I am not surprised by Drs. Hogue and Huntington’s study findings regarding family physician burnout rates in rural vs. metropolitan areas. For 25 years, I have been practicing in a community of 4,000 people that is 300 miles from the nearest metropolitan area of Anchorage, Alaska.
Physician burnout is a problem everywhere and working in a small community is not a panacea. But I have found that the rewards of living in a rural community more than make up for the long hours.
I have had the opportunity to watch children I’ve delivered grow up to be strong adults. I am now delivering the babies of babies I delivered. This continuity alone may account for lower rates of burnout, because I find joy in following the long-term health of families and individuals.
My scope of practice is broad, including maternity care, pediatrics, upper and lower endoscopy, emergency medicine and hospital medicine. Previous studies have shown that a broad scope of practice contributes to resiliency.
I am fortunate to live and work in Valdez, Alaska, which I consider to be the most beautiful place on Earth. I live within walking distance to work. I find that getting out into nature and exercising have a tremendous impact on my resiliency. I have never understood why some physicians work in a town or city they hate so they can go somewhere they enjoy during their time off. Why not live and work in a place you truly love?
The causes of burnout are multifactorial. I have found that political strife within our community, moral injury from tragedy that my patients experience and administrative burden are all contributors.
Ultimately, for me, the sense of mission trumps all else. I care for my community. I see my patients in the grocery stores and at the schools. I know that I have made a difference. I see it every day. That sense of mission propels me out of a warm bed in the middle of the night to go to the hospital in an Alaskan winter snowstorm. It sustains me when I have a difficult encounter in the emergency room or when I must deal with prior authorizations on behalf of my patients. In a rural community there is less separation from what matters, the reason we all went to medical school in the first place, to care for people.
John Cullen, MD
Board chair, American Academy of Family Physicians
Practicing family physician in Valdez, Alaska
Disclosures: Cullen reports no relevant financial disclosures.