My RTT experience took place at a 25 bed hospital in a town of 4,200 residents in the Western Mountains of Maine. A majority of my time was spent seeing patients in a family medicine practice adjacent to the hospital providing care to a patient population consistent with a rural demographic as patients hailed from a large geographical area and had limited access to medical care.
While I am a native of Maine, I grew up in a relatively large city and rarely had exposure to a patient population and patient care model that had such geographical, economic and point-of-care accessibility constraints. It was truly an eye opening exercise to experience some of the confines and restrictions that health care providers contend with in a rural setting, even one a few hours from where I live.
Limited resources impact course of care for patients
The rotation allowed me to participate in providing care in a setting where limited resources and location have major impacts on the course of care for patients. I came to appreciate the flexibility a major city or health system offers when something as routine as a specialty or sub-specialty referral has major implications for a patient from this region. While many specialists are able to make weekly visits to the region, often more advanced studies, whether imaging or procedural, often require the patient to spend an entire day in the process of receiving a consultation. Patients will often be traveling hours to and from a referral visit, and this requires adjusting work schedules, child care, transportation and added expenses to an already stretched budget.
This RTT experience has given me a new appreciation for the convenience of having in-hospital specialty care in a larger setting, but it also gave me a great deal of respect for the added component the physician must incorporate into their care plan. The physicians here respect the impact that a referral or specialist visit has on a patient and their quality of life, and they are able to successfully incorporate this into their decision making while constantly re-assessing the value of each referral or procedure.
Continuity of care across many generations
My experience with the Swift River Rural Track has also allowed me to learn in a primary care setting that embodied family medicine in the fullest sense of the term. I was often providing care to entire families at a time, from newborns to grandparents in a singular office visit. This allows for physicians to truly appreciate family lineages, dynamics and pathologies that run through the generations. It also allows a certain continuity of care that is not often seen in larger settings. Physicians here still see their inpatients and round in the hospital in the mornings, during lunch and after their clinics close for the days. Patients always appreciate seeing a familiar face and it allows the physicians a chance to truly see their patients throughout their entire hospitalization including post-discharge follow-up visits.
My rural training track rotation has truly given me a new perspective and appreciation for the quality of care rural physicians provide in spite of the significant boundaries they face both geographically and in having limited access to advanced care. My time here has exposed me to a patient population with a vastly diverse socioeconomic background and limited consistency and compliance in their health care history. I have thoroughly enjoyed my rural track rotation, and highly recommend one to any medical student who desires to gain an appreciation of true family medicine, or providing care with limited advanced care options.