{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/gb1xd0s61k/manifest","type":"Manifest","label":{"en":["Dr. Scott Rempel"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2021-02-13 (created)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Subject"]},"value":{"en":["Covid-19 (topical term)"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","rural","Kansas","Quinter county","Gove county","telehealth","pandemic","conservative","vaccine","elderly","long term care"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/204/657/small/ScottRempel%282-13-21%29.mp4_1691684229.jpg?1691684229","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657","type":"Canvas","label":{"en":["Media File 1 of 1 - Scott_Rempel_(2-13-21).mp4"]},"duration":1704.04,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/204/657/small/ScottRempel%282-13-21%29.mp4_1691684229.jpg?1691684229","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/204/657/original/Scott_Rempel_%282-13-21%29.mp4?1691684228","type":"Video","format":"video/mp4","duration":1704.04,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657/transcript/48792","type":"AnnotationPage","label":{"en":["Transcript of Dr. Scott Rempel interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657/transcript/48792/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Morgan Weiler: So would you please state your full name?\n\nScott Rempel: My name is Scott Lloyd Rempel.\n\nMorgan Weiler: And then, what is your present title?\n\nScott Rempel: I am a family physician in Quinter, Kansas. I'm also the Gove County Health Officer out here in Quinter. I'm our long-term care director. And I think that is it. Oh, and I'm a staff physician at Gove County Medical Center as well.\n\nMorgan Weiler: Great. And then where did you attend medical school?\n\nScott Rempel: I went to KU School of Medicine and graduated from the Salina Program in 2016.\n\nMorgan Weiler: Okay. And then where did you complete your residency?\n\nScott Rempel: I went to residency at Smokey Hill Family Medicine Residency Program in Salina, Kansas, and completed that in June of 2019.\n\nMorgan Weiler: Great. And then can you speak a little bit about your current positions, and what you do on a daily basis?\n\nScott Rempel: Yeah, I'm a rural physician and work with my wife, actually, who's also a family physician. We do full scope family medicine out here. We do OB with C-sections. We cover our own emergency room on a rotating basis, with four other physicians in our practice. We round on our own inpatients, and I am the long term care director as well for our facilities. So I take care of all the patients there. And for the County Health Officer out here, we have a small health department, so I do a lot of supervising there as well.\n\nMorgan Weiler: Yeah. And the next question talks a little bit about patient population. You already mentioned long term care facility, full spectrum. Can you tell us a little bit about your population you treat other than that age range?\n\nScott Rempel: Yeah, so we take care of everybody from newborns up until, I think my personal oldest patient is 103 years old. We have a pretty elderly county, as a whole of, sizable portion of our population is over age 65. We treat everybody. We don't... We have a lot of Medicare patients. We have some Medicaid patients and quite a few privately insured people here as well.\n\nMorgan Weiler: All right. What unique challenges do you and your practice face surrounding COVID-19?\n\nScott Rempel: It's a really broad question, but I think rural medicine in general faces unique challenges in healthcare. And that's certainly also been true with dealing with COVID and this pandemic, we simply just don't have the resources that a lot of other places do. And I'll kind of expound upon this question and say my community, not just my practice, if that's okay.\n\nScott Rempel: Our community, so Kansas, has a very decentralized public health system, and every county has their own health department. So every county and their health department has had to figure out how to navigate this pandemic on their own, which has been a challenge.\n\nScott Rempel: We only have three nurses I believe, that are staff members at our health department. So trying to figure out how to manage public health measures, and contact tracing, and quarantine, and vaccines, and this and that and the other is difficult just because we don't have the manpower to do all those jobs like they do in some bigger communities. As far as our practice goes, though, we are a private practice and COVID, and the beginning of this pandemic, and probably up until about September, has been really difficult. Sorry, my dog's barking in the background.\n\nMorgan Weiler: [inaudible]\n\nScott Rempel: It's been financially challenging. There was a period of time, especially when Kansas went under lockdown, or whatever you want to call it, where people just were avoiding coming to the doctor and we are business owners, and we have to pay our employees and... He's going nuts over there, it's supper time.\n\nScott Rempel: But we have to figure out how to pay our employees and pay ourselves. And when we don't see patients, that's really, really difficult. Also in Quinter, and Gove County, and this is true in a lot of places in rural Kansas and rural America. There has been a big struggle with public health in general, because of politics. And I don't know, is there another question on this sheet that kind of will allow me to talk about that?