Jun 28

Rural Psychiatry

By Dr. Micaela Wexler
I am a  psychiatrist working in a rural setting in Missouri. I provide both inpatient and outpatient care, as well as consultations on the medical unit, and emergency psychiatry. I treat children, adolescents, adults and geriatric patients. My specialty is treating family psychiatry.
I received my medical degree from Western University in Pomona, CA, and completed my residency in psychiatry at Kansas University Medical Center.
When I accepted this job right after residency, I had several fantasies about what I would experience.  I thought it was going to be an easy way to pay off my student loans and  I felt guilty signing the contract.   I thought I would have enough leisure time to learn how to play golf, remodel a Victorian house, and  make a quilt. I was worried that I would be bored at work and lose all the skills I had learned in residency. On the other hand, I was very scared about the statistics involving substance abuse and suicide for rural physicians, especially psychiatrists.
Three years into my job, none of these fears, or fantasies, have come true. I decided to preserve rather than remodel my Victorian house. I still haven’t made a quilt.  But, no, this job is not boring, and I won’t lose my skills. Rural psychiatry is hard work, but it is very rewarding. Every single day I see a new, challenging case. I see between 20 to 30 patients a day.  And, I have been forced to learn new skills: autism assessment, family therapy, marriage therapy.
My patients have complex situations; the suicide rate is much higher than in the urban setting; the unemployment rate is difficult to confront; and, the substance abuse problem can be mind numbingly overwhelming.
My biggest challenge is confronting the severe shortage of mental health services day after day. And, while I do feel overwhelmed at times, I also have had many days when I see the hopefulness that comes from helping people through desperate situations.
And, there have been some wonderful surprises for me. My neighbors are phenomonemal, making sure I am safe and well cared for. The employees also take care of me. Something I did not expect at all from a small town is the openness neighbors and hospital employees have shown about my “alternative lifestyle.” To them, I am not part of a “lesbian” couple; I am simply part of a couple. Everyone has been so welcoming to my partner, me and our daughter. People here have their priorities straight: they LOVE children, and it doesn’t matter to them how those children got here.