You Have What It Takes To Be A Small Town Doctor

1. You Have What It Takes To Be A Small Town Doctor R. Daniel Whitaker M.D., FAAP Pediatrician

2. Growing Up • Born and raised in Jasper, Alabama-population 14,352 • Father isan insurance salesman, Mother isa housewife • Youngest of 4 boys • Graduated from Walker High School (5A)

3. Damn, It Takes Forever To Be A Doctor! • Undergraduate degree in Biomedical Sciences from Auburn University • 2nd Class of the Rural Medical Scholars Program at the University Of Alabama • Medical School at the University of Alabama School of Medicine • Residency at T.C. Thompson Children’s Hospital in Chattanooga, Tennessee

5. Reasons for Rural Physician Shortage • Lack of encouragement during medical school for primary care and rural physicians • Negative perception from peers • Overworked and under paid • Lack of specialist • Poor and uneducated patients • Bigger is better • Location of undergraduate and medical training

7. Professional Misconceptions • Less educated if you are in a primary care field • Couldn’t make it in the big city • Overworked and under paid • Inadequate facilities • Not fulfilling • Lack of interesting patients • “Missionary” work

10. Overworked • Hospital rounding vs. Hospitalist • Office hours • Number of patients seen per day • Answering service • Call schedule

15. Under Paid

17. Rural Hospitals=Poor Facilities? • My local hospital is a 131 bed facility • We have a 7 bed ICU, fully staffed 12 room ER, Medical and Surgical floors and a new Labor and Delivery wing • Our Radiology Department includes a new in house MRI, Nuclear Medicine, Mammography, CT, etc. • We also have PT, RT, Lab, etc. • All with small town service!

20. Help is NOT Far Away!!! • Telephone • Advice from local colleagues • You will establish a network- locallyand regionally

21. Rural Docs are ALONE! • Anesthesiology (2) • Emergency Medicine (5) • Family Medicine (3) • General Surgery (5) • Hospitalist (2) • Internal Medicine (8) • Neurology (1) • Obstetrics and Gynecology (4) • Ophthalmology (2) • Orthopedics (3) • Otolaryngology (3) • Pediatrics (4) • Radiology • Urology (3)

22. Boring? Where do the Zebras Come From? • Wilm’s tumor • Hepatoblastoma • Brainstem Meduloblastoma • ALL • New Diabetics • Pyruvate Dehydrogenase Deficiency • HIV • Trisomy 13 • Cystic Fibrosis

23. Pros • The people are so friendly! • Everybody knows your name. • You are a “big fish in a little pond” • No traffic • Word of mouth • Easy to get involved in the Community

26. CONS: • The people are so friendly! • Everybody knows your name. • You are a “big fish in a little pond” • No traffic • Word of mouth • Easy to get involved in the community

29. My Clinic • Hospital owned and managed • 4 Internists and 2 Pediatricians • 1 semi-retired Urologists • 3 CRNPs • Lab • Radiology

31. Business Structure • Employed by Hospital • Less Headaches- just show up and work • Fewer management responsibilities • Trust the Hospital- accounting, office manager, hospital executives • Less financial risk • Nothing happens quickly • Autonomy over my practice

34. Enterprise, Alabama History • Incorporated in 1896 as an agricultural town • 1915 the economy was threatened by the Mexican Boll Weevil which destroyed 60% of the cotton crop • 1917 Coffee County produced the most peanuts than any other county in the US • 1919 the city erected the Boll Weevil Monument as a symbol of man’s willingness and ability to adjust to adversity

35. BollWeevilMonument

36. Enterprise, Alabama Today • Population 26,562 in 2010- Almost 25% growth in last 10 years • Enterprise High School (6A)- about 1,500 students (10-12 grade) • Economic base is agriculture, local industries, and Army Aviation Center at Ft. Rucker • Bama Jam- Taylor Swift, Alan Jackson, Brooks and Dunn, Kid Rock, The Zac Brown Band, etc…