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Challenges in Rural Medicine

Challenges in Rural Medicine

When talking about the community in which Daniel Singleton practices medicine, the word "underserved" might actually be an understatement.

Singleton, a family medicine physician from Buena Vista, Ga., says the closest hospital to his solo practice is 30 minutes away. "One of the major challenges to providing primary care in southwestern Georgia is that there are no doctors…well very few doctors. We have a healthcare deficit of 35 primary-care providers," he says. "It's significant."

As a young doctor, just four years out of residency, Singleton undoubtedly could have gone down a more familiar path that others his age have taken. He could have worked as an employed doctor, either for a practice or a hospital, in a large metropolitan area. Instead, he went to Buena Vista — his hometown — and opened up his own practice.

Those four years have been filled with ups and downs. Singleton spoke with Physicians Practice about the challenges he's faced in patient education, technology, and whether he can continue practicing independently in today's environment. Below are excerpts from the interview.Dr. Daniel Singleton

What are some challenges you encounter with practicing medicine in an underserved community?

It's the same challenges everyone has working with an underserved population. Generally underserved means lower socioeconomic status. From that, you have [lower] levels of education and understanding of the disease process, and all the other socioeconomic strains that cause most of the [problems] we have to deal with in the healthcare system. It's rural poverty.

I'd say 80 percent have multiple chronic diseases. We're kind of like a food dessert. My patients don’t have access to reliable nutritious food. They haven't had access to reliable primary care for more than a generation. No one has ever told them they can't eat Cheetos if they are a diabetic. And it's not like there are many other options anyway.

What makes you continue to serve in these communities?

This is my hometown. This is where I grew up.  Geographically, we're not that isolated. We're an hour and 20 minutes from airport in Atlanta. … We're 25-30 miles from any big box store you're going to look for.

Also, I was a Peace Corps volunteer. I enjoy challenge. I enjoy service. I enjoy dealing with some of the socioeconomic problems associated with healthcare. This was a perfect opportunity coming out of residency to see if I could make this work as a private practice.

I've been at it for four years and economically we do OK. I am concerned with changes going to happen with MACRA [Medicare’s payment reform] and whether or not practices like mine can survive the changes. It's difficult to meet the human resource requirements to make some of that stuff happen. I try to take advantage of technology all of the time … in order to make my life more efficient.

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