[dropcap]A[/dropcap]aron Zaks, a family medicine intern (first-year resident) at Shasta Community Health Center in Redding, CA, did not set out to practice medicine on the Sacramento River, deep in the shadow of the Cascades foothills where Chinook salmon spawn.

In his final year at Touro College of Osteopathic Medicine in the California suburb of Vallejo, Zaks had interviewed confidently at several residency programs in urban and suburban areas of California. His goals were simple; make good on his four years of undergrad at UC-Berkeley and his four years of medical school. He wanted a family medicine residency, maybe near home in Benicia—maybe Contra Costa hospital, where he was born.

But the annual residency match threw a wrench in all that. The hospitals where Zaks had interviewed had too many qualified candidates, and he ended up with no job for a frightening few days. He had to enter the SOAP (Supplemental Offer and Acceptance Program), an update to the old “Scramble.” Both are essentially a “Hunger Games”-like battle for the scant number of unfilled residency spots in far-flung areas.

“You wake up Monday morning,” he remembers. “You have until noon that day to gather your application. At noon it’s sent to all the residencies [that have openings]. Then you start getting calls from various program directors. It’s kind of a lot of big-name people. And they say, “Why do you want to come to Tennessee?”

One of those calls came from the faculty at Shasta Community.

Zaks says, “I couldn’t impress anyone else [on the phone] the way I could with them, because I wanted to go to Redding.”

He had never lived in a rural community. Still, it was Northern California. He had already experienced the Midwest during a mandatory med school rotation in Tulsa. He wanted to be near home.

Before he knew it, Shasta had said yes, and he was packing his bags for a county with a grand total of 178,000 people.

Aaron Zaks
Aaron Zaks

“For the first month, I was just trying to keep my head above water,” says Zaks. “Being an intern is significantly more demanding than being a second- or third- year. I work close to 80 hours a week many times.”

Luckily, he has several Touro classmates in his intern class, which helped to ease the transition. Most, like Zaks, are from suburban communities.

Like all SOAPing medical school graduates, he had to shake off the perceived stigma of being the last chosen for the intern class.

“I didn’t tell a lot of people that I SOAPed. I kept it essentially a secret. It was a big thing that I wasn’t proud of.”

Living in his new bucolic setting has been healing.

“It’s beautiful out here. There’s nature, mountains, skiing in every direction, but Redding’s got a little bit of a city feel to it.”

In between long shifts, he runs or hikes.

On being a physician for the many rural communities surrounding Shasta, he says, “You think you’d see a lot of spider bites and raccoon scratches and those kinds of really rural problems,but it’s not really that. People have the same problems as they do everywhere else. They all show up in the emergency room.”

The biggest adjustment?

“How spread out everything is. You’re continually running into pretty major transportation challenges. If we want to refer someone to a higher level of care…we don’t have a pediatric ICU. If a child is intubated and ventilated, he needs to get down to Sacramento, which is 160 miles. Kids get airlifted.

“There are a lot of people that live in Susanville, Happy Valley, all these little towns that are spread out. Things that are accessible to people in other places aren’t accessible there; if you’re talking about seeing a physical therapist, it might be an hour and a half out. Home health nurses can deliver IV antibiotics, but all those things are reduced when you’re out in the mountains. If you have a heart attack, it’s 60 miles for an ambulance to get out to you. Everything’s a little more inaccessible.

We have a whole team of social workers and case managers that coordinates discharges, follow up, getting canes and walkers. It’s something the hospital does well.”

His residency tries to address the homelessness in the area despite the distances.
“Our program director goes out in the HOPE van out to the homeless and provides a lot of treatment for wounds and things like that. In some cases, we can get them the medications that they need.”

Then there are all the slightly scary firsts of being a brand-new doctor.

“First baby, first circumcision, your first injection into the knee or shoulder. That’s a little bit difficult and nerve-wracking. But we’re first in line for procedures. We’re often the first assist on surgeries. In other programs, you have a lot of ER residents, surgery residents, orthopedic surgery residents, everyone trying to do a lot of procedures.”

The friendly atmosphere of the hospital is another huge plus.

“It’s a small-town feel when it comes to the doctors and specialists. You get to know all of them. I feel comfortable, most of the time, sending a text message to a specialist if I have a quick question. Other hospitals, they have larger residencies, and there’s not as close a feeling. You walk around this hospital and know a lot of people.”

Will he be a career rural medicine doc?

“I’m keeping myself open to being talked into staying around here. I just want to be a straightforward family medicine doc, seeing adults and teenagers. One of the best things about family medicine is, you can go anywhere. And when you’re talking about rural docs, youre talking about family medicine. You can’t do nephrology without dialysis; you can’t do [interventional[ cardiology without catheterization.”

In other words, true rural medicine means being a generalist.

Gratitude flows through his voice, and you sense that Zaks understands how the SOAP could have gone so much worse.

“My favorite thing is that I’m actually a doctor. It took a few months, but I can introduce myself as a doctor and take care of people and do the job of a doctor. You can tell overall that I’m having a good time. Family medicine is what I wanted to do , and this is the place that is letting me do that.”

He makes a request, proudly.

“Tell the fourth-year medical students that residencies in Redding—Shasta and Mercy family medicine—are really good.”

Take that, SOAP.

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Dr. Monya De is a physician and journalist who trained in the University of California-Los Angeles (UCLA) health system, where she designed a software-based program to track patients’ follow-up records. Dr. De has served as an ABC News medical reporter, and she contributes to regional and national media outlets such as the Los Angeles Times, The Economist, and East Bay Express. Since 2009, she has been as a medical storyline technical consultant for various nationally acclaimed television shows, including “Glee,” “The Ghost Whisperer,” and “House,” among others.