I've dealt with many frontier emergencies throughout my career -- some of them life-saving, but nothing quite eclipses the experience of being the only medical provider to coordinate care for a man carrying his severed arm. In that moment I was reminded that as a rural health physician assistant (PA), I must be prepared to make quick life-or-death decisions for whomever walks in the door.
Now working as a primary care PA at a remote health clinic in rural New Mexico, I see injuries that can be just as jarring as the man holding his own limb. From hard-working community members with ranching and bull-riding trauma injuries to the elderly battling diabetes and children with infectious diseases, each patient interaction comes with unique and sometimes unexpected challenges.
My clinic -- the most remote within its network of clinics -- is situated in a town of about 1,600 people, predominantly Hispanic, about 3 miles north of the Mexican border (I use Spanish to converse with roughly 90% of my patients). It's an outpatient setting that relies on resources from hospitals to coordinate ambulance services or summon Life Flight helicopters for medical emergencies. This system operates similar to other rural clinics and hospitals -- allowing remote providers to address holistic patient needs and work largely autonomously.
Working in literally the middle of nowhere is where I've wanted to make a difference since I decided to become a PA. After I convinced Duke University to take me on for PA school, I was passionate about using my education and skills in some of the most remote towns in America for folks who otherwise might not have access to affordable, high-quality care. And that is what I now do every day.
However, sacrifices and risks underlie rich rewards. There are undeniable economic obstacles that my patients face -- being at or below the poverty level, being uninsured. Some of my patients are undocumented.
For them, I'm their only option for care because they cannot travel south to the border or north toward border patrol checkpoints. These realities add a layer of complexity to working in rural medicine -- a tough sell for PAs who must consider educational limitations and cultural and social differences in these small communities. Smaller patient populations can also be more demanding on the clinician due to provider shortages and the wide range of patient problems.
While working in a rural setting complements my desire to live in isolated pockets of the country, professional isolation is a reality. My collaborating physician works 50 miles away but is always reachable by phone, and the next nearest clinic is about 40 miles north. Since I chose to reside in the community where I practice, I've become somewhat of a "celebrity" within the community. People stop me on the street or ask me to look at their knee in the post office. I try to keep a low profile because I don't want to get trapped in the dairy aisle at Walmart.
Ultimately, it's a trade-off for rural healthcare providers. While suburban and urban areas typically offer higher compensation packages, access to sophisticated technology and more specialty opportunities, rural settings give me the independence to handle a full spectrum of cases, often outside the immediate reach of a physician. Less technology and resources require me to depend more on the fundamentals of my generalist PA education and skills gained through practical experience. For instance, I must know how to do everything from putting on a splint to performing Pap smears and reading x-rays. My clinic doesn't have a CT scanner, so I heavily rely on my physical examination skills to diagnose and treat patients.
I started working in rural areas because I wanted to improve the lives of those with few options. Every day is a test of my skills, readiness, and endurance. I continue because I love my community and the relationships I've built with patients -- who are my neighbors and friends. It's a privilege to have their trust, and it's a privilege to be here for people in this way.
Kristy Thomas, MS, PA-C, has been certified by the for 18 years. She has practiced in primary care at a number of rural clinics throughout Alaska, Nevada and New Mexico. She lives on an 80-acre ranch in rural New Mexico with six dogs, 26 cows, one horse and three roosters. She's also an avid international traveler, having visited Honduras, Turkey, Peru, Nepal, Egypt and Mexico for medical missions and other adventures.