After over 30 years as a permanent primary care provider, Dr. Stephen K. from San Francisco, California, has recently completed his first locum tenens assignment across the country, in Vermont. After selling his CA practice in 2017, Knox worked in another primary care facility for about three years, and then took over an older doctor’s practice for three more. Finally, after an additional stint in urgent care, Knox decided to explore locum tenens options with his Barton recruiter Peter Matu.
“Peter was reminding me the other day that I guess I just contacted him once, and we kind of hit it off.” said Knox. The two bonded over a Kenyan connection, as Matu is a native, and Knox has visited before. “It was almost every day he was calling me with something, someplace else.” Knox said he ended up in the VT clinic after hitting it off with one of the doctors who runs it. That, combined with Knox’s New England college ties was enough to move him to the green mountain state for six months.
“I’ve always worked in urban practices, I trained in New York City, and then San Francisco and suburban, but… it’s semi-rural here and you know, Rutland is a town of about 15,000 people, but, you know, it gets suburban and then rural very quickly.”
Knox said the clinic he worked at was a federally qualified health center (FQHC), which meant anybody and everybody were welcome. The clientele ranged from local business owners and manufacturing workers, to homeless people who had been put up in local hotels for the winter.
“The social determinants of health have been very different here, you know, in California, certainly San Francisco… It’s much more health conscious than it is around here. And so the problems have been quite a bit different,” said Knox.
Knox said back in CA, “people do tend to take care of themselves. But here, you know, smoking, obesity, those kinds of issues are much more prevalent than they were in my practice in San Francisco and any of my practices in… or throughout the Bay Area.”
“Now, I’ve worked in homeless clinics before and I’ve worked in emergency rooms in the cities. And so, I’ve always treated a whole spectrum of patients, but [Vermont] was pretty intense. There’s a lot of illness here. A lot of illness and it has not been boring, that’s for sure,” he said. “It really took me out of my comfort zone, and as one of the things about being in a rural semi-rural area is, you know, there is a doctor shortage out here.”
From Rutland, the Dartmouth Medical School is about an hour and a half away, and The University of Vermont is about two hours away. These are the two largest medical institutions in the state, and according to Knox, many residents are forced to make that commute for care.
“There’s a shortage of some specialists out here and that has been a challenge. You know, it challenges my knowledge of internal medicine,” said Knox. “I have been frustrated by it, to be honest with you…. But at the same time, people for the most part have been very grateful about the care… a lot of people, you know, we’re just happy to be heard sometimes.”
Knox said as opposed to back home, “things move a little bit more slowly in terms of how quickly people can get into subspecialists,” in VT. “And so the responsibilities were greater.”
Even after three decades of practice, dealing with a different patient pool and set of practices proved to be challenging for Knox, leading to lots of learning. “There’s a lot of illness out here… a lot of people who don’t have those resources here and it sometimes is very difficult to help… I think I’ve been challenged throughout my career no matter what I’ve done but… Difficult cases were much more common here than they’d been throughout the rest of my career.”
As a result, Knox said his locum tenens experience provided him satisfaction and has made him “more comfortable with going outside, not my area of expertise, but just kind of stretching myself a little bit in terms of evaluation treatment.”
Moving forward, he said he will likely pursue further locum tenens work with Barton Associates following a short hiatus.“Everybody that I’ve worked with at Barton has been very personable, but very efficient at what they do. Very effective in what they do,” said Knox.
Though he enjoyed his journey to the northeast, Knox thinks he may have spent his last winter in the snow. “Peter and I are still actively working together… talking to somebody in the San Francisco Bay Area about a job and so hopefully we’ll get that set up again,” he said. “But to be honest with you, now on like a 20 degree day, it’s not so cold anymore.”