On the Loss of One Rural Doctor

Dr. Benjamin Brewer, a doctor in rural Illinois, writes in his Wall Street Journal column [subscription req'd] about the impact of losing one doctor in his rural Illinois town -- both economic and personal. Some excerpts & comments follow.

In a small community, the departure or unexpected death of a doctor is felt not only by the doctor's patients, but by his or her colleagues, the hospital and even the local economy.

Patients who lose a doctor often go through a grieving process and a feeling of being at bay. While some gravitate quickly to a new physician, others wait until they get sick to search for care. Some end up traveling outside the area. It's inconvenient for patients and financially detrimental to the local hospital, which depends on referrals.

According to the Illinois Chamber of Commerce, the departure of a physician from Illinois represents a $1.1 million annual economic loss, including the loss of 12 office, hospital and community jobs.

Nationally, the average physician generates $1.54 million in inpatient and outpatient revenue for his or her affiliated hospital, according to a survey by Merritt, Hawkins & Associates, an Irving, Texas-based physician search and consulting firm.

Highlighting the occupational stress doctors face, even in small towns, Brewer notes that his town's only woman doctor recently closed her practice and moved away: "She's heading to a state with lower malpractice costs and is joining a group practice setting, where she'll have more time off to find a balance between medicine and motherhood."

Who can really fault her? A couple of years ago, my internist did the same thing -- "lit out for the territory" -- (Montana) after sending his patients a frank letter about needing to de-stress and get more family time. Watching him take on more and patients, and more staff to handle insurance claims, over the years, I'm surprised he waited so long.

Back to Dr. Brewer. He finishes this column with a touching personal vignette:

A few months after I started my practice, a local doctor retired and then suddenly died. He was an internist with an interest in cardiology and had some very complicated patients. As he wound down his practice, he wrote notes summarizing his care and evaluations in progress, along with some of his patients' particular quirks.

When I eventually inherited several of his patients, those notes made my life easier. They were a godsend really. Some of the patients had stopped their blood-pressure or diabetes medication when their prescriptions ran out. They came in feeling bad after being without their medicines for months.

Even with the crib notes, I still can't always decipher what the special shot was that he mixed up for Evelyn's rheumatism or gout or lumbago or whatever. Some of the things that he gave I don't think they make anymore.

But I do the best I can, tapping the accumulated wisdom of a lifetime in medicine revealed in margin notes.