As the Treasure Valley continues to grow at dizzying rates and more newcomers show up in our fair city, many are concerned about sustainability. How do we meet the increasing demands placed on all sorts of infrastructure: roads, schools, housing, and healthcare? If people are leaving "crazy-town" and coming to a slower paced and "nicer" place, how do we make sure they don't bring crazy with them? How do we help enculturate people to the area's values and heritage that make it special?
These are certainly questions that many communities face whenever there is a migratory influx. There may be plenty of "Welcome Refugees" bumper stickers emblazoned on tailgates, referring to foreigners fleeing violence and persecution. But on the other side of the bumper you might see it qualified by "Except Those Driving Up Housing Prices."
Speaking of driving, it reminds me of an ad that appeared years ago in my alma mater's alumni newsletter. It had a picture of a steering wheel and instead of the typical trumpet on the horn button, there was an icon of a man bent slightly at the waist, gesturing for somebody to go first. The headline said something to the effect of, "If everybody was a Cougar, perhaps our horns would announce, 'No please, after you.'" It's the kind of message I wish could be given to every new driver seeking an Idaho license.
It causes me to think about what kind of messaging and onboarding could or should happen with physicians coming to settle in Idaho. ACMS' membership has grown by 36% over the past six years, from 1229 members to 1766, mostly migratory and settling into large groups or hospital systems. That kind of rapid growth can quickly dilute important values – I've seen it happen when our charter school added 40% new seats one year. While I'm not a physician, here are a few pieces of the local medical zeitgeist I suggest we might want to project and protect:
Independence is Still Alive and Well
Part of the Mountain West states' pioneer ethic is a strong libertarianism, which believes in only minimal state intervention in the lives of citizens. While Boise itself leans politically towards a more moderate progressivism, statewide, these two tensions manifest themselves in many areas including healthcare. Whereas other large markets have almost entirely absorbed solo and independent practices, in the Treasure Valley there remains a thriving independent physician movement representing about half of all ACMS members.
Collaboration is King
Thankfully, the 2012-13 anti-trust lawsuit against St. Luke's Health System by Saint Alphonsus, the FTC and Idaho's Attorney General's did not put an end to the long-standing collaborative spirit in local healthcare. The frontier attitude of "we're all in this together" is slowly reemerging from the shadows in demonstrable grassroots ways between various departments and initiatives. For those arriving from cutthroat medical markets, it is important to help them understand what “Boise Nice" means and to assert that collaborative-competition ("co-orpative") is a viable alternative.
Some of the primary reasons people move to our city are to take advantage of nearby recreational opportunities, the family-friendly vibe, and relative affordability. Welcoming a new physician to town can include introducing them to your favorite non-profit or medical association, inviting them to help coach a kid's sports team, showing them the best biking trails, or tipping them off to the best craft beers or local wineries.
Self-Care: An Ethical Duty
This value may be more aspirational than the others, but there is a growing and emerging trend of tending to your own sustainability as a physician. The research is clear on this point: the better you take care of your own physical and mental health, the better prepared you are to give high-quality care to your patients. You can help acclimate new colleagues encouraging them to practice their humanity first and medicine second so that when they bump up against the inevitable occupational challenges of medicine, there's plenty of cushion to absorb it.