Growing up in a small town with a mother who had been a physician there for decades was both a blessing and a curse for Mary Finta, MD ’19.
“We couldn’t get through the grocery store in any less than an hour because she would run into people she knows all the time,” Finta laughs. “But I think it’s cool that a community can be that tight knit, that your physician or health care provider can offer you really great care and also just be a normal person out in the community who you see on a regular basis.”
As safe and as nurturing as Marshfield was, the city of roughly 20,000 people in central Wisconsin was not where Finta envisioned spending her adult life. Like most teens who graduate high school in a small town, she said the last thing she wanted to do was stay, so she opted for a big city environment by enrolling in college at the University of Minnesota Twin Cities.
But during a study abroad program in Spain, where she was stationed at a rural nursing home, a newfound appreciation for small town life came into focus.
As she shadowed nurses and geriatricians making their rounds and going through their daily routines, she was exposed to the creativity required by rural medicine providers and the unique relationships between the doctors and patients. If the hospital didn’t have the resources to do the things available in larger, more urban centers, such as a CT scan, the doctors would come up with other ways to answer the question that needed to be answered.
And it was striking how deep and invested the relationships that developed between doctors and their patients were, she said, most notably those of a veteran geriatrician who had worked at the same rural hospital for decades, and his patients — a lot like her mother back in Marshfield.
“I thought that was a really creative approach to medicine, being able to rely on your intuition a little bit more,” she says. “And I just appreciated the sort of relationship that you can get that isn’t always possible at a larger center. Like, he would see them at the grocery store and want to say hi to them and talk to them. I just thought it was cool that they could forge those deeper relationships.”
A special homecoming
Having earned her medical degree in May 2019 from the Wisconsin Academy for Rural Medicine (WARM) — the program within the University of Wisconsin School of Medicine and Public Health that prepares medical students to work in rural areas — Finta spent the past two years following her passion for rural medicine that had first been sparked in the Spain countryside. And she’s done it, in all places, at the same Marshfield facility where her mom has worked for nearly 30 years, as she did rotations at WARM’s Marshfield Clinic Health System/Northern Academic Campus.
“For me there’s something really special about working in the same hospital as my mom,” she notes. “I think it’s really cool that she’s spent her whole life here and has really built up a practice, and now I get to sort of follow in those footsteps a little bit.”
Now, when Finta goes to the grocery store or the library or walks around town, she’s stopped by her own patients, not her mom’s. What annoyed her as a child now points to the unique opportunities present in rural settings for developing relationships that go beyond the walls of the hospital.
But she approaches these interactions carefully, so as not to breach confidentiality, she explains. Besides, her patients usually want to talk about their kids or their days — normal, casual conversation, in other words — not their medical conditions.
Challenges of rural medicine
While rural medicine provides opportunities for a more creative, person-centered approach to health care, it also presents various, distressing challenges. For instance, health disparities are a persistent challenge in rural medicine. Partly due to a lack of resources — especially compared to urban hospitals — and high levels of uninsurance and underinsurance, rural populations have worse health outcomes than their urban counterparts.
There’s also a significant geographic shortage and maldistribution of physicians in Wisconsin. While about 30 percent of Wisconsin residents live in rural areas, only 11 percent of physicians have rural practices.
Geographic isolation, lower socioeconomic status, higher rates of health risk behaviors, and limited job opportunities also contribute to these health disparities, according to the Rural Health Information Hub.
“Growing up here, you don’t think about things like health disparities and patients who don’t have insurance or who are undocumented immigrants who can’t get insurance,” Finta says. “So, coming back here and seeing that those are still very real issues in a rural setting, where there are not necessarily resources to address those things all the time, has been really interesting for me to try to figure out.”
How to address health disparities when there are not ample resources to go around has been the mission of both Finta and the Wisconsin Academy for Rural Medicine, and Finta said disparities are especially bad at Marshfield’s free clinic, which serves uninsured and underinsured people, including undocumented immigrants.
To stretch its resources, the clinic has had to get creative. For instance, it hosts a diabetes clinic each month solely dedicated to improving diabetes outcomes. Insulin is expensive, so patients who have too much will donate it, allowing those without insurance to access the essential drug without going bankrupt.
The importance of insurance to health outcomes applies to much more than just diabetes, Finta explains, and the free clinic is continually working to better meet needs.
“I think the free clinic is helping, but there’s certainly still a lot of progress to be made,” she observes.
Invested in communities
While Marshfield doesn’t necessarily have the advanced lab or diagnostic testing that some urban hospitals have, living and working in a rural center gets doctors invested in the community and wanting to serve it outside of the hospital, she says.
“People who choose to practice rural medicine tend to be very invested in that cause, so the people around you are really working toward the same goal that you are in wanting to bridge the gaps between those who have resources and those who don’t,” she shares. “I think it’s really special that everybody is in this place in the middle of nowhere because they want to be here, and they want to make this place a healthier and better place for people to live.”
Although her time at Marshfield is over, she’s keeping an open mind for her future plans. She will do an internal medicine residency at University of Michigan in Ann Arbor, a place she said will be great for training purposes while also retaining a small-town feel. She could see herself returning to a rural area, though.
Finta concludes, “I think there’s a lot of need in rural communities, and I want to be one of the people who can help meet those needs.”
By Parker Schorr
This article appears in Quarterly magazine.