Why Rural? – Rural Health Voice Conference Essay Winner

“I’ve never even heard of that place. Why do you want to go there?”

That’s the question I got asked often when I chose a rural medical school and then again when I chose a rural town for my rotations. I don’t care to answer, so I laugh and say, “I don’t like sitting in traffic!”

When I first moved to rural Kentucky, I met an old woman whose grandson was trying to convince her to move to Florida with him. She looked him in the eyes and said “I was born here. I worked here. I raised my children here. And when death comes knocking on my door, he’ll have to do it here, in Middlesboro Kentucky.” I remember being surprised that someone could have such loyalty to a town that has 5 stoplights and no Chipotle. Then I lived in a rural town. And then I got it.

The truth is that someone who has never experienced life in a rural town will never understand it.

It all comes down to the community. In a rural area, the loyalty to the town can be felt in the air every Friday night for the high school football game. The roads leading up to the high school fill with the cars of people sporting their school’s colors. A group of men who played for the team 40 years ago all sit together and heckle the referees, just like their grandfathers did in 1976. And at the end of the game, regardless of the outcome, the crowd erupts in cheers for the players.

In a rural town, the entire fire department is made up of unpaid volunteers. Their dedication to the town is evident when 20 people sprint out of their houses in the dead of night to respond to a house fire or a flipped car. The chief is always someone whose ancestors settled the town and spent their childhood years with their nose pressed against the windowpane when the fire trucks roared past.

The people in a rural town are a family, in every sense of the word- they welcome everyone with open arms, and yes, bad news travels fast, but so does good news. When I joined the smallest city in Virginia’s Fire Department, within two weeks I knew every first responder, town official, and city council person. The city manager knows my name. No one is treated like a number, or a vote, or a temporary pawn – everyone is a person.

And yes, rural hospitals are different from those huge tertiary centers. They don’t have multiple ER doctors for a night, or a neurosurgeon on standby, or even a cath lab. But those conditions also breed some of the best doctors you will ever meet. When you don’t have a hematologist or gastroenterologist or neurologist at your disposal, that leaves one person to be all of that – you. The doctors I have met in these small hospitals have the best physical exams I have ever seen. I worked with a doctor who could examine a patient in 10 minutes and tell you exactly what their labs will come back with – and he’s yet to be wrong. Another doctor treats patients who have known him since he was 11. They’ve watched him grow up, they know his parents and teach his children – more proof of that community you can’t get in big, urban places.

As a rural doctor, your expertise and knowledge hold more value than whatever patients see or hear elsewhere, giving you the chance to dispel myths, answer questions, and support your patients’ decision-making. Working in a rural hospital means probably taking on more than you signed up for. Yes, you deal with the medicine, but you also become a therapist, a life coach, and a personal cheerleader for your patients. I’ve seen doctors go to war with insurance companies to make sure the coal miners that built their town at the expense of their own lungs get every benefit they can get.  I believe we are seeing the distrust that grew towards healthcare professionals all those years ago start to fall and be replaced by a working relationship.

But how do you put these thoughts and feelings into a simple sentence? So when my friends from Atlanta and Austin and Pittsburgh ask me “Why do you want to be there?” I just laugh and shake my head and say, “I don’t like sitting in traffic.”

Nada Buntic, OMS-III
Lincoln Memorial University
DeBusk College of Osteopathic Medicine