Dr. Thomas Told, longtime Craig doctor, reflects on past and present work
Told stresses the importance of the family practice doctor
June 30, 2016
Craig — Dr. Thomas Told recalls growing up in rural areas of Utah and Wyoming, places with sprawling open spaces that put distance between people — including between doctors and patients.
"There was a lot of distance between where we lived and a doctor," said Told, during a recent visit to Craig. "There were either blizzards in Wyoming or mountains in Utah that kept us from seeing a doc. So as a kid, I just really felt like somebody had to go out and be an old-fashioned country doctor."
That, in many senses, is what Told became, practicing as a family doctor in Craig for about 35 years, beginning in 1974. He's now vice president for Academic Affairs for Rocky Vista University, in Parker, and the dean of the College of Osteopathic Medicine at the university. He and his wife, Mollie, keep residences in both Craig and Parker.
Before becoming dean, Told served as director of the rural medicine track at the college — an area to which he still contributes. Told, acutely aware of the need for rural family doctors, has worked hard to attract students who may want to practice rural medicine. From 2009 to about 2011 he worked to develop what he called the "rural medicine honors track."
"A lot of people would say, 'If you can't do anything else, you go out and be a rural country doctor,'" he said. "I turned that around. I took the most academically able — the top 25 percent — of the students in our school and I groomed them to be rural physicians. I gave them extra training in a lot of things that would make them a more effective rural doctor."
Told said that a number of students were interested in "wilderness medicine," and so he encouraged them to connect that interest to rural medicine.
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Told said his work as a dean has involved, among other things, prompting medical students to broaden their studies and to become equipped to reach more people.
"The more you specialize, the less people you take care of," he said. "What we need to do if we're going to take care of people out in the rural areas is we're going to have to broaden their field of interest. We're going to have to create medical students who know a little about a lot of things rather than people who know a lot about a little."
In the last graduation class, he said, 47 students out of about 150 were training to be family doctors from Rocky Vista University — higher, he said, than in recent previous years. He said he'd like to see half of the students in family practice.
"More students have gone into sub-specialties because they perceive that's where they can make more money and pay their debt faster," he said. "However, I think what we have to do is inspire students (to know) they can have a good living … and there are more programs to help students pay their loans in rural areas than there are in urban areas."
Told noted, too, the Affordable Care Act‘s emphasis on generalized medicine.
"The Affordable Care Act has (emphasized) population health, wellness, and that is a field that is certainly owned by family physicians and primary care," he said.
As Told reflected upon his career, past and present, he also described the atmosphere in Craig during his decades of practice.
"Craig went through a series of booms and busts," he said. "It was in a boom when I came, when I started on July 10, 1974."
His first patients had a ruptured appendix.
"During that time, the systems were stressed," he said. "There were only four of us (in the office). We would see tons of people in our office — we were overloaded. They'd go to the emergency room, and we'd have to shut our office down and go see people into the evening."
Told said the area later went through a "philosophic change" regarding "whether or not we should continue to have care (mostly) by family physicians, or whether we should insert specialists into care."
What followed, he explained, was an increase in specialty care doctors — a trend he's observed throughout the country.
"I think that's where we are in medicine today," he said. "We're becoming so sub-specialized … and we need to broaden our base."
He stressed the importance of access to health care.
"I think we do need to give health care to all Americans, but I believe what we need to do in order to do that is bolster the generalist," he said. "We have to put docs out in communities with broad bases, and then use the whole team: nurses, (physician assistants), physicians working together in team-based care."
Told's medical degree is in osteopathic medicine (D.O.), a field that attracted him because of its broad medical base.
"It was more of a primary care oriented specialty … and I knew that most osteopathic physicians settled in towns of under 10,000, so it was a good fit," he said.
When he arrived in Craig he was the only osteopathic physician, although more would come later. He said the field now has gained more acceptance than when he was first practicing, and he noted a recent move to merge accreditation standards, for graduate medical education, for osteopathic (D.O.) and allopathic (M.D.) physicians, by 2020.
As a 2014 news release for the American Osteopathic Association puts it, "The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) have agreed to a single accreditation system for graduate medical education (GME) programs in the U.S."
Throughout Told's career, he's immersed himself in both patient care and broader administrative work. For much of the time that he practiced medicine in Craig, he served as Moffat County Medical Officer. And since beginning his work at Rocky Vista University, he's helped to shape the training undergone by medical students.
"The richest experiences are hands-on direct patient care," he said. "But I realized early that in order for us to preserve the doctor-patient relationship, the doctor has to be involved in policy-making."