A Private Pracice 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 ryan@medicalschoolhq.net.

[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.

“In rural areas, typically, there's not as many doctors around and certainly fewer specialties.”

[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.

"I don't think I would be as rewarded or fulfilled working in a city environment."

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.

"It's not just about practicing medicine, it's about the community."

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 able to shift gears quickly is really a key trait because you never really know what's going to walk in your door."

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.

"Everything is relevant in family medicine. That's what I love about it but it also can be difficult to keep up with things. And if I don't know the answer, I know how to find the answer."

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.

"Learning everything I could on all specialties just all continued to support the idea that family medicine is basic comprehensive specialty that encompasses everything."

[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.

"Patients tend to present later with more complicated diseases."

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.

"You're going to see things that you may never see again in your career."

[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.

"Everyday is different. I don't know what the next patient is going to be."

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 love