The curse of the rural surgeon

So a couple of things happened in the last few weeks.  Firstly, I attended a social media for female physicians seminar in Collingwood.  That has, in part, led me to start this blog.  The seminar (led by an enthusiastic female social media expert) encouraged us to own our internet presence.  While I know about Rate MD websites and others, I don’t spend a lot of time perusing them.  A rant about these sites and their pitfalls and problems I will save for another time.  Anyway, in googling my name, as suggested, I came across one of these sites.  While there was some nice stuff there,  a disgruntled patient stated about me (without any detail as to why) that (paraphrasing here)- “There is a reason this doctor is practising in a small town.”

The second thing that happened was the whole blow up about a front page Toronto Star story regarding Gardasil vaccine causing devastating health problems in a series of young girls.  While I am not going to go into the whole thing, the simplified version is this.  The story the Star ran was ridiculous from any scientific or logical point of view.  An obstetrician/gynecologist, Dr. Jen Gunter, wrote an online rebuttal, correctly pointing out that when you give one million people a vaccine at a certain age, occasionally a few of those people are going to develop devastating health problems around the time of vaccination, and it is not going necessarily going to be related to the vaccine.  Dr. Gunter was then  derided (without being openly named) in a subsequent column in the Star defending the original story (by Heather Mallick, if you want to know), as being a “rural doctor”.

Hmmm.  We rural doctors, not very smart or talented are we?  Or at least that is the assumption. As the old joke goes, isn’t it a fact that 50 % of doctors will graduate in the bottom half of their class? Why would we not want to practice in a huge, complex, academic hospital with legions of medical students, residents and other trainees following us every step of the way?  Must be because nobody wants us.  We are not the cream that has risen to the top.  Well, I am a rural doctor, living in Limehouse, Ontario, and working at Georgetown Hospital, a couple of kilometres from where I live.  Not because I have to be here, but because I want to be here.  I worked for awhile in the largest teaching hospital in NSW, Australia, and while I enjoyed that experience, what I do now and where I work suit my family and lifestyle much better.  I get to do my own operations (nothing better as a surgeon) and avoid research, teaching, and committee work, along with a long commute.  This is time I spend with my young family which I won’t get back again.  The tradeoff?  I work on call every other week.

This is coming from someone who was once the first author of a paper entitled “Hypothermic effect of lipopolysaccarhide in rats with biliary tract obstruction.” and who spent a year doing a Master’s degree in the molecular biology of breast cancer’s spread to the liver. Academic career here I come, but as John Lennon said “Life is what happens to you while you’re busy making other plans.” Life intervened, and after meeting that special someone, marriage and a couple of kids born in Australia, it was time to move back to Canada to be closer to my family.   Surgical jobs are increasingly difficult to find, and I was lucky to be hired in Georgetown, a town not unlike Ancaster where I grew up.  Georgetown was easy driving distance to my family, and unlike Ancaster, had a hospital I could operate at.

I did not do any of my medical or surgical training in the GTA, so nobody here knows me.  The default assumption when I call a major teaching hospital for help with a difficult or complex case, or for access to resources our hospital simply does not have, let’s say an ICU,  often is that I must be a moron.  I spent a year doing a transplant and vascular access fellowship at a major teaching hospital and then was hired back to be on staff.  I used to BE the person getting the phone calls from remote and rural areas asking for help, even if that was in another country.  All I will say is that I never said no to someone asking for help.  A surgical colleague of mine related a story of an elder statesman surgeon discussing a soon to be newly minted surgeon and where he was going to find work.  “He’s not good enough to work in the community,” the elder surgeon said, “He’ll have to work in a teaching hospital.”  Different way to look at it for sure.

I’m not implying that all people who work in teaching hospitals need to be sheltered from the big bad world of community medicine.  Someone has to do the research and teach.  Most academic doctors are smart and motivated people who do the best for their patients while juggling a lot of other competing interests.  But most rural doctors are also fantastic people who also do the best we can for our patients, often with a harsh on call schedule and not a lot of back up when our patients crash in the middle of the night.  So although the term rural surgeon may be derogatory to some, it’s a label I wear proudly.


2 thoughts on “The curse of the rural surgeon

  1. Leslie You GO GRRL! Kudos to you. I love “I used to BE the person getting the phone calls from remote and rural areas asking for help … I never said no”. It’s not you it’s the System at Teaching hospitals: no beds, OR cutbacks, egos – you know

    Liked by 1 person

    1. Thanks for your kind words. I was actually going to add- “….a courtesy not always extended to me by my academic colleagues.” I find it a bit backward that the places doing the training of surgeons are the “Centres of Excellence.”. Surely the places where you won’t find trainees, and where it is the consultant surgeons doing the operations skin to skin and all the care should be the Centres of Excellence? And yes, there are very large egos to be found at academic institutions.


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