Last summer, I read an article on small-town life in my alumni magazine. A professor of social sciences, Robert Wuthnow, had written a book about his research on small towns in the United States: “Small-Town America: Finding Community, Shaping the Future.”
The article prompted some reflections on my past two practices. I spent three years in a town of 900 people and then 13 years in a town of 9,000. Although I was raised in the Baltimore metropolitan area (I believe the population was 1.5 million while I was there), Johnson City did not seem a small place after my last two locations.
After growing up in a big city, I found small-town life very pleasant. I liked knowing all my neighbors and knowing nearly everyone in my church. I liked having people value my opinion. A family doctor in a small town has a voice in some decisions, even if not politically active.
I liked meeting my patients in the grocery store and walking for exercise with a neighbor (who was also a patient). We began walking when I challenged him to exercise.
Traffic was never a problem. Neighbors and friends kept an eye on my children, and helped reinforce the positive small-town values. I tended to know my city and state representatives. In fact, right as we moved away from the town of 9,000, an acquaintance from my Rotary Club was elected governor of South Carolina.
There were a few things I liked less. There was no anonymity. Do something stupid and the whole town was aware of it very quickly. Church politics, both in my church and that in the churches my partners attended, had a higher impact.
It was quite disruptive to our practice. All five of my partners attended First Baptist Church. When First Baptist Church split acrimoniously into two groups, four partners went with the first community and one with the second.
There was less diversity in the small towns. People who didn’t fit well tended to leave fairly quickly. Another family doctor, who had no experience in small towns, lasted less than six months. Some social events required a significant drive — 30 minutes to the minor-league baseball games, 60 minutes to plays or concerts and 75 minutes to the zoo.
Research and study, at least until the Internet became highly developed, was more difficult. My access to a medical school library was at least a three-hour drive during the first few years of my career. Even after I had an Internet connection, my dial-up modem connection was inadequate for doing research.
Wuthnow confirmed my impression that the reality of small town life is a mixture of good and bad. He also noted two common misconceptions. First, that small-town life is stress-free and nearly perfect and secondly, that small towns are backwater communities from which people escaped as soon as they had an opportunity. Wuthnow interviewed 700 people in dozens of communities. The article noted that a more thorough look at small-town life had not been done for 50 years.
His first conclusion is that small towns are complex enough and different enough that generalizations are flawed. Yet some generalizations do apply. Many small town residents value cooperation, mutual responsibility and sharing. A higher proportion of the people in a small town do volunteer work, including more of the wealthy members of the community, but 20 percent of the volunteers still do 80 percent of the volunteer work. Also, border disputes between neighbors are more common, despite the stated values of cooperation, mutual responsibility and sharing.
Small towns had some characteristics that attracted people. Residents there were more likely to help people who are struggling financially. The pace of life was slower. There were more opportunities to form deep friendships and housing was more affordable.
Having lived in both small towns and large cities, Wuthnow’s research findings largely ring true to me. I did more volunteer work when I lived in small towns because the needs that I could address were easier to spot. I lived life at a slower pace, except during flu epidemics, when my practice was overflowing. My house cost about 60 percent of what a similar house in Johnson City cost. And I have deep friendships from that time, which I have maintained.
Small towns may contribute to a healthier American society.
I have concerns that Americans don’t make as many deep connections to each other in this age of smartphones, Facebook and texting. I liked knowing all my neighbors, yet I bear much of the responsibility for not knowing all my neighbors in Johnson City.
Do these shallow connections weaken our government? I suspect our republic may not function well when most potential voters are not interested in the candidates or the issues.
Wuthnow’s research, which agrees with my own experience, hints that small towns may be different. Perhaps small towns will remain somewhat insulated from these negative trends in our society. Perhaps small towns will provide the leadership to transform our institutions so that they function well in our technological age. Don’t we need this leadership?
Dr. Jim Holt of Johnson City is a physician and faculty member at Johnson City Family Medicine Residency.