In early 2008, Dr. Martin Trott announced to his partners at his private practice in Cleveland, Ohio, that he was leaving the group after 14 years. A month after departing, he opened the doors to his new medical practice in Jackson Hole, Wyo. Twelve years later, in 2020, Dr. Trott remains the only otolaryngologist in Jackson Hole.
Dr. Trott and I met in a fortuitous way. My husband and I love to ski, so last year we went to Jackson Hole on vacation. We ended up eating dinner one night at a delicious, local hole-in-the-wall Thai restaurant where the tables are so closely packed together that you can’t help but share the meal with the strangers sitting next to you. Naturally, my husband and I started chatting with the couple seated at the table beside us. When they learned I was an otolaryngologist, they said, “Surely you must know Marty, the only ENT in Jackson!” I was struck by the idea that a whole city could have one single otolaryngologist—more than that, they were on a first-name basis!
In truth, Jackson does feel like a small town. The airport is one gigantic room—there are no terminals. And when you land, you walk out onto the tarmac and straight into the single room that is the airport. For a city with such vast mountain ranges and national parkland, it’s incredible to discover it truly is a small town.
Dr. Trott completed his residency training at the Cleveland Clinic in 1994. After his training, he was recruited to join a private practice with four other otolaryngologists on the west side of Cleveland. Together, they proudly built a busy medical practice that, in addition to five otolaryngologists, ultimately included two sleep laboratories, a CT scanner, two allergists/immunologists, and a thriving surgery center. Dr. Trott was in the 95th percentile for productivity year after year. He worked incessantly, completing 80 thyroidectomies, 30 parathyroidectomies, countless tonsillectomies, and even stapedectomies. But his work-heavy lifestyle also took a heavy personal toll: He hardly saw his three children.
It was during this period of overwork and burnout that Dr. Trott happened to see an announcement in a newspaper that an otolaryngologist in Jackson Hole was selling his private practice. As it turned out, the otolaryngologist had been trying to sell the practice for five years, but without success.
“Growing up in Western New York, I would never in a million years have thought I would end up living in Wyoming,” said Dr. Trott. “I didn’t even know where Wyoming was! Fifteen years ago, I don’t think I could have picked out Idaho, Iowa, and Montana on a map. And now, obviously, this part of the world is my home.”
I ended up reaching out to Dr Trott, and we had a marvelous, hour-long conversation. He’s filled with energy and passion for his life and work as an otolaryngologist. This interview was condensed and edited for clarity.
Sarah K. Rapoport: Tell me what it’s like to be an otolaryngologist in Jackson Hole, Wyoming.
Martin Trott: It’s almost like being a family practice doctor in a small town. I’m the only otolaryngologist in the region, and the town of Jackson has a population of around 6,000 people. Living in any small town, you have to get used to the new definitions of proximity. Patients will drive for two and a half hours to come see me.
Also, before moving here, I hadn’t appreciated the challenges presented by small towns: You essentially lose your anonymity. On any given day, many of the people I see and interact with are also my patients. For example, today I went to my dentist for a teeth cleaning, and my dental hygienist is one of my patients. Even my dentist is one of my patients! In big cities, it’s relatively easy to be anonymous. Not so in Jackson.
SR: Was this the type of life you had imagined living when you moved to Jackson?
MT: Not at all. My hope, when I moved to Jackson, was to slow down. But when I arrived, I was shocked to find the practice I had inherited was worse than slow; it was moribund. I was seeing just two or three people a day initially, and I couldn’t stand the slow pace. That was how I learned that no matter where you go, you cannot escape the essence of who you are. I’m someone who enjoys feeling challenged, and I missed being busy.
So, while I steadily grew my new otolaryngology practice, I also enrolled in a master’s program in medical administration. Now, in addition to my active practice, I also run a medical group here in Jackson. I’ve learned how to perform venom immunotherapy for bee stings from my old partners in Ohio who are experts at it. I teach visiting medical students from the University of Washington for 10 weeks each year, and I teach a business of medicine class at their medical school. I also make time to participate in medical service trips to Vietnam together with colleagues from the University of North Carolina’s department of otolaryngology. Recently, I even became certified in hypoglossal nerve stimulator implantation for sleep apnea. Now I’m the only person in Wyoming and Montana who can implant the device!
I may have left a fast-paced career for a slower-paced town, but my life has grown more global and I have a larger impact on my community here in Jackson than I ever did in a big city.
SR: How has working as a solo practitioner in Jackson Hole changed the way you practice medicine?
MT: Since working in Jackson I’ve broadened the scope of my practice. I view my job here as a way to serve this community, and this has pushed me to become a better general doctor than I was before. For instance, I’ve learned that it’s often better for patients to have procedures done here in Jackson instead of traveling to other, larger medical centers in Utah or Washington state for their care. For example, last year I had a young female patient who contracted meningitis with a coalescent mastoid during a huge snowstorm. We couldn’t fly her out of Wyoming, and I had already placed a tympanostomy tube in her ear, but she was gradually getting sicker. So, I performed a mastoidectomy with a facial recess approach, and she got better. She woke up with no pain.
Contrast that story with when I first came out here. Back then, I was scared doing straightforward tonsillectomies because I couldn’t turn around and ask for help. There was nobody here but me—I became a more general doctor out of necessity.
SR: Some of your contemporaries aren’t shy about saying, “The medical system is broken.” Practicing in a slower-paced world, do you have those same existential concerns as your contemporaries about the practice of medicine?
MT: There are a lot of discouraged doctors who are in my age group, I think. I have colleagues, probably even here in Jackson Hole, who say that practicing medicine and being a doctor isn’t what they expected it would be. But when my son asks me whether I would choose this path again, my answer is, “Definitely.” I love what I do. It’s much more manageable than when I was seeing 40 or 50 patients in a day.
Before the coronavirus hit us, I would see 20 to 30 patients on a busy clinic day, but there could also be far slower days. And I take calls here, and my colleagues know they can rely on me to help them when I’m available, so I answer my own phone all the time. If the emergency department at the hospital here in Jackson calls me, they know I’ll pick up the phone. My practice is broader and richer here.
SR: As the world has been changing due to the COVID-19 pandemic, how has your world changed with it?
MT: If anything, I think it’s brought our community in Jackson closer together. People are understandably leery of entering healthcare institutions right now, but I’m finding a lot more graciousness among patients than I had experienced before. Every day I have patients thanking me for being available for them, even in the middle of the pandemic.
SR: Given your contrasting experiences, first as an otolaryngologist in Cleveland and now as an otolaryngologist in Jackson Hole, what counsel do you offer your medical students as they consider their career paths?
MT: I try to remind them that whenever they feel discouraged, they need to rediscover the passion that first drove them to medicine. I may have left a fast-paced career for a slower-paced town, but my life has grown more global and I have a larger impact on my community here in Jackson than I ever did in a big city. And making that transition felt hard at the time, but making the move helped me rekindle my passion for practicing medicine that will sustain me for the rest of my career.
Dr. Rapoport is a laryngology fellow at the Grabscheid Voice and Swallowing Center at Mount Sinai Hospital in New York City.