There’s still more than a trace of rugged independence in these four cities spread across the U.S., and it translates, among other things, to a near-multitude of opportunities for outdoor enjoyment and sports from kayaking along the coast to speeding down ski hills in the scenic Northwest. Take a look at Asheville, N.C.; Portland, Maine; Bozeman, Mont.; and Knoxville, Tenn.
If recent efforts are any indication, Knoxville may be the American City of the Year in terms of efforts to promote outdoor activity.
The evidence includes three major city and volunteer developments in recent years. Work has been completed on the Volunteer Landing and Marina at the edge of the Tennessee River. The Ijams (pronounced "Eye-ams") Nature Center is a 300-acre wilderness paradise. And Outdoor Knoxville, with hundