Featured Doctor


USA : rural family doctor

David Schmitz MD is a rural family physician from Idaho in the USA. He is the author of WONCA News Rural round-up for November 2014.

What work do you do now?

The road to rural health seems to be as unique as our rural communities themselves. For me, I am still striving to derive access to quality healthcare in rural areas as the meaning for my daily work.

After graduating family medicine residency, I practiced for six years in St Maries, Idaho, USA; a town with 2302 persons and no traffic light. In this mountainous state our communities are often isolated and ensuring access to emergency care services, mental health, obstetrical care and primary care and prevention are all encompassed in the role of family physicians – but each community is unique.

I returned to the Family Medicine Residency of Idaho, in Boise, as a rural faculty member, in 2005. From curricular development focused on preparing family physicians for competent and confident careers in rural practice, to outreach and policy development, I have continued to have opportunities to grow. I am now the Program Director for two Rural Training Tracks which meld a year of training in the urban hospitals, with the second and third years taking place in rural communities. These “RTT programs” are an exception to the typical accreditation rules and have outstanding graduation rates placing physicians into rural and underserved practices (more). I also help to advise a federally funded project with the National Rural Health Association supporting RTTs across the United States. In my role as director, I see patients, precept and mentor residents, take medicine call and deliver babies – I get to be a family doctor.

I am also an active researcher. I have found that research allows us to form a foundation of evidence that, when combined with a story, provides what we need to have a convincing conversation about improving access to quality healthcare in rural areas. By reaching out and cooperating with other rural communities and providers we stay connected to what the key issues are in education and patient care. These environments and relationships are often changing due to everything from economics to use of technology. Working with partners such as our State Office of Rural Health, we have published in the areas of Rural Family Physicians Scope of Practice, Rural Physician Satisfaction and Grit, and Rural Community Recruitment of Family Physicians, the “Community Apgar Program”.

What other interesting activities that you have been involved in?

I have found that we can learn much from each other through cooperation in advocacy and in making a difference reaching out for rural health. The American Academy of Family Physicians (AAFP) recently allowed for the first time, formation of Member Interest Groups. I was able to found our group on Rural Health at AAFP, and many members have begun to interact on various topics from practice issues to workforce shortages.

I am also on the board of the National Rural Health Association, as the Clinical Services Chair. Connecting these organizations in policy and advocacy is a powerful tool to affect regulation and necessary steps in improving rural health and workforce in the United States. I have served in additional leadership roles within the AAFP, as president of our state medical association and with our state rural health association.

Becoming a part of WONCA and the Working Party for Rural Practice has been a fantastic opportunity for us. I have felt the kinship of my peer family physicians and while I am relatively new, I have been encouraged to share my experiences and my effort in our aligned mission of better health for rural patients worldwide.

What are your interests as a family physician and also outside work?

These activities keep our family very busy and in fact, my wife Shannon has joined the cause for rural health in several ways as well. Shannon is the Executive Director of the Idaho Rural Health Association and is also involved with our volunteer outreach activities to rural communities including patient education, drug use prevention and suicide prevention. Our family also enjoys camping and the outdoors. My individual interests include flying kites, trying to understand physics, philosophy and a historical approach to differential theology.

What is it like to be a rural family doctor in USA?

The United States is undergoing varying degrees of transition in healthcare delivery and at a very real level, healthcare access. Some states but not all have chosen to participate in an expansion of healthcare insurance to the economically disadvantaged (Medicaid). Public health and mental health are clearly seen as areas of need, but it is unclear how this will be organized and administered going forward. The role of the family physician is also changing to the leading of Patient Centered Medical Homes, while some family physicians are more often providing a set of services exclusively in hospitals, or emergency room settings.

There is a great deal of variety in the context of a great deal of change. Technologies such as telemedicine and the electronic medical record are still varied and their use can be seen as both innovative and disruptive to the usual way of practice. Some family physicians are employed by large systems of healthcare facilities and others have joined a new increased interest in providing direct primary care to enrolled patients separate from any outside system at all.

For rural health, we can each find our unique road to making a contribution. Mine has been as a provider, educator, researcher and advocate – and it’s a great job.