Rural Psychiatry Isn't Easy, but Rewards Are Ample

Each morning, psychiatrist Bob Franklin leaves his house in the woods and drives down a dirt road, past the herd of buffalo, to the little crossroads where he sometimes stops for breakfast at Abe's Cantina. Four days a week, he heads straight on to his office in Taos, N.M. But on winter Fridays, he turns right instead of left at the stop sign by the Arroyo Seco Elementary School and follows the winding road up through the steep-sided valley to the ski slopes a dozen miles away.

Attractive as it is, the scenery and the skiing aren't the only reasons that Robert Franklin, M.D., M.P.H., has created a psychiatry practice in rural New Mexico that fills a niche for patients and for himself.

Franklin's career has had its twists and turns like the dirt road from his house. In that way, he reflects colleagues who work in Taos, population 5,193, and best known as a vacation spot for skiers in the winter, hikers in the summer.

Franklin took an unusual path to psychiatry and to Taos. He grew up in Los Angeles, the son of parents from a small town in Montana. After medical school, he pursued a residency in general preventive medicine at Tulane that included a master's degree in public health from Tulane's School of Public Health and Tropical Medicine. He took a faculty position there and worked in French-speaking West Africa where he created a regional public health school and taught epidemiology and statistics. The school provided a series of short courses for African doctors who often served both as clinicians and health officials and couldn't leave their practices for the years of full-time study that existing public health schools demanded.

After 25 years of transatlantic travel and life as an expatriate academic, Franklin decided it was time to do something else. That change of pace turned out to be a three-year residency in psychiatry at Tulane starting in 1994. He also wanted to raise his children in the United States. He moved to Taos in 2000—his wife grew up 70 miles south in Santa Fe. For two years, he worked at what is now called the TriCounty Community Services, a state-funded clinic.

After that initiation, he cobbled what he calls a “chessboard” working life, putting together bits and pieces to make up a (mostly) full workweek.

“I see myself as a community psychiatrist,” said Franklin in an interview. “About one-fourth of my patients are on Medicaid, some are on Medicare, and the rest have private insurance.”

He trains primary care doctors in identifying and treating depression, anxiety, and bipolar disorder under a grant program that also provides money to pay psychiatrists to consult with the primary doctors when they need help with psychiatric cases.

Accepting insurance has opened the doors to a lot of work, although it meant hiring an office manager who spends half her time talking on the phone to insurance companies about the same kinds of problems that psychiatrists in other areas face, he said. “But I've never been turned down for a diagnosis or treatment.”

Franklin's odyssey through public health influenced his choices of where and how to practice.

If he lived and worked in Santa Fe, the state capital and a town far wealthier than Taos, he might charge much more, he said, “But that's not what I'd want to do.”