Thursday, January 10, 2008
Where are all the doctors?

By Anthony Policastro, M.D

People often wonder why there are not enough physicians that practice in rural communities. The explanation is fairly simple. It has to do with the way we train new physicians. When we think of physician training, we think about the medical aspects of that training. We think about seeing a lot of patients. We think about seeing complicated things. We think about doing a lot of procedures. However, not all of the time that physicians spend training is in the hospital. They spend time at home. They spend time in their local area. They learn how to live outside of the hospital. They become accustomed to a certain life style. When we think about where training programs are located, we realize that they are in metropolitan areas. This is a necessity. There have to be enough patients for the young physicians to learn from. There has to be enough variety in patient conditions to learn the many different conditions that exist. The result is that physicians in training get used to living in a metropolitan area. They get used to having a wide choice of stores. They get used to having a wide choice of restaurants. They get used to cultural events. They get used to professional sporting events. What is also unrecognized is that their spouses also get used to these things. Their spouses probably have more time to spend outside of the home than does the physician on call. There is a certain expectation that develops for free time. That expectation cannot easily be met in a rural area. The result is that many physicians will not consider moving to an area that does not have the things that they and their spouses are not used to having available. Another important piece of this has to do with the type of practice. In metropolitan areas, physicians in training frequently do hospital admissions. That allows the practicing physician to make rounds once a day without having to go into the hospital at night for admissions. For example, pediatricians who practice in Wilmington send their patient admissions to A I duPont. When there is a sick newborn, the interns and residents at either Christiana Care or St Francis Hospital will care for that infant. In Seaford, the pediatrician on call will have to go to the hospital for admissions or for sick newborns. If that happens in the middle of the night, there is still a full schedule of office hours the following day. The third factor is related to being on call. In big cities there are more patients. That results in the need for more doctors. Thus there are more doctors to share the night and weekend call. The result is more free time for the physician. Thus because of lifestyle, free time and intensity of after hours call, many young physicians will decide to stay in a metropolitan area. There are a lot of benefits to practice in a rural community. However, those physicians will never look at a rural practice. Thus the number of individuals willing to look at rural practice is less. It results in rural communities having to compete over those fewer individuals for the many positions that they have available.

New Year's Resolutions for Kids

by John Hollis
Director, Community Relations
Nemours Health and Prevention Services

Based on recommendations from the American Academy of Pediatrics. Help your children, even very young kids, resolve to set some healthy goals for 2008.

I will clean up my toys/my room.

I will brush my teeth at least twice a day.

I will wash my hands after using the bathroom and before eating.

I will drink mostly water and low fat milk.

I will hardly ever drink sodas, sports drinks or other sugary liquids.

I will find a sport or physical activity that I like and do it three times a week.

I will wear my helmet when I ride a bike or skateboard.

I will wear a seatbelt every time I get in a car.

I will use sunscreen when I'm outdoors.

I will eat fruit and vegetables every day.

I will spend no more than two hours a day in front of a television or video screen.

I will never give personal information about myself to anyone on the internet.

When facing a difficult decision, I will talk with an adult about my choices.

I will be nice to other kids and friendly to those who seem shy or lonely.

I will treat other people with respect.

I will help out in my community.