A Private Practice Rural Family Medicine Doc Shares His Story

Session 75

Dr. Kelsey Hopkins works in rural private practice in Southern Illinois. Learn more about rural family medicine, what he likes about it and what he doesn’t like, the unique environment, how to connect with other physicians, and so much more!

If you have any suggestions for new guests to have on the podcast, just shoot me an email at [email protected].

[02:00] An Interest in Family Medicine

He actually realized he wanted to be a family medicine physician before he got accepted to medical school. Growing up in a small town in Illinois, he is the fourth of eight kids. Everybody was born at home after the first two. So there was no one in his family that was in medicine. Naive to the healthcare field in general, he didn’t know there were different specialties so he just thought that as long as you went to the doctor, they give everything. Then he found out there was a rural medicine program, the RMED program at the University of Illinois – College of Medicine in Rockford. He explored this and it’s where he ultimately went.

And so, family medicine turned out as what matched what he thought just a general doctor was. He didn’t know you could subspecialize. This was typical in a rural setting. Kelsey describes that they would travel 20-30 minutes or more to go to the doctor. And this is true in a lot of ways.

In rural areas typically, there’s not as many doctors around and certainly fewer specialties. So typically as primary care, they do more than they would in an urban area because they have less colleagues to assist them with things. So the training is oftentimes different and the role is different.

[04:05] The Decision to Go Back to a Rural Area After Training

Having been born and raised in a rural environment, Kelsey thought he was comfortable with this kind of lifestyle. He felt it was where he was most comfortable and where he would want to raise a family. So when he found the RMED program, got in, and got into the residency in Indiana, doing the rural training track, he thought all this aligned to his life goals. As he got more training to do it, all the more that he wanted to get back to a small town and stay in that environment to live. On top of this, he realized the healthcare needs so he felt it would be a very rewarding career. He considers this not only as a career choice, but also as a lifestyle. For him, he was truly accomplishing what his initial dream was. And living that out is very rewarding for him.

Painting the picture of a rural setting, Kelsey has one partner who is an internist and pediatrician, the only practicing pediatrician, until recently a hospital had another part-time one in the local area. Then there are three other family doctors. One has just retired. Then there are several nurse practitioners.

They have a local hospital down a mile from his office, along with a couple of surrounding hospitals that are 20-30 minutes away in most directions. In terms of patient population, there are 7,000 people roughly in town. They call from a patient volume from around the area. He had even one patient that morning that traveled 100 miles who traveled from Missouri to come see him. They have a local niche so that patients within 20-30 minutes are able to see a doctor in the area.

[07:25] Traits that Lead to Being a Good Rural Family Medicine Doc

Kelsey says that especially if you’re from rural, you seem to fit in better. You get it. You understand the lifestyle better. It’s not just about practicing medicine, it’s about the community. The patients’ attitudes towards you may be different and their healthcare needs may be different. So understanding rural life is really important.

The University of Illinois College of Medicine in Rockford actually coined the term “rurality.” This means being how rural somebody actually is. It’s a way of life people understand when you’re from that environment in terms of relating and communicating to your patients.

Moreover, Kelsey thinks you also need to be flexible. You have to be able to like a variety of different things. Be able to shift gears quickly and this is a key trait in that you never really know what’s going to walk in your door. Their walk-in clinic is open from 8-9 where their patients only can walk in in the first hour and it’s all hands on deck. Then they see however many they have come in. So be as flexible as seeing up to 16 people.

Being a being good communicator is critical as well. You have to enjoy teaching and talking to your patients about things that may not even relate medicine. This is key to having a good bedside manner. Just be there with the patient. Don’t just see them in their disease state but see them as a whole.

[10:05] Other Specialties of Interest

Kelsey knew that going into medical school, family medicine was what made the most sense for a rural town because as one provider, you can impact thousands of patients. More than 80-85% of what they’re going to come to him for, he can synthesize the info, work it up, and he can handle it most of the time so patients won’t have to travel outside of town.

During his fourth year as he was doing his rotations, co-rotations, and subspecialty selections, it became crucial for him to realize that everything is related to family medicine. There’s nothing that’s off limits. He also takes his education track into account for having been able to at least know something about most things.

Kelsey loved OB, Urology, Cardiology – so there was nothing he thought that he wouldn’t do at all. There’s also a huge need for Psychiatry in rural medicine and even nationwide. This is also a big part of primary care. He does like Psychiatry. He actually did some training in that during residency and he found it has helped him everyday.

