Meanwhile, in Vermont
A PCP at last
Last April I began practicing Primary Care in Vermont at Rutland Naturopathic on Thursdays. A friend of mine was expanding his clinic and needed extra hands, and I wanted a chance to help. It is a 3 hour drive one way. I leave around 5:15am in the morning, see patients from about 9-4pm, and return between 7-8pm. I am blazing through audiobooks and podcasts and enjoying a learning curve for the mechanics of things like insurance billing that is essentially vertical.
The licensing laws around Naturopathic Medicine in the states in which I have practiced has kept my career outside the Primary Care model. In Massachusetts, attaining licensure came with the specific concession that we would not claim the title PCP. However, it was how I was trained and with the system inverting more precariously every day to balance a wealth of specialists on a dirth of PCPs, I wanted to get in the ring. I was able to contribute to the pandemic response though work on the Contact Tracing team, but being excluded from clinical care was painful.
More importantly, I needed to remember the value of what I know and keep pushing for ways to use it effectively and with humility. In the Boston area, I continue see people with complex, chronic symptoms or diagnoses. In Vermont, I see these things earlier in the diagnostic progression and it is mixed with acute issues.
In Vermont, I can take insurance, including state Medicaid, so I am able to see folks with diverse education, work history, housing stability, and other social factors. It reminds me how powerful the daily habits can be and how elite this medicine quickly becomes. Are the diet suggestions that I make sound for someone with IBS working in the financial district of Boston and also for someone who is navigating the shelter system? In Vermont, I’m also pushed to incorporate the diets of folks who wildcraft some of their food or who grow enormous gardens and hunt as a significant portion of their diet. Sedentary hibernators are mixed with lots of people who spend hours a day hiking, horseback riding, skiing, and chopping wood.
I have lots to write about specific experiences, but as a point of return, I want to say that this choice to split my practice between my virtual work in Massachusetts and my in person work in Vermont grew out of some challenges that reminded me how key it is for me to feel useful. At the heart of every case that defies expectations across the history of humanity and the expanse of medicine, is a connection to something greater. The most fortunate are strong threads in a tightly woven community. The rest of us must orient towards the star that guides us ever forward. I was discouraged and I did what more of us probably need to do. I stopped making noise and I listened very, very hard to see where I was called next.
More soon.