The Making Of A Doctor
By John Burke, M.D.
Call me a country doctor. That’s what I am. People recognize me at the local gas station and the corner market. I actually like that, and I’m pretty sure they do, too.
Most medical students look forward to finishing school and their residencies and finally setting up a practice in a major city—or at least a nice suburb. Some of us, though, are drawn to something very different: the sense of belonging and satisfaction that practicing medicine in a small town can bring.
I did my residency in internal medicine at Emory University Affiliated Hospitals in Atlanta, Georgia. The Emory program is one of the best in the country, and Grady Memorial Hospital is one of the toughest hospitals to train at. Doctors say if you can survive Grady, you can survive anything—and that's the way you feel after working there. (And by the way, forget what you see on Grey’s Anatomy. In a real-life residency, you’re too tired to think of anything except your job.)
When I finished my residency I already knew I wanted to practice in a small town—a place where I would know people, where I would be part of the community, and where I could make a difference.
After three years of residency in the South, my wife and I wanted to move back to New England to be closer to our families. We both had grown up in the city, and we wanted a safe and sane place to bring up our kids. We narrowed our search to rural Maine.
My path
Medicine was always an interest for me. My mother says that other than wanting to play for the Red Sox, all I ever talked about was becoming a doctor. I'm not sure where that came from, but I was interested in science, and I knew that being a doctor was an important and respected profession.
My mother and father were both immigrants from Ireland: my mother graduated from high school but did not attend college, and my father went to a two-year technical school after grammar school. However, both were great readers, always up on current events, and they emphasized the importance of education to all their kids. (I'm the oldest of six.)
After high school in Boston I went to Dartmouth College in Hanover, New Hampshire, where I majored in biology and pre-med. My med school years were spent at Boston University School of Medicine, which was a pretty intense experience!
One of the most challenging courses was gross anatomy, which involved dissecting a cadaver and memorizing an incredible amount of data about the human body.
Med school was a pressure cooker, but I did really enjoy it, especially the final two years when I worked in a hospital setting, actually using the information that I had learned in the previous two years.
Getting started
Other than making enough money to support my family, I didn’t have a lot of concerns when I first set up my small practice—perhaps because I knew very little about running a business of any kind.
Looking back, I feel now that one major deficiency of medical education is the lack of business/financial education. I assumed that working very hard and being a good doctor was going to be enough. Little did I know!
I also learned very little about dealing with a rural population in med school. After all, doctors gravitate to cities because that’s where most people live. My own idea of what small-town medicine would be like was primarily a fantasy—but interestingly enough, that fantasy did turn out to be true in many ways.
The health issues of rural medicine are really not much different from those in more urban areas in terms of the basic problems of hypertension, diabetes, heart disease, etc. One difference is that I see very few cases of HIV. While there is less drug abuse than you’d see in a city practice, prescription drug abuse is catching up. Perhaps the biggest difference is the percentage of geriatric patients I see on a regular basis. Geriatrics often makes up 50% of a family practice.
I am quite lucky in terms of my access to most major medical resources. Good hospital care is available in the nearby small cities of Waterville and Augusta. And patients needing cardiac surgery, transplant surgery, or neurosurgery are referred to Maine Medical Center in Portland, which is only about an hour away from Vassalboro, where my practice is based.
Country benefits
One of the benefits of being a country doctor is that I really get to know my patients and their families. The people who come to my office are my neighbors and friends.
It continues to amaze me how much better I can treat a patient’s medical condition when I know his or her family history, workplace conditions, and patterns of exercise and activities. Another advantage is that my patients get to know and trust me, too. My family and I are members of the community.
A friend of mine in Atlanta thinks I chose a rural practice because I was searching for a place where I could love people and they would love me in return. I feel very lucky that this has largely been the reality.
My practice
In my own small-town practice, most of the people I treat currently have health insurance and can afford medical care. The problem is convincing them—especially men—of the importance of preventive care.
The Maine ethic is generally “if it ain't broke, don't fix it,” and I suspect this is true of most rural areas. So one piece of important advice I find myself giving to people over and over again is to control the things in their life that they can: stop smoking, get regular exercise, limit their caloric intake.
Pills are not the answer is to every health problem. Preventive care is essential both for good health and reducing long-term costs.
Communication
While I do have some patients who use the Internet to diagnose themselves, most realize that there is almost too much information there, and they need my help to interpret it. Part of my work is helping patients help themselves on the way to good health.
People stop me in the grocery store and lots of other local places to ask me medical questions—that comes with living in a small town. Most, however, don't want to talk about their private affairs in public, so the questions are usually fairly broad and my answer usually involves them calling for an appointment, as a more thorough exam and questioning are needed.
Getting there
I received an abundance of loan and scholarship assistance from Dartmouth College. During med school, I also received a Public Health Service scholarship based on a commitment to practice in an underserved area for three years. However, that became a lifelong commitment for me—I knew what I wanted for my life and my family.
Of course there are disadvantages to choosing a rural or small-town practice. It took me a while to adjust to the lack of streetlights and sidewalks, as well as to the scarcity of shopping and cultural amenities. When we first moved to Maine, my wife and I sometimes wondered whether or not we were sheltering our kids too much by choosing to live in a small town, but in the end, all turned out well—and we would do it again in a heartbeat.
Dr. Burke lives and practices in Vassalboro, Maine. He and his wife Christine enjoy kayaking at their camp on East Pond and snowshoeing in winter.
2009