[13:40] Types of Patients

Kelsey explains that rural family medicine deals with more complex disease states. You see more of the social determinants of health at play because there’s a transportation issue, underinsured patients, and no insurance of patients. So you have to deal with the other things too while taking care of the person in a more social fashion than you do just the medicine.

Oftentimes, rural patients would present “later to care.” It doesn’t always mean that everyone who’s rural is a farmer. But there’s a lot of that industry in most rural towns. That said, there are several businesses there, college, and all sorts of industry around.

He’d also encounter patients like farming equipment injuries as well as those unrelated to trauma. Kelsey has observed that people tend to wait things out longer than maybe they would if they could see a specialist if they were just a few minutes walk.

Additionally, Kelsey would see other cases like Neuropathy, COPD, obesity-related diseases, diabetes, hypertension, infections and allergies, etc. As well, they deal with the more complicated states. And he would still have to sometimes manage such conditions since the patients don’t to leave town to go for a follow-up. Pretty much, he sees all specialties on a daily basis as well as a significant number of mental health.

Moreover. he points out the importance of being thorough in that you’re not always going to get the classic symptoms written on the textbooks.

[17:12] Typical Day and Work-Life Balance

Kelsey’s day usually starts at 7-7:15, having early clinic one day a week. The rest of the week, he starts at 8. He gets around 25-35 patients each day. They have a walk-in clinic and sees a lot of chronic disease patients with complicated check ups. And then he’d try to work up double or triple-booked people that need to be on the same day. He also works on acute cases within the same day. At the end of the day, he goes to the nursing home when necessary. Then he goes to his family with three children by 6:30pm. He puts the kids to bed then finishes his paperwork from 9-12.

He basically long days in terms of paperwork. Patient care usually stops around 5:30, sometimes later if he needs to go to the nursing home. Sometimes, he might also do end of the day procedures like vasectomy. Wednesday is  typically a procedure day for him. He also does skin cancer removals and nail surgeries, and other surgical things.

In terms of schedule, nothing really goes according to plan but then again, flexibility comes in here. Overall, he likes the excitement this brings, having busy days.

Kelsey considers having enough work-life balance, especially that he’s got the support of his wife. He was employed in a hospital for five years then he ended up doing private practice, which they did everything from scratch. He loves Tuesdays because he sets it for family time. He also has Saturdays and Sundays off. He makes sure he’s super thorough at work otherwise he gets burned out if he doesn’t take time away. So makes sure his family doesn’t get to the back burner so he could still have a lot of time with his kids.

The good thing about private practice is that he could take time off. There’s more flexibility in your own decision making. You might feel like there’s not enough time with your family, but Kelsey assures it’s definitely doable.

[22:30] Path to Residency Training Along the Rural Track

The Family Medicine track is three years although you can opt to do more training in other subspecialties. One of them can be high risk, OB C-section track. ACGME has changed has change their core criteria in how many months of OB and the different things a program requires to have. But you can always do elective time to do more like an away rotation if you wanted to.

The rural training track is an addition to the regular training, which they did during their second year. They went to a rural clinic with no resources where they did office procedures and EKG machines.

This taught him a lot of things about decision-making when you’re by yourself when there’s no other help available. There’s a lot of autonomy and realizing that the bottom line could stop with you.  There may not be anyone else to give you a second opinion at your beside.

After done with training, Kelsey though there’s not enough time to train but the nice thing is when you’ve gotten extra training, you’d feel prepared for rural practice. And what’s nice in the rural practice is you get to practice a lot of things on top of your training ability. You get to do a vasectomy, C-sections, etc. Things you can’t normally do in an urban area. So when you’ve done enough of those and got trained to do that in your residency, that allows you to get credential when you’re out in practice at a hospital or a clinic. You’ve done enough to say you’re confident and you’ve been trained.

As opposed to urban areas where there are subspecialists, you get to do all of this in the rural area since there’s no one else around. And you’re the go-to person. So having that extra intensity of training really helped him when Kelsey was in practice so he could do everything he was trained to do and not just let things go by the wayside because the environment didn’t fit.

[26:40] Forming Connections and the Network He Needs

Kelsey is happy that most specialists are happy to receive a phone call from him so he could call different hospitals in the area, if he needed to talk to specialists. They also have specialists that come half day a week. For instance, a cardiology comes to them a couple of days a week where they’d do a stress test, etc. They’re very receptive to him and the notes are awesome. They don’t have a full-time surgeon as they’d have to share the calls to other local hospitals. So a lot of cases get sent out having no full time in-house surgeon.

