Prof Bill Ventres - Healthcare on the Margins & Storylines of Family Medicine

Prof Bill Ventres is a family physician, medical anthropologist and (recentrly retired) Distinguished Chair of Rural Family Medicine at the University of Arkansas in the USA.

 

Episode Summary:

1.30  Bill tells us about his professional background and how he became interested in rural health

04.30  What made him choose to live in El Salvador?

09.30  What has he most enjoyed about living and working in rural areas?  What did he find most challenging?

13.45 What is Arkansas like, what is the context there like?

19.00  Storylines of Family Medicine - why did he decide to do this project?

29.45  What are some insights about practicing in rural and remote contexts?

33.05  What insights has he had in his work on rural workforce development?

36.20  What were the main challenges for building a rural workforce?

38.55  What are some possible solutions to rural workforce challenges?

43.30  How are rural and urban practice similar and different?

49.15  What would his top advice be to policy makers?

51.10  Top three tips for students and early career professionals thinking about a rural career

 

Key Messages: 

He has spent his career working with people who find themselves on the margins of society.  

He started his work in urban underserved settings.  After spending some time in El Salvador he returned to Arkansas and started working in rural areas.

He is now a student of Latin American Philosophy while living in El Salvador. 

Many people in rural and underserved areas feel left out, many people in rural and underserved areas feel on the margins of a greater society, and that the medical system does not really attend to their needs. 

He most enjoyed listening to the stories his patients told and hearing about the experiences that people had.  That is one of the wonderful things about being in a small practice, one really gets to know the pulse of all the people in the community. 

The biggest challenge were the not so happy stories about access.  No one wants to be number one in maternal mortality, it is a problem of rural poverty and exacerbated by a long history of exclusion and structural racism. 

Arkansas is economically the third poorest state in the USA.  There is one larger city, Little Rock, famous for what happened in 1957 when the president sent troops so that 9 teenage black children could attend the local white public school and that was the beginning of desegregation. The rest of the state is rural. Walmart is based in northwest Arkansas, so that part of the state has seen a revival.  There is huge income inequality.  

Storylines of Family Medicine - this is a published series of papers that shares reflections on family medicine from residents and family physicians.  

For caring for a community of patients the medical model does not work well for the kind of things that we encounter in family medicine.  

There is a transcendental nature to the work that we do in family medicine.

The biggest cultural barrier is between medicine and real people.

He was interested in hearing what motivated other people (family doctors), they told their stories of what was the one tenant of practice that motivated them.  He asked 136 doctors to share their story in the form of short essays.  

Family medicine means attending to the needs of the patient whatever they may be in the context at hand. 

Modern rural medicine uses up to date knowledge transmitted to rural communities, rather than the traditional model which sends rural patients to urban centres. 

The presence of a physician and the presence of a hospital helps to support small rural communities.

The future is in the hands of young family physicians.  Find other practitioners who are like you and work together to speak up, advocate and receive support.  

We all need support, and in rural areas sometimes that is hard to come by.  We need to find people who hold similar values and share a similar vision of the importance of the work we do. 

Challenges are financial, attitudinal, geographical, and unanticipated consequences of AI in medicine.  

 

Embed yourself in a community, find a community and do that work. Be open to a different way of seeing that work than what you learned in your medical training.

We should be training people to be socially accountable to their community.  Understanding the needs of rural communities form the biomedical point of view and the social community point of view.  

It is important to find people and institutions that are helpful. Finding someone whose ideas can resonate with yours. Some international organizations such as WONCA or TUFT and Deep End Project.  Linking with organizations and groups like that to become a collective course.

Burnout is about not having true meaning behind the work that you do.  

Have students in your office so that you can pass things on.  

People living in the interstitium of society are similar in rural and urban areas.  

 

Rural health is being disappeared in the US and funding is being cut off at present - stay the course.

If you don’t feel comfortable advocating, find someone who is.

Medical education is stuck in a model that isn’t working for rural health, let people know, show the work of rural medicine to new generations of physicians.

 

There is a richness to the work and it can be incredible

Be in it for the long haul.

I am I and my circumstances.  Grow that self over time.  The work I do is worthy and my circumstances, the rural circumstances that I chose helps to engage me, and I reciprocally engage the community.  Bring that to patients.  

 

Thank you for listening to the Rural Road to Health!

Rural Health Compass