Live & Practice: Small Towns

Living in a small town or city has its advantages: a built-in sense of community, an easygoing lifestyle and shorter commutes. Physicians practicing in small towns and cities across America often develop especially strong relationships with their patients, and those relationships can afford extra insight into what’s going on with their patient population. This isn’t to say, however, that a small town doctor looking to work there is limited to joining small practices. Many of these locations have large health systems that serve vast patient populations, including community members as well as those in outlying areas.

Small Town #1: New Braunfels, Texas

This town of 70,000 people has no shortage of things to do. The city is known for its many seasonal traditions, including Wurstfest, the annual German food and drink festival going on its 56th year; Wassailfest, a holiday event where revelers stroll downtown and sample the spicy cider drink at stores or restaurants participating in the wassail competition; and the annual arrival of Santa Claus to New Braunfels.

“My grandparents came to New Braunfels about 25 years ago. They were looking around Texas, and they were looking for a place that they thought the kids and grandkids would all enjoy. They looked all across Texas and moved to New Braunfels,” says Eric Francis, M.D., a family medicine physician with Resolute Health Hospital in New Braunfels. “Over the past 20 to 25 years, all the grandkids have slowly migrated to this area. . . . It took 25 years, but now we’re all in the same town.”

Francis explains, “I grew up in El Paso, Texas, and I went to a small liberal arts school just west of Chicago called Wheaton College. I moved back to Austin for a year between undergrad and medical school, and that’s when I officially met my wife.”

Francis stayed local for medical school but took a risk for his residency. “I did medical school in Houston at Baylor College of Medicine. Then I put the map on the table and my wife and I said, ‘Hey, where would be a good place for me to do my residency?’”

Francis and his wife decided on the University of Colorado. Francis says, “I finished my residency and internship there, and I was working for Kaiser Permanente for about six years. For nine years, we lived up in Colorado, and our third child was on the way, and we thought, ‘It would be nice to be closer to family.’ Resolute Health Hospital just happened to be starting up at the same time. . . . I liked the vision they had. I pursued that opportunity and now I’m here.”

Today, Francis, his wife and their three children live in New Braunfels and enjoy the area’s wide variety of activities, including one of the largest water parks in the country, Schlitterbahn New Braunfels Water Park.

Danyl Butler, director of business development for Resolute Health Hospital, says the area’s diverse activities and attractions draw talent. “There’s something here for everyone—activities or events for families, festivals, beautiful German architecture, and access to water sports.” This variety is helpful for Resolute Health, as they are always recruiting. Says Butler, “There is a huge shortage of primary care providers in the market, so we are actively looking to bring primary care physicians and family physicians to New Braunfels. Although primary care is our primary focus, there are also opportunities for medical and surgical specialists.”

Resolute Health Hospital has 128 beds and was founded in 2014. Butler says, “Resolute Health Hospital has all of the latest amenities and technology. The culture at Resolute Health is also a plus. We have a very engaged workforce with high employee satisfaction scores. Our patient experience scores are consistently among the highest across Tenet Healthcare-owned hospitals. The hospital is built in one of the fastest-growing areas of Comal County.”

Resolute Health also operates a primary care clinic in the medical office building attached to Resolute Health Hospital. There is also an outpatient physical rehabilitation center on the campus. Resolute Health is affiliated with Tenet Healthcare-owned MedPost Urgent Care clinics in New Braunfels and nearby Seguin.

Francis says two main factors make New Braunfels so special: “It’s a combination of the water sports—the rivers and lakes—and just the uniqueness of an old German town. They’ve got festivals. There’s the Wurstfest. It’s fun to be able to celebrate sausage and German people in a big festival. There’s this uniqueness here that you don’t find anymore. Last month, the whole town shut down for the annual county fair. Kids can march in the parade to celebrate the fair. The schools are out for the parade.”

