeless people, college students, farmers, and people across the full spectrum of socioeconomic status.  The settings in which I could gain experience in, include an urban setting and just minutes away a more rural setting. This variety of patient populations and practice settings offers a good breadth of experience, which will help me develop into a well-rounded physician, allowing me to better serve my future patients.

In addition to the medical education I would be receiving in the Sparrow/MSU Family Medicine Residency, practicing in Lansing would enable me to be involved in medicine beyond the scope of individual patient care. With the Capitol building just miles away from Sparrow Hospital, I would have the chance to be involved in health advocacy measures and policymaking. This is a role I have always seen myself assuming.  In my medical school experience thus far I have had the pleasure of working with the American Medical Association (AMA) in fighting for patient rights, addressing concerns of Medicaid expansion, and giving opinion on possible extension of nursing responsibilities. With the marriage between Sparrow and MSU, involvement in academic medicine and helping train future physicians is also an opportunity I would be interested in pursuing. Having made a home for myself and my family in Lansing, I have discovered many areas of interest in which I feel I could be a great asset to the Lansing community outside of residency responsibilities, such as work with MAFP, MSMS, and CareFree Clinic.

My family and I have been in Michigan roughly four years. We moved here one year prior to my start of medical school. My husband and I, and our children, have cultured a group a friends that are very supportive and loving. Not having our own families around was difficult at first, but we have now built a base of support that we value very much. As I transition on through my medical education, I feel it is important for my family and I to have a good support system, and we have found that in Lansing.

Added benefits to continuing my medical education in the Lansing area are the connections I have made in the community and available resources to patients that I have grown to know and have experience with. Acceptance into the TIP Program would allow me time to further develop these connections by working with the Sparrow/MSU Family Medicine Residency during my fourth year of medical school. Throughout my four years in Lansing I have been compiling a list of community resources. I find it interesting the number of resources available that seem to be under utilized. I don’t think there is a great system in the community health sphere that allows patients or health care providers to tap into and grasp all the services that are out there. Through researching activities for my own family I have discovered wonderful free or low-cost activities such as yoga, gym memberships, and medical education seminars – things I feel would benefit the exact population I hope to serve.

When beginning to consider and discuss with my husband possible residency locations, the choice was clear to both of us – Lansing is where we belong. My time on the Family Medicine Clerkship in my third year of medical school was very rewarding and brought me much joy. I was able to get a feel for life as a resident in the program and a sense of what the curriculum entails. Somewhere in my third year I was given a piece of advice from a resident – one indicator of the quality of a residency is the happiness of the residents. In family medicine every resident I had the pleasure of meeting and working with showed a level of happiness that I hope to find in residency. The MSU/Sparrow Family Medicine Residency offers a curriculum I feel fits well with my practice goals. Everything about my medical school experience, from my move to Michigan, to where the rest of my curriculum has taken me, and the mentors I have met along the way, seems to have fallen into place perfectly. I feel that Sparrow/MSU Family Medicine residency is a continuation of that serendipitous path.

 

(July 2015)