By Austin T. Smith, MD
I trained at an urban facility (Vanderbilt University in Nashville, TN) and fell in love with my department, academics, and the city of Nashville, TN. I stayed on faculty after training with the full intent of remaining in an academic career. I published multiple peer-reviewed manuscripts, became a reviewer for several journals, served on committees, helped develop multi-disciplinary institutional protocols, among several other projects. I was well on my way to an academic career and excited about my career trajectory! My family enjoyed our city, I enjoyed my job, so we had no plans to leave.
Life, on the other hand, had other plans for us.
My in-laws moved to Utah and after a complicated pregnancy, my wife wanted to be closer to family. Moving, and essentially changing careers, was an extremely difficult situation for me. I had my dream job, but my wife really wanted to move. She was incredibly understanding and left the decision to me, but ultimately, I decided family was more important than my career. We decided to move to Heber City, UT where I would be a community emergency physician in Heber City and Park City.
Choosing family over career was an obvious choice for me, but it didn’t mean it was easy. I knew I would miss the Level 1 Trauma activations, the academic opportunities, and extreme patient acuity level. Being in a rural setting sounded boring, unexciting, and was frankly not something I wanted to do.
When I first started the job, I really didn’t like it. It was probably more because I missed my old job and colleagues more than anything “wrong” with my new job. However, it grew on me.
My procedural skills improved exponentially. When you’re in single coverage and your consultants are either non-existent or not in house, you learn and hone skills very quickly. What was (and, likely at most places, is) a consult is suddenly now a bread-and-butter procedure. While we do have a tertiary care center fairly close by, patients often don’t want to be transferred and weather frequently makes the tertiary care center much further than the actual mileage.
In addition to enjoying this new level of autonomy that isn’t present in large academic centers, I also fell in love with the family environment of my new hospitals. Everyone knows everyone. That includes doctors, nurses, techs, environmental services, maintenance -- everyone! The camaraderie is unprecedented. Conversations with consultants are conversations with friends. They are productive, patient-centered, and respectful. That family-feel creates a level of trust and it feels like anyone will do anything for each other. Even with the stresses of the pandemic, that wonderful culture has been preserved because it is so deeply rooted in the hospitals and community.
As I warmed up to the idea of actually enjoying my new job, there was a moment when I suddenly realized I didn’t just enjoy my job, I loved it. I was at a restaurant with my extended family when a hostess recognized me and went on and on about how thankful she was that I “fixed her finger.” She had the restaurant owner, chef, and lead bartender come out to the table to introduce themselves and made sure that we were well taken care of. I realized at that moment how incredibly special it was to take care of the folks in my small community.
There is nothing more rewarding than taking care of the people you see every day whether that be reassurance, laceration repair, resuscitation, or the behavioral health patient. Since then, I have been recognized and thanked by so many people in public. It’s also almost monthly that a card or even gift basket arrives at the emergency department thanking staff for their care.
Sure, I miss my old colleagues and academics. But I’ve found ways to remain involved in academics, and more importantly, I could not be happier taking care of my community and having made a decision of family over career. While this was not the career I saw myself in, it is more fulfilling than I ever could have imagined.