For most people, the term country doctor conjures up an image of a kindly person with a black bag and stethoscope who dedicates part of their day to making house calls – comforting, convenient and caring.

Though Dr. Michael Snyder, who practices at WellMed at Pleasanton in Pleasanton, Texas, possesses those traits, he is also a sophisticated health care provider specially trained in rural health care.

Though his focus now is mostly on older patients – helping them be as healthy as possible through preventive medicine and healthy lifestyle education – Dr. Snyder has used his wide range of skills throughout his career.

“As a rural doctor, you have to have a broader understanding of all the issues that you might encounter than if you are practicing somewhere with all the possible specialists in the world,” Dr. Snyder said. “Out here, you may do a lot more than you would do in a city setting.”

Clinicians in more populated settings usually have an array of specialists available, but rural doctors often must handle many of the more complicated health conditions themselves.

Most rural primary care physicians work with a population that often lack ready access to hospitals, after-hours urgent care clinics and specialists. Rural residents also face a widening gap in mortality rates. They tend to take part in riskier health behavior such as drinking alcohol and smoking and are more likely to make a return trip to the hospital after discharge.

For these reasons, it’s critical that small-town primary care physicians and support staff, who may be the only health care resource within a hours-long drive, are well-versed in preventive health care and in handling emergencies that normally would be referred to a hospital or specialist.

In the past, Dr. Snyder treated accidents, heat exposure and insect and snake bites.

“Everything in Texas is trying to bite you, stick you or sting you,” Dr. Snyder said.

While practicing in the Idaho-Montana area a few years ago, Dr. Snyder also treated gunshot wounds.

“I saw multiple gunshot victims up there,” he recalled. “One was not an accident, but all the rest were hunting or shooting accidents.”

As a rural doctor, “you may have to practice in other areas in addition to primary care,” he said. “You may be called upon to be a hospitalist, provide ICU care, geriatric care, hospice care and C-SNP care (special needs patients). You also could end up in an emergency room situation.”

One unforgettable incident happened while Dr. Snyder was practicing in Eastern Idaho.

“A young patient had fallen into an irrigation ditch filled with 38-degree water and was not breathing,” Dr. Snyder said. “The main hospital was two and a half hours away by car and 45 minutes by an air ambulance flight, so we warmed him up. He survived and was running around my clinic three months later as if nothing ever happened.”

Fortunately, Pleasanton has access to San Antonio medical facilities less than an hour away, but Dr. Snyder said it’s a distance many patients would rather not travel.

“Depending on why you are sending someone there, they will go, but for the most part they would rather we figure it out here,” Dr. Snyder said.

One area of rural health care that is more difficult to manage is mental and behavioral health care.

“Most of it is done by telemedicine and there are some people not very satisfied with that,” Dr. Snyder said. “They would rather come in to see me, mostly to make adjustments to their medications.” This can save them a drive into the city, but for patients with more serious illnesses, such as bipolar disorder or schizophrenia, making the drive may be inevitable.

Even with the difficulties, Dr. Snyder is happy.

“I’m in a rural location that caters to seniors and that fits me,” Dr. Snyder said. “I think I’ve ended up in a great place for my background.” And, thanks to WellMed’s home care program, he gets to do home visits, or house-calls, just like a doctor of yesteryear.