\n\nMorgan Weiler: No, if you want to expand upon that, you can do that now.\n\nScott Rempel: Yeah, okay, absolutely. So a lot of public health measures tend to... This is hard for me to answer because I have to kind of toe a line here, but we live in a very, very red part of the country, a very conservative county, and there's a lot of people who believe in their personal liberties and being able to govern their own lives, and their own business. So any sort of public health measure that people feel like is telling them what to do, doesn't go over well.\n\nScott Rempel: So we tried to have a mask mandate in our county, for example, back in August I talked to our county commissioners and we had a mask mandate that was passed. And I think that lasted for about two weeks before there was so much political upheaval, that those commissioners felt like they had to retract that mandate because of their constituents' requests.\n\nScott Rempel: And so in this part of the country, unfortunately, I think if people wear a mask, they are viewed as being perhaps a little bit more on the liberal political spectrum. And some people don't like that, is what I would say. And I'm sure everybody knows... Well, I'll just leave it with that. So trying to navigate this pandemic in a really conservative community has been difficult at times.\n\nMorgan Weiler: As director of the long term care facility, can you speak a little bit about the challenges you faced with handling that patient population?\n\nScott Rempel: Yeah, absolutely. So we actually made the news, unfortunately, here in Gove County back in, I think it was September 29th. I was rounding at our longterm care and had a patient that I was talking to, who was about 95, who told me that she just... Food just hadn't been tasting good the last couple of days. And I kind of looked at her and thought, \"This could be it.\"\n\nScott Rempel: So we tested her for COVID and she had COVID and that night we reflexively tested all of our residents. I think we had about 35 residents in our long term care at that time. We tested them all for COVID-19 and I believe six of them came back positive.\n\nScott Rempel: We tested all of our staff members as well. And a couple of them came back positive. Over the next couple of weeks we went from having six people who were positive, to four days later, because we were on like a four day testing cycle, so four days later we tested everybody again. And there was a handful of a few more people who tested positive.\n\nScott Rempel: By about four weeks after our first positive case, all but two of our residents ended up testing positive for COVID-19, and over the course of that month as well, I believe we had 19 of our residency passed away from COVID. And that was really, really difficult to manage.\n\nScott Rempel: It was really, really hard on our staff. It was hard on our community, and because of our population size in our county, which is about 2,500 people, that mathematically made us one of the deadliest counties in the country. So we had a lot of reporters calling us because of that, which was unfortunate.\n\nMorgan Weiler: How did you handle that from a PPE perspective? [inaudible] facility workers, [crosstalk] positive COVID.\n\nScott Rempel: Yeah, so we actually had already developed a really good plan about what we would do when we had an outbreak of COVID. Because what I had told our facility, and our hospital, from the beginning of this pandemic back in March, was that you shouldn't be thinking, \"If this is going to happen,\" we should be thinking, \"When this is going to happen.\" And we should have a plan.\n\nScott Rempel: So we had different wings of our long term care that were set up for people who were positive and weren't positive. Were negative I guess. There's staff members who were assigned to each of those wings. Let me pause for one second.\n\nMorgan Weiler: Yeah.\n\nScott Rempel: Best dog ever, except for right now. And we had already trained our staff on, our long term care staff, on how to doff and don PPE. So that was good. We have a really, really good emergency preparedness director here in our county who had already been accumulating a pretty good stockpile of N95s and gowns and gloves, etc. So that was really beneficial. So we've never had any supply problems. And I think that's about it.\n\nScott Rempel: Probably the hardest part of all of this, was making sure that staff consistently wore PPE appropriately. That's a really difficult thing for some people. And when you have to do it for 12 hour shifts, it is incredibly hard. So just a lot of education, is how we tried to manage it.\n\nMorgan Weiler: Yeah. And then, this is kind of a different topic. How do you see COVID-19 impacting the learning of students and residents in family medicine?\n\nScott Rempel: Well, that is a really good question. In the beginning we were really, really trying ... Well, and the school was telling us... KU has been telling us with our students that we have come out here, that you can't have them around any patients who might potentially have COVID.