Says Francis, “New Braunfels, I would say, is the best place in Texas to live. It’s an old, unique town, but within 45 minutes you can get to two of the best cities in Texas: Austin and San Antonio.” And during the summer, New Braunfels is the place to stay cool. “Our neighborhood is connected to the river. In this part of the country during the summer, you tube in the river. You can get a lot more land down here. There’s a forest in our backyard. The kids really enjoy the outdoors,” says Francis. “It’s nice to be in a small town that has its own unique character. New Braunfels itself is pretty self-contained. Everything we need is here.”

Small Town #2: Carson City, Nevada

You can drive from one side of Carson City to the other in under 15 minutes, and the small town is also within driving distance of Lake Tahoe, San Francisco, Sacramento and beaches in California and Oregon. The city—the state capital—is nestled along the western border of Nevada, just to the east of the Sierra Nevada.

David Baker, M.D., has called several different regions of the United States home. He has lived in Davis, California; Omaha, Nebraska; Albuquerque, New Mexico; Portland, Oregon; and now Carson City, Nevada. He says he has enjoyed Carson City most of all these places.

“We love the area, period,” he says. “Some of it is the basics. The weather is phenomenal. It’s sunny 320 days a year, and there’s no humidity. The location is phenomenal. We are located on the backside of the Sierra mountains. We’re close to San Francisco, the Sierras, the California coast and the Oregon coast.”

One reason Baker has moved around so much is his medical training. He earned his undergraduate degree at the University of California-Davis and attended medical school at Creighton University in Omaha, Nebraska. He completed his residency at Oregon Health & Science University in Portland, Oregon, and a fellowship in cardiology at the University of New Mexico in Albuquerque. He made his way to Carson City, where he has been practicing cardiology for 10 years. For the past six years, he has worked for Carson Tahoe Health, the largest provider of medical care in Carson City.

Carson Tahoe Health has an 80-acre campus in Carson City with virtually all its services concentrated in one location, a 352,000-square-foot medical building. The facility has 144 acute care beds with 138 private rooms. The facility also has an open-heart surgery program with a private cardiovascular unit, a women and children’s center, a hybrid OR suite and vascular and catheterization labs.

Shay Dusek, practice administrator for Carson Tahoe Health, says, “Carson Tahoe Health is a private, not-for-profit health system with a beautiful modern hospital and offices. All decisions are made locally, and management is accessible to physicians, solicits physician input, and responds to physicians’ suggestions and recommendations.” Dusek is currently recruiting physicians in family medicine, internal medicine, oncology, general cardiology, psychiatry, pain management, and neurology.

“The lifestyle is good,” says Baker, on working for Carson Tahoe Health. “The hours are good. The people you work with are quite good. It’s nice having everything right on campus. You concentrate all your services in one location. For a small community, we have excellent care.”

Quality of life is what initially attracted Baker and his wife to Carson City. They thought it would be a good place to raise their two daughters. “Now they’re both grown and in college, but that was one of the things that brought us to Carson,” Baker says.

“We are a family community. This is a family kind of a town. This town is where Nevada began. We were once the seat of the Utah territory before we became the capital of Nevada. Lots of people think Vegas is the capital. It’s not. It’s Carson City,” says Ronni Hannaman, executive director of the Carson City Area Chamber of Commerce.

“We are a small community. We are a community in every sense of the word. People here are very, very friendly,” says Hannaman. Carson City has a population of 55,000, but 15,000 people commute there every day for work, for shopping and, of course, medical care.

Nevada’s economic benefits are especially attractive for job seekers. Baker explains, “There are no state income taxes, and the casinos pay a decent amount of taxes. The sales tax and property tax isn’t that bad. All of this keeps more money in your pocket.”

Of course, Nevada’s casinos are also a draw for many. Carson City is approximately a seven-hour drive to Las Vegas, but Hannaman says that the Carson City community tends to be more outdoorsy. “If someone is really into the outdoors, the living here is great,” Hannaman says, adding that hiking, bicycling and skiing are popular among locals.

Baker agrees, “It’s a very outdoorsy community. We’re nearby 20-odd ski mountains. I do a little bit of skiing. A lot of my colleagues will get in 70 or 80 days of skiing a year. I do a lot of hiking, backpacking and camping.”

