While some of his classmates dream of high-profile medical practices in urban hospitals, Lance Harmon has a simpler -- and more complex -- medical practice in mind.
He'd like to be a country doctor, practicing in a town where everyone knows everyone. Where patient and doctor worship together on Sunday and volunteer for the PTA together during the week. He likes the idea of knowing his patients in many ways and taking care of whole-body health needs, rather than just parts of the body.Give him a town of about 10,000 people and he'll be a happy man. In such a place he'd like to settle down with wife Cerisa and their three small children.
But Harmon's dream of a small-town practice is the exception, according to Robert J. Quinn, coordinator of the new Primary Care Preceptorship at the University of Utah School of Medicine's Department of Family and Preventive Medicine. And that's part of the reason the school's faculty decided it would be a good idea to send fourth-year medical students into rural communities, where they can work with people who don't have as many medical options as their urban cousins.
"Many in the future will be working for profit in city hospitals. Without this experience, they might never have an understanding of what it means to serve with underserved populations," said Quinn.
U. medical students spend a lot of time in the classroom, he said, and perhaps "not enough time in clinical settings." The preceptorship is part of an "instituted curriculum reform."
This year, the program is an elective. Starting next year, all fourth-year students will be required to choose from family practice, obstetrics or internal medicine and leave the city behind for six weeks.
Not surprising, perhaps, Harmon was the first student to sign on. He spent the summer in Richfield, working with Dr. Jeffrey Chapel.
It's a contrast to the medicine that students learn at one of the country's premiere hospitals, Harmon said.
"I think it's to get the students away from the ivory tower university setting and help them become more familiar with the struggles and kind of where the rural practitioners are coming from as far as the facilities they have and what they can and cannot do in rural settings, as opposed to the university setting where most of our training is done," he said.
In the university setting, patients often come to a particular doctor by way of referral, after a lot of the workups have been done and a diagnosis made.
In Richfield, the doctor and the doctor-to-be often start from scratch, first studying, then diagnosing and treating a patient. And the types of medical needs they met are broader than many doctors will face in a daily practice.
"While I was there, we saw a lot of strokes, ATV accidents with leg fractures, everything. In a family practice you see a broad spectrum of general medicine," Harmon said.
They also delivered a lot of babies -- 15 to 20 in a month. Chapel "was probably working 90 to 100 hours a week. I ended up working at least that, because I put in another 30 or so on a public health project."
The public health project is another course requirement. After assessing a community's needs, the students are required to tackle a community health problem. Harmon chose an education program to prevent the spread of a sexually transmitted disease.
The preceptorship strengthened Harmon's resolve to practice medicine one day in a rural setting. It is in a smaller community that he believes he will be able to "use neighbor relationships to care for them as a physician and understand where they're coming from in their family settings more intimately than I might in a larger community.
In a small town, he said, "I feel like I can actually as an individual make a difference in the health-care trends of the community."