\n\nScott Rempel: And we actually had a student out here with us. I don't remember what month it was, but he left partway through his rotation because KU pulled all of the students back to the main campus because of COVID.\n\nScott Rempel: How it's going to impact learning though, going forward? I think there's going to be a bigger emphasis on tele-health probably, we've certainly utilized tele-health with specialty clinics in the past that we've learned to utilize it with our own patients as well.\n\nScott Rempel: I really, really, really hope there is more of an emphasis put on teaching about public health as well, because I did a lot of public health training, and worked in public health before I went into med school, so I was lucky that I had that background. But we have students, or we had students at the beginning of this pandemic, who didn't know the difference between isolation and quarantine. And we use those same words interchangeably all the time, but they're very, very different concepts and they apply to different people.\n\nScott Rempel: And so I am really hopeful that... Family medicine is the cornerstone of medical care in a lot of communities, especially rural communities. And so I really hope that ACGME, and the med school in general, put a bigger emphasis on public health because COVID-19, we might not call it COVID-19 in the future, but this kind of coronavirus, SARS-type illness is here to stay. It's never going to go completely away in my opinion. It's going to wax and wane, just like seasonal flu does.\n\nMorgan Weiler: Just out of curiosity, what are your thoughts on masks every winter?\n\nScott Rempel: Masks every winter? I am a huge proponent of masks. We know that they work, and they work pretty well. It's really interesting to look at flu numbers this year. If you look at CDC, they have weekly totals for influenza that's reported to them from across the country. And I actually have a picture on my phone, but I won't try to show it on the screen, but the weekly flu numbers for the entire nation over the past two months have been anywhere between 20 and maybe 50, 75 cases of flu a week, which is just mind-boggling.\n\nScott Rempel: And the only reason that our numbers are so low as a country is because of masking, and social distancing to some degree. But I think a lot of that is masking. So people saying that the masks don't reduce transmission of viruses, that's just hogwash.\n\nMorgan Weiler: And at Wesleyan we've had a couple of RSV, but we have not had one positive flu this year, to date.\n\nScott Rempel: And you're right. And RSV has been the same way. I mean, we haven't seen... And sometimes that comes later in the spring, but we haven't seen a single RSV case out here yet either. And that's just mind-boggling.\n\nMorgan Weiler: So what changes brought by COVID-19 will be permanent?\n\nScott Rempel: I think social distancing, and masking in certain situations, is here to stay. Eventually, I think it's going to catch on fully, even in areas like ours, in rural America. I think that we are going to see a shift in how people get their medical care too, to some degree. I think there'll be a little bit more use of tele-health as well, a little bit less of an emphasis on inpatient visits maybe. And that might be seasonal.\n\nScott Rempel: I'm really hopeful, as well, that we'll see a little bit of an improvement in funding and training in public health in this country as well. Public health isn't funded well at all. And if you look at, on a per capita basis, for funding, the state of Kansas, hasn't seen an increase in public health funding since the early 2000s. It's been the same on a per capita basis. And that's really sad and frankly, it's not sustainable.\n\nScott Rempel: If we continue to have problems with communicable diseases, like COVID-19, you can't expect people to put up with the stress and the work that they do in public health, and do it with less money, or the same money. We need to pay better.\n\nMorgan Weiler: Ah, that's really interesting. So it sounds like you've learned a lot, but is there anything else that you've learned through this pandemic that you'd like to touch on?\n\nScott Rempel: Yes. And I don't know if I should say it, but I guess I probably will go ahead and say it, because I think it's important to put this out there. So it has been really interesting to me to be in a small community where everybody knows everybody, and everybody looks out for their neighbor, and then have this kind of disconnect with that kind of community idealism, and see what people actually do to protect their neighbor and one another, it's just kind of odd to me.\n\nScott Rempel: What it comes down to is like a lot of things in life. And in medicine, you see this with people who smoke too, either the 30 year old person who smokes heavily and we tell them, and tell them, and tell them, that you need to stop, increases their risk of lung cancer. And they just keep smoking and they get it up here, but they don't get it here. And it's not until they see their parent, or their grandparent, get stage four lung cancer, because they were a smoker, that they get it and they stop smoking. And so what this pandemic has taught me, to some degree, is that it is really, really hard to get our population and our patients to do all the right things until it hits home for them.