“The great thing about working for Carson Tahoe Health or any of the many private practices, is you can live at Lake Tahoe, Reno or any of the towns and surrounding communities like Genoa or Virginia City,” says Dusek. “You get the benefit of smaller town living with no state taxes and with access to world-class ski resorts and next door to beautiful Lake Tahoe.”

Small Town #3: Marlton, New Jersey

Just 30 minutes from Philadelphia, 90 minutes from New York City and 2 hours from Baltimore, Marlton is popular among people who want to be near family in one of these major geographic areas while enjoying a small-town lifestyle. Marlton has strong community spirit, with several annual festivals sponsored by local government and scores of free exercise facilities, family activities and classes such as yoga and karate for residents.

Small towns and rural areas sometimes present a challenge for healthcare providers. That was the case when a rural southern New Jersey community first contracted with CFG Health Network, which is based in Marlton.

The community asked CFG to cover its psychiatry needs. But a week before the contract was to begin, there was a new requirement: all physicians had to be able to get to the facility within an hour of getting a call.

None of CFG’s physicians lived within an hour of the facility, so a team from CFG traveled to Virginia to learn about what was then a new pilot program for telepsychiatry. And with that, a new CFG service line was born.

Back then, the telepsychiatry machine cost $25,000. CFG owned two: one at the hospital and one that traveled weekly between office locations.

Now, it’s a different story. Thanks to HIPPA-compliant technology for laptops and tablets, half of CFG’s physicians work outside New Jersey. One even practices from his sailboat in Florida.

In all, CFG employs about 1,200 people, including approximately 200 psychiatrists and 90 nurse practitioners. About 10 of those clinicians are based in Marlton. The network provides telepsychiatry services for a variety of settings, including hospitals, prisons, schools and treatment facilities. CFG also owns a residential treatment facility and outpatient clinics.

James Varrell, M.D., was part of the original team that traveled to Virginia to learn about telepsychiatry. He is now CFG’s medical director and president. He grew up in Marlton and enjoys its small-town feel. “My mother works at our office still,” he says.

Another Marlton medical employer is Virtua Health, a non-profit health system that operates three hospitals in the Marlton area. Virtua Memorial Hospital is a full-service hospital with 433 beds. Virtua Voorhees Hospital is a new facility with 388 beds, all of which are in single rooms. Virtua Marlton Hospital has 188 beds and offers advanced surgeries and spine, joint replacement and stroke specialists.

Virtua also operates 24 primary and more than 70 specialty practices. Says Courtney Kennedy, physician network director for Virtua: “We’ve been named ‘Best Place to Work’ by the Philadelphia Business Journal 11 years in a row.” She is currently recruiting for urgent care, family medicine, gastroenterology, surgery, neurosciences and hospitalists.

Marlton offers an easy drive to Philadelphia and New York, and it’s also close to the shore. “Marlton’s a very nice middle-class town,” Varrell says. “It also has a great school system.”

There are lots of activities for families in Marlton, according to Allison Bittner, special services & communications supervisor for Evesham Township Department of Recreation & Senior Services. Evesham Township includes Marlton, and its municipal offices are located in Marlton. “We offer quarterly recreation programs: winter, spring, summer and fall,” she says. “They range from arts and crafts to exercise classes, like swimming or karate. Yoga is extremely popular among adults.”

Bittner says the Evesham Memorial Sports Complex, free of charge for residents, is another popular destination for families. This indoor recreation facility has basketball courts, volleyball courts, tennis courts and a very large playground for kids.

“We do a lot of special events throughout the year that are open to the public,” says Bittner. “We do a lot of July 4th activities: we have a parade, we do a 5K run, we do fireworks at night. We put on a Harvest Fest in the fall, Winterfest in the winter, and Marlton Day in May, sponsored by the Marlton Business Association. It’s on Main Street, and it highlights the local Marlton businesses.”

“For anyone who wants to raise a family, it’s a great place,” Varrell says.

