University of Minnesota
August 17, 2011
Therese Zink tends to the feet of World War II vet Stanley Wegman at the Fairview Zumbrota clinic, where Zink practices two days a week. Sarah Carlson, a med school hopeful shadowing Zink for the day, looks on.
Photos: Patrick O'Leary
U professor and physician Therese Zink helps spread the word about rural medicine
By Rick Moore
It’s nearing 6 p.m. on a Friday, and Therese Zink has said goodbye to her last patient of the day at the Fairview Zumbrota primary care clinic in southeastern Minnesota. Just as her visitors from the U are about to leave the country doctor alone and head back north, Zink offers up a surprise.
“Do you want to see Jimmy?”
Jimmy is a 10-year-old miniature donkey on Zink’s farm four miles away, and the offer is too good to pass up for a couple of metropolitans.
So we travel along a dusty gravel road, enter Zink’s 20 acres along a bucolic, maple tree–lined path, and get a tour of the chicken coop and the large barn where Jimmy displays his considerable charms alongside two horses, Indy and Benia. Carrots are eaten; friendships made.
Although she’s spent many years in large cities, it’s plain to see that Zink loves the rural life. And that’s perfectly apropos, as she’s been an integral part of a University program that helps steer medical students toward careers in rural medicine.
Sampling life as a country doc
Zink is a professor in the Department of Family Medicine and Community Health at the U, and for the last six years she has been a faculty member for the Rural Physicians Associate Program (RPAP). RPAP was established in 1971 to give med students the opportunity to spend nine months practicing primary care in rural communities throughout Minnesota.
It’s a program whose need likely won’t be lessening over the coming years. Even though outstate Minnesota is thinning (37 of Minnesota’s 87 counties suffered population losses over the past decade), rural physicians continue to be in high demand. But the U has been ahead of the game in trying to anticipate and address the shortage, both with RPAP—which can accommodate 40 students per year—and the medical school at the Duluth campus, which is geared toward rural practitioners.
To date, about 1,300 students have completed the RPAP experience, and of the currently practicing physicians, slightly more than half are in rural settings, with 75 percent in primary care.
In addition to her work as a physician, Therese Zink continues to write. She's currently four drafts into a novel. Photo: Patrick O'Leary
“It's the longest running program we know of in the world that's geared toward nurturing interest in rural medicine and primary care,” says Kathleen Brooks, director of RPAP. "Those numbers are pretty amazing given the declining trend nationally of students interested in primary care."
Adds Zink: “That experience of what it’s like to be a small-town doc shows students that it’s doable and there’s really some great value to that kind of lifestyle.”
Rural roots and a need to tell stories
Zink grew up in southern Ohio and moved at age 10 to the farm where her mother was raised. Her dad was a dentist and the family had sheep, chickens, and horses. “All the biology that happens there, I was fascinated with,” she says.
She started as a pre-med major at Marquette University in Milwaukee but was turned off by the competition, so she studied English and theology instead, which winds up being very relevant. Eventually, Zink attended medical school at Ohio State, and served a residency at the former Ramsey Medical Center (now Regions) in downtown St. Paul.
While her medical career blossomed, Zink began delving more into creative writing. And as time passed, she saw the need to draw out the stories of her students, many of whom were having significant, if not profound, experiences in med school.
“The privilege of walking with patients through the best and the worst of times is a process of learning how to look intimately into people’s lives,” Zink says. “It’s really a transformative process. I think it’s important for students to understand that and figure out how to manage it.”
Zink collected some of the stories of RPAP students’ experiences in rural medicine, added stories from other rural practitioners from around the country, shared some of her own, and last year produced a book titled “The Country Doctor Revisited.”
The stories and poems are a poignant look at rural health care, its challenges, and many changes over the years.
The closing tale by Zink is about soothing the family of a dying man, and how Jimmy, whom that family earlier borrowed for a Christmas nativity pageant, unwittingly bonded them all in a time of crisis.
Donkeys don’t often play that role in Minneapolis.
A different perspective
Obviously, much has changed in rural medicine. The big black bag of the old-time country doc, as pictured on the cover of Zink’s book, is more likely to be found in an antique store rather than on amazon.com. But some aspects of rural medicine remain constant.
“You’re [still] expected to be your patients’ friend as well as their doctor,” Zink says. “That’s something we’ve been looking at with RPAP, because students are taught not to have dual relationships—that you’re either the doctor or the friend; you can’t do both.
“But that’s impossible in rural areas. Rural providers need to figure out how to negotiate that.”
Doctors handle that in different ways, notes Zink. Some choose to live outside of the community they practice in. Others choose not to socialize much within the community. Still others integrate fully but figure out a way to compartmentalize their relationships.
“We need to have more people going into family medicine and primary care,” says Zink. “For me, it’s nice to have a platform to get this message out.”
Zink seems to have the best of both worlds—urban and rural. In addition to being at the U and practicing in Zumbrota, she travels for RPAP and also works as a preceptor (overseeing family medicine residents) one day a week at the Phalen Village Clinic in Maplewood.
She balances her medical work with her writing, which is usually limited to early mornings and weekends.
“Caring for patients can be exhausting. And the writing is a way that I rejuvenate myself. You go in that creative space. And yet it’s the stories of caring for patients and teaching that give me ideas for the stories. So the one really feeds the other and vice versa.”
And while she appreciates the groundbreaking work that the U is known for in terms of medical research, she loves it when these other stories can be told.
“I think it’s nice for the University to feature this perspective of medicine,” she says. “I always say that this is not about me. This is about promoting primary care and about promoting rural health. … We need to have more people going into family medicine and primary care. For me, it’s nice to have a platform to get this message out.”
Left: Therese Zink displays eggs laid by some of the dozen chickens on her 20-acre farm near Zumbrota. Right: Zink's miniature donkey Jimmy, who has now been featured in at least three stories, one book, and a Christmas nativity pageant, prefers carrots to eggs.