Tracy, it definitely might seem that way, that the small-town docs are burned-out or otherwise bumbly doctors and I'm sure that's true in some cases. In other cases, you get the really rarin'-to-go docs who have grown up in small towns themselves and so want to give back to those communities, or you get docs who manage to salvage some of the debt they accumulated for med schools because the area is an underserved population and they get tuition repayment from their practice. And there really aren't any "crappy" med schools because the competition is fierce for all of them and they make you work your arse off the same amount!
But I do think it's important for people in a small town need more help when it comes to their health and going to a place like a major academic medical center is obviously the right thing to do. At least in those centers there is active research occurring on a daily basis and the docs have a lot of support from colleagues around them to figure out the more bizarre-o problems.
If you've been found to have motility problems, this could very well be affecting your guts on an intermittent basis. Sometimes the body works in mysterious ways. There are so many constant fluctuations (in diet, activity level, emotional response) at work. Have you tried keeping meticulous food and symptom journals to see if you can find any pattern to your "worse" days compared to your "better" ones?
One thing I think you need to re-visit is the reason for your octreotide treatment. Did they ever say anything about having a carcinoid tumor? I ask because octreotide is a standard treatment for that. It's a weird tumor, and pretty rare, but it can cause a lot of problems.