painting of a country doctor's horse and buggy standing outside a warmly-lit farmhouse, next to a windless pond with a formation of wild geese framing the sunset. We imagine the physician is inside with his black bag beside him, delivering a perfect baby. It is too ideal to be real... or is it?
• There is still much idyllic about the world of the modern country or prairie doctor. She or he still makes rounds at the small town hospital every day managing the severely sick; still sends them home to follow later in the office; still has to understand an encyclopedic medical knowledge to nail the diagnosis; and still senses the life story of many patients having watched and even helped them through the joys and tough times of years of living. The country doc's still around.
• There are some differences from that painting, though. Now the country doctor consults the specialist by e-consult over a video screen; co-manages the sickest patient in the local hospital with e-ICU; keeps up on rapidly changing medical knowledge with teleconferences and internet learning; summons information about medicine side effects through a smart phone; if needed flys the emergency crash victim by helicopter to a trauma center; and so on.
• But as rewarding as this great life for the doctor may be, there are fewer medical students drawn to it, and for many reasons. Now the country doc called a primary care provider, spends too many hours filling out forms or computer records instead of seeing patients; is paid less than almost all of the other specialties; in the larger cities gives up seeing hospitalized patients to the "hospitalists;" most of the med student teachers are specialists from the big city; and the list goes on. The country doctor is going by way of the horse and buggy. And the big loser in this picture will be the patient.
• In both the city or country, especially with all the advances in medical science, we desperately need the patient advocate and coordinator who is expertly trained to know the whole picture of his or her complicated patient.
• We shouldn't let the idealistic life of the country doctor become just a painting.
• Dr. Rick Holm wrote this Prairie Doc Perspective for "On Call®," a weekly program where medical professionals discuss health concerns for the general public.  "On Call®" is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. "On Call®" airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com.