\n\nScott Rempel: And once this pandemic kind of took its toll, it hit home for a lot of families out here, then we started to see more supports at the health department, or support to hospitals, what we were trying to do with less criticism. Because we faced a lot of criticism, a lot of nasty letters, and emails, and phone calls for quite a while, because people thought we were overreacting and it wasn't until it really hit home, that people started to believe us, which is really sad.\n\nScott Rempel: There was a period of time, a couple of months ago, where I was worried that medicine had lost a lot of its credibility, where people just didn't trust the experts, we're the experts. And that's obviously fueled by social media. There's a lot of false information on social media, and I'm hopeful now that people are starting to gain their trust back in us. Because that's really, really important.\n\nMorgan Weiler: Yeah. That resonates with me as a student. I see that same stuff from our side, and hear that same type of thing.\n\nScott Rempel: And it happens with our own family members too, to some degree, and our own friends, and it's challenging. And at times it can be hurtful, and I think we all have to keep trying and do the best we can, and try to educate.\n\nMorgan Weiler: Yeah. So if you could do the past year over, would you do anything differently?\n\nScott Rempel: So unfortunately, being in private practice, in a new private practice, fresh out of residency for three, well, actually for about five months before a pandemic starts-\n\nMorgan Weiler: What a challenge.\n\nScott Rempel: Yeah. Big challenge. And I kind of probably shot myself in the foot in a business regard by going ahead and accepting the position as County Health Officer in April. So, I had only been in practice and been able to build a patient panel for about six months. And then I overnight became the most unpopular person in our county probably. And I was that damn liberal doctor who's making us wear masks, and that didn't help my cause.\n\nScott Rempel: But I don't know if I would do it all over again or not, because I think we've done good things out here, and I'm proud of what we've done. And I am just so hopeful that someday 5, 10, 20 years from now, I can tell my kids. And if I have grandkids, my grandkids, \"I did the right thing.\" And I hope, I hope the history looks favorably on what we have done in medicine and public health, even though it sucks right now.\n\nMorgan Weiler: Yeah. So, was there anyone that helped you kind of get through that, especially being brand new into practicing on your own? Was there anyone that helped you through that, whether it's professionally, personally, state level, national level?\n\nScott Rempel: Yeah. So my wife has been a huge, huge supporter of mine. She's a family physician too, like I said, and she's my business partner, and my life partner. And she's been incredibly supportive and patient, and a good cheerleader too. Because I've needed that sometimes.\n\nScott Rempel: We are also blessed to have really good partners in our practice. Dr. Michael Makan is one of them. He had been the County Health Officer before all of this really started, and realized that he just didn't understand public health that well, which is why he asked me to do what I did. But he's been just tremendously kind and helpful, and patient with me through all of this.\n\nScott Rempel: And our other two physician partners, Doug Winchell, [inaudible] have been great too. They remember what it's like to be new in a community. They know what it's like to be married to another physician.\n\nScott Rempel: And yes, so our community has been good. And there's also been several community members who we know through church or, through the hospital even, or whatever, who have all been really kind and made cinnamon rolls for us, and cookies, and taken us out to eat, and probably made us gain a little bit too much weight with all the food, but it's good.\n\nScott Rempel: And then there's a group of Public Health Officers in Kansas who have Zoom meetings every week. And Dr. Bacani McKenney is one of those in Fredonia, and she's such a great person, and a good cheerleader. There's been no shortage of kindness and appreciation within our own community.\n\nMorgan Weiler: That makes me hungry. Cinnamon rolls. What is your sense of where family medicine is going in the future?\n\nScott Rempel: Family medicine is here to stay. And I think it's going to become even more important and highly regarded in the coming years. I really do. The way that medical care is getting reimbursed by Medicare and insurance companies is shifting too, as I'm sure a lot of people are aware of. And I think we'll be compensated better in family medicine too, compared to our specialist peers over the coming decades. So I think the future for family medicine is very, very good.\n\nMorgan Weiler: So any views on important issues in this specialty, related to COVID-19, that we have not addressed here, or that you would like to share?\n\nScott Rempel: No, I think that about covers it.\n\nMorgan Weiler: Yeah. Well, I'm going to go ahead and stop the recording.\n\nScott Rempel: Okay.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2334/collection_resources/104624/file/204657#t=0.0,1704.04"}]}]}]}