QUALITY: Just a Small Town Doc, Living in a Lonely World?

Benjamin Brewer, M.D., is a small town doctor who moonlights as a Wall Street Journal columnist. He writes often about the crisis of primary care in our country. In today's column, he laments the trend of too many medical students looking for a "fast track to minimal call, high pay and the lifestyle perks," in more lucrative specialties like Radiology, Ophthalmology, Anesthesia and Dermatology (ROAD). Compare that, Brewer writes, with a career in primary care that offers "long hours, unpredictable schedules, big med school loans, paperwork hassles, and declining income compared with other medical specialties and the legal risks. "

But the end result is also increasing clear: a crisis of primary care in our nation that has been linked to higher costs and lower quality across the nation. We've talked before about potential ways to create more incentives for primary care (such as medical homes, and loan reimbursement). But Brewer presents another powerful reason for choosing primary care: the patients.

What sustains me in my practice is the importance of the work and the satisfaction of seeing patients get well and the kids grow up. You can't hide from your results as a country doctor. I see nearly everyone I treat around town, and I like it that way. ...

I'm happy to report there are still places where doctors don't shy away from coming in at any hour to help with an emergency. My colleagues rallied to operate on a pregnant woman who ruptured her uterus in the car on the way to the hospital last month.

We had five doctors, essentially a third of our medical staff, responding to her critical condition at 11 at night. We stopped her from bleeding to death and attended to her critically ill baby.

Without small-town doctors and hospitals, patients like her might die trying to get to larger hospitals farther away. We know what it means if we're not there and it keeps us pushing on. ...

I try to share the joy of small-town practice with medical students who come to work with me during their training. For some, holding the first baby they delivered independently forms a deeper connection with the wonders of medicine. Sometimes it's sharing in the success of a critically ill patient coming around that does it.

Some, like me, revel in hearing the stories of the patients that show true healing is more than writing a prescription or doing a procedure.

A few students are concerned that after a few years, what seems to be a calling to a medical career might turn out to be just another job. That might be the case for some people, but it hasn't turned out that way for me.

We could go on and on and on about the benefits of primary care to the journey that is health care reform. Which is why it's nice to hear from one doctor who won't stop believing in what he's doing.