One of my most formative professional experiences occurred early in my career. I received a National Health Service Corps scholarship to help pay for medical school and was obligated to serve two years in a designated physician shortage area as payback. For a host of reasons, all bureaucratic and irrational, the term of my service began after just one year of graduate medical education, a surgical internship. The only place that would have me was Randolph, a small, very rural town in the southwestern corner of New York State.

I was to be the only physician — the “Town Doc.” I had an office in an old converted fire station, a receptionist and, thank goodness, a very experienced physician’s assistant (PA). Thirty miles away was a 20-bed hospital with a pediatrician, internist and general surgeon on staff. Tertiary care was available 90 miles west in Erie, PA and 70 miles north in Buffalo, NY.

I rapidly realized that, due to my lack of experience, I would have to depend on others if I was to meet the medical needs of my community. A “mini-integrated delivery system” was born with the PA and me as the primary care initial point of contact and the pediatrician, internist and general surgeon as our back up should things get too complicated.

Based on the experience of our back up, specialists in Buffalo were identified and referral relationships developed rapidly. This team approach allowed a very inexperienced physician to credibly meet the primary care needs of the community. The importance of our medical outpost to the local populace could not be overstated. Without us it would be at least a 30 mile drive, frequently in very inclement conditions, to access even the most basic of services.

As I have contemplated the development of our integrated delivery system, I reflect back on these times and the lessons learned with some frequency.  The critical need to have ready access to primary care, the benefits of linking primary care to other components of the health care delivery continuum and that a team approach synergistically maximizes the impact of each team member. I believe these are good lessons for all of us to keep in mind in an era of health care reform.

John Brumsted, MD, CEO, The University of Vermont Medical Center and The University of Vermont Health Network.

John R. Brumsted, MD is the President and Chief Executive Officer of the University of Vermont Medical Center and the UVM Medical Center Partners.

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