Small Town #4: Pierre, South Dakota

In a way, South Dakota’s state capital is also the healthcare capital for half of the state. Pierre offers a tight-knit community where physicians can build meaningful relationships with patients. Its medical community serves a patient population spanning a 100-mile radius around Pierre. This presents unique and interesting challenges for providers. Physicians must tailor treatment for patients who drive long distances for medical care. Luckily, the natural beauty of South Dakota makes these drives scenic.

“I was born in this town. I did all my schooling here,” says Thomas Huber, M.D., a family physician with the Sanford Health Pierre Clinic. Huber was part of the first class to graduate from the University of South Dakota Sanford School of Medicine. Students who came before him had to transfer from Sanford’s two-year medical school to receive their degrees at a four-year school. But while Huber was a student, Sanford became a four-year degree-granting medical school.

“When I finished my schooling, and it came time to decide where I wanted to be, my choices were to go to the western part of the state or go to the river,” says Huber. “Pierre is on the river. The Missouri River comes right through the center of the state. I decided to practice in Pierre. There are lots of opportunities in this community. Pierre is the state capital. It has a low unemployment rate and a very high percentage of college-educated people who work here. It has an abundance of outdoor activities available either on the river or on the prairies, if you like to fish and hunt, which I do.”

Huber offers high praise for Pierre: “My wife is from here, and all of our families are still here. If I was faced with making that decision again, I would still end up here.” Huber has three adult children. His middle daughter lives in Pierre with her husband and two children, which Huber says, “worked out great for Grandma and Grandpa.”

Suzette Hohwieler, a physician recruiter for Avera Health in South Dakota, says, “South Dakota is a great place to live, work and raise a family. South Dakota has a strong economy, and many communities have been recognized nationally for their family-friendly atmosphere, excellent educational system and low crime rate.” Hohwieler is also quick to mention that South Dakota has no state income tax or corporate income tax.

Avera operates Avera St. Mary’s Hospital, a 60-bed hospital in Pierre. Avera Medical Group Pierre includes 52 physicians and advanced practice providers in 13 specialties. Sanford Health, which operates the Sanford Health Pierre Clinic where Huber practices, provides services including family medicine, cardiology, pediatric cardiology and 3D mammography.

Hohwieler says, “The market area provides the physicians and staff the opportunity to get to know their patients, as well as their families.” Huber adds, “The area we serve here is not limited at all by the town that we live in. We’re the center of the state, and we have a population of the two communities on the river. We’re the only medical community for a 100-mile radius, perhaps even more so. You get to have special relationships with all the people who live in the community. You learn how to make it work for the people.”

Pierre is excellent for those who love the outdoors. Says Laura Schoen Carbonneau, CEO of the Pierre Area Chamber of Commerce, “We are very, very heavy into outdoor recreation. People are very enthusiastic about fishing and hunting. Pheasant season is huge. It’s almost like a national holiday. We have lots of privately owned land and lodges, and pheasant hunters from all around the country come to Pierre and hunt.” Schoen Carbonneau says small-mouth bass, salmon and walleye are the most popular targets in the area.

Schoen Carbonneau also emphasizes the area’s central location, great for both local getaways and cross-country travel. “We have one of the nicest regional airports in the state, with 50-seat jet service to Denver,” Schoen Carbonneau says. “People can get away to Rapid City, to Sioux Falls or Bismarck. Because we are in the middle of the country, if you’re flying, it makes for very easy connections going east or west. Just because you come to Pierre doesn’t mean you can’t be connected on a larger scale as well.”

Still, the local connection is what keeps many residents in Pierre. Huber says, “If you grow up in a smaller community, I think your ties are stronger, and it’s been proven by the fact that when I came back here many years ago as a young physician. In the clinic I went into, there were lots of patients in that clinic who knew me as a little kid and watched me grow up.”

Huber calls this a “continuity of familiarity.” He says, “Some people in medicine might view it as not a good thing, but I view it differently. When you know your community and you know the people in the community, it makes it a little bit easier for you as a physician to understand how best to take care of the diversity of patients you see and the diversity of issues they may have. I don’t see that as a detriment; I see that as a very positive aspect of practicing medicine in a smaller community.”