He also forms relationships by the quality of the institution and the group of partners and they have a good working relationship that way.

[28:30] Other Special Opportunities

One of the things he picked up long ago was a change in ownership of a local nursing home. Kelsey and his partner are the local nursing home directors. Outside of medicine, he was asked by a college to teach Anatomy. It’s he something he does as a volunteer work.

This said, you could do nursing home directorships, health department board, or hospital board, things that may not be employed positions. Sometimes, family doctors can fill in as hospitalists. He did this initially which he did for a couple of weekends. Then you could moonlight in the ER or outside of town.

Others do wound care, doing more surgical stuff and just subspecialize in it. There’s also sports medicine as service team doctors in small towns.

[30:22] What He Wished He Knew that He Knows Now

The one thing that comes to his mind is that it pays to be thorough and it pays to keep up on things. Just really take advantage of your training. One thing he wished he knew different was that when you’re in training, you get told to get as much exposure as you can so that you’re the most comfortable when you come out. He did some moonlighting in the ER. And this gave hime a ton of leg up for practice which involved quick decision making, seeing acuity, and solving a lot of primary care things.

Moreover, it really matters that you get the exposure to everything. Even when you’re tired, if you have the opportunity to learn something, you should do it. When you’re in private practice or even if you’re employed, when you’re out in practice, it’s very draining financially on the company to have you get some new training that you could have received but you didn’t. And telling yourself during residency that you’re going to get that later, actually rarely happens.

[33:10] What He Likes the Most and Least as a Rural Family Medicine Doctor

Kelsey finds it very rewarding to see his patients and his employees from the perspective of him being in private practice. He describes this as being a family environment. There are stressful and long days but he still enjoys coming to work no matter what.

He loves the fact he could make an impact on patients in a lot of ways. Every single day, you get to see different patients and different acuity and the different lengths of visits. So he likes how rewarding it is at the end of the day to sleep at night knowing that he did his best and some days, he saved a life. He realized that the things he was trained to do always matter. That being said, he feels very fulfilled and rewarded that he can offer a lot of services to patients. He feels very well-trained at his medical school and through residency. He loves teaching as well and students rotating with him. Two things he love doing.

On the flip side, what he likes the least is the paperwork. It’s something you can’t get away from so it’s about reframing your mindset about it. It’s important in a lot of ways and it’s a necessary part. And this is also part of doing service to the patient that is a reference point for the next visit. This completes the patient’s care as you’re putting down on paper what you did for them and what you plan to do for them. Just look at it as an extension of the physical exam of things that it’s just part of taking care of somebody. It’s a necessary evil.

They’re hiring some people that help them in some paperwork to help him out. They help out a couple of days a week and he sees this as great help.

[39:05] Major Changes Coming to Rural Family Medicine

He sees more hospitals merging with larger ones that gives access to more visiting specialists. The Electronic Medical Record is universal now. There may still be people using paper but this is going away. The communication in rural medicine may change but the quality of care remains the same.

Contrary to the misconception that rural doctors are antiquated, Kelsey begs to disagree, saying that in their office, they have the same technology that tests for influenza and strep that they could do in just 10-15 minutes.

Rural doctors are on the ball with the latest updates on things because you have to stay up on it. Keeping ideas is no different than it is in the urban areas. It’s just that he doesn’t have somebody to bounce ideas off when he’s in the hospital or in the lounge getting a coffee. This is part of the residency that he misses. That said, it’s not antiquated there.

If he had to do it all over again, he’d still do it 100%. As a doctor, you’re considered a local expert on health and different things. You serve in the community. But it’s not always about what he would want but what the community wants. So he wouldn’t have wanted this any other way. And even beyond financial constraints, he still decided to push through with the private practice, seeing the needs of the community

[43:00] Final Words of Wisdom

If this is something you’re interested in, Kelsey recommends looking at a program both for undergraduate and residency that may provide you with that kind of training instead of just traditional training. It’s worth exploring.

If you have a rotation in medical school that is not what you think it’s going to be but you’re really interested in it, then try to explore your options. And if you want to do it, there are ways to do it. There are different options to repay your debt and be able to work in a rural area. You can have a family regardless of what specialty, just be able to know how to carve it out. Lastly, try to connect with preceptors as they can really help you.

Links:

[email protected]

RMED Program – University of Illinois

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