Kristy Thomas, MA, PA-C
Rural Health: “Not Glorious, but Sure as Heck Rewarding
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 PA, I must be prepared to make quick life or death decisions for whoever 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 locals 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 inhabitants, overwhelmingly Hispanic, about three miles north of the Mexican border. It is an outpatient setting that utilizes 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 rural America for folks who otherwise might not have access to affordable, high-quality care. I meant it, and that is so what I do every day.
However, sacrifices and risks underline rich rewards. There are certain economic and cultural obstacles since most of my patients are uninsured and at or below poverty-level. Some of them are illegal. For about 90 percent of my cases, I communicate in Spanish to patients who live on the “island” of Columbus. For them, I’m their sole option because they cannot travel south to the border or north towards the border patrol check point. 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” among the locals. People want 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 a pap smear and reading an x-ray. 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, but 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.
About the author:
Kristy Thomas, MS, PA-C, has been certified by the National Commission on Certification of Physician (NCCPA) Assistants for 18 years. She’s 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 since the age of 17, having visited places like Turkey and Cozumel for scuba diving, Machu Picchu, Peru and Nepal for trekking, Egypt for pyramid exploration, and Honduras and Mexico for medical missions, among other adventures.