Psychiatr News May 2, 2008
Volume 43, Number 9, page 9
© 2008 American Psychiatric Association
Rural Psychiatry Isn't Easy, but Rewards Are Ample
Aaron Levin
Making a success of psychiatry in rural Taos, N.M., means putting a
career together piece by piece to create a challenging and never boring
mosaic.
Each morning, psychiatrist Bob Franklin leaves his house in the woods and
drives down a dirt road, past the herd of buffalo, to the little crossroads
where he sometimes stops for breakfast at Abe's Cantina. Four days a week, he
heads straight on to his office in Taos, N.M. But on winter Fridays, he turns
right instead of left at the stop sign by the Arroyo Seco Elementary School
and follows the winding road up through the steep-sided valley to the ski
slopes a dozen miles
away.
| |
Psychiatrist Robert Franklin, M.D., M.P.H., relaxes on the porch of a
local restaurant in Arroyo Seco, N.M. Franklin balances clinical work at his
office in Taos and several other venues with family life—and the
occasional day skiing—in the mountains of northern New Mexico.
Credit: Aaron Levin
|
|
Attractive as it is, the scenery and the skiing aren't the only reasons
that Robert Franklin, M.D., M.P.H., has created a psychiatry practice in rural
New Mexico that fills a niche for patients and for himself.
Franklin's career has had its twists and turns like the dirt road from his
house. In that way, he reflects colleagues who work in Taos, population 5,193,
and best known as a vacation spot for skiers in the winter, hikers in the
summer.
Franklin took an unusual path to psychiatry and to Taos. He grew up in Los
Angeles, the son of parents from a small town in Montana. After medical
school, he pursued a residency in general preventive medicine at Tulane that
included a master's degree in public health from Tulane's School of Public
Health and Tropical Medicine. He took a faculty position there and worked in
French-speaking West Africa where he created a regional public health school
and taught epidemiology and statistics. The school provided a series of short
courses for African doctors who often served both as clinicians and health
officials and couldn't leave their practices for the years of full-time study
that existing public health schools demanded.
After 25 years of transatlantic travel and life as an expatriate academic,
Franklin decided it was time to do something else. That change of pace turned
out to be a three-year residency in psychiatry at Tulane starting in 1994. He
also wanted to raise his children in the United States. He moved to Taos in
2000—his wife grew up 70 miles south in Santa Fe. For two years, he
worked at what is now called the TriCounty Community Services, a state-funded
clinic.
After that initiation, he cobbled what he calls a "chessboard"
working life, putting together bits and pieces to make up a (mostly) full
workweek.
"I see myself as a community psychiatrist," said Franklin in an
interview. "About one-fourth of my patients are on Medicaid, some are on
Medicare, and the rest have private insurance."
He trains primary care doctors in identifying and treating depression,
anxiety, and bipolar disorder under a grant program that also provides money
to pay psychiatrists to consult with the primary doctors when they need help
with psychiatric cases.
Accepting insurance has opened the doors to a lot of work, although it
meant hiring an office manager who spends half her time talking on the phone
to insurance companies about the same kinds of problems that psychiatrists in
other areas face, he said. "But I've never been turned down for a
diagnosis or treatment."
Franklin's odyssey through public health influenced his choices of where
and how to practice.
If he lived and worked in Santa Fe, the state capital and a town far
wealthier than Taos, he might charge much more, he said, "But that's not
what I'd want to do."
'Working to Live'
It's not entirely what Michael Dudelczyk, M.D., wants to do either.
Dudelczyk lives in Santa Fe, but has worked part time in Taos for 30 years. A
New Jersey native, he came west after medical school at the New York Medical
College.
| |
New Mexico's great open spaces and snow-capped mountains are a draw for
visitors and residents. They also create challenges for providing mental
health services to a widely scattered, ethnically diverse population.
Credit: Aaron Levin
|
|
He did his residency at the University of New Mexico, a child psychiatry
fellowship at the University of Colorado, and stayed—"I did my
city time," he said. Over the years, he's run inpatient and outpatient
units but now practices on his own at several sites, a practice pattern that
"just sort of happened," he said in an interview.
He spends two or three days a week at TriCounty Services or the Casa de
Corazon family and children's clinic in Taos, plus a day every other week at
the Taos Picuris Clinic of the Indian Health Service. He couples that work
with a day or two a week in a more middle-class private practice in Santa
Fe.
Another psychiatrist, Debra Solomon, M.D., spent 19 years in solo private
practice, accepting no insurance, in Providence, R.I. A few years ago, she and
her husband "felt the call" of a new lifestyle and followed it to
New Mexico.
"Taos is a magical place," she said. "Life here isn't
about what you do for a living. People around here work to live, not live to
work."
Solomon, too, works at TriCounty Services two days a week, anchoring her
development of a separate "healing practice" attuned to the people
who consider Taos a "spiritual Mecca," in her words.
Both Solomon and Franklin noted one epidemiological curiosity in their
practices.
"I've never seen so much bipolar disorder in my life," said
Solomon. "I think bipolar is way overdiagnosed, but I don't know if the
prevalence here is environmental, or maybe [people with bipolar illness] feel
more accepted here."
Collaboration Helps
Caring for people with psychiatric disorders is a collaborative task in
small towns. Franklin largely does evaluation and diagnosis, coupled with
medication management. He refers patients needing psychotherapy to one of the
100 counselors, of every variety, who work in the area.
He's also supervised three fourth-year University of New Mexico psychiatry
residents who have worked at the clinic since he's been in Taos. If he could
lecture to medical students about their future working lives, he'd tell them
how to combine rural practice with earning a decent living. It took him a
while to get his practice up and running, but now he lives where he wants. At
the urging of one son (who is now in college), he's taken up competitive
mountain-bike racing. Another son, in high school but spending the semester in
Italy, plays the violin and inspired Franklin to take up the cello in his 60s.
(Two younger children still live at home with him and his wife.)
Even at Tulane, he gravitated to rural settings, where strong family ties
meant that some relative was willing to take responsibility for a patient, he
explained.
"In urban areas, people were often lost souls with nobody to help
them," he said. "In the countryside, the family became case
managers."
Franklin understands that many physicians coming out of residency look for
the steady paycheck of a salaried job, but the need for psychiatrists
everywhere opens opportunities.
"You don't get rich doing rural psychiatry, but you are your own boss
and can set your hours," he said.
He also noted the drawbacks.
"I can't go anyplace in this town without seeing a patient," he
said. "I feel I'm part of a community and doing a service, but it's not
easy. If I were single and dating, I wouldn't feel comfortable at
all."
He tries to take cues from patients about how to respond when he encounters
them on the street and talks to them in the office about how to handle social
situations in which they encounter each other.
A certain professional loneliness can set in too. New Mexico's Rural
Community Psychiatry Network helps overcome that to some extent. The network,
based at the University of New Mexico in Albuquerque, includes about 60
practitioners, meets face to face twice a year, and uses conference calls in
between to trade shop talk, answer practical questions, and overcome the
isolation.
All these elements, taken together, make up the small but complex practice
of psychiatry in Taos, N.M.
"There's always a satisfaction in helping people," said
Dudelczyk, by way of summing up. "I can make a difference and make a
living. It's been good."
Related Articles:
-
Rural Psychiatry Residency Bridges MH Care Gap
- Aaron Levin
Psychiatr News 2008 43: 13-45.
[Full Text]
-
Psychiatrists, Patients Praise Benefits of Telehealth
- Aaron Levin
Psychiatr News 2008 43: 13.
[Full Text]
Get information about faster international access.
Privacy Policy
Copyright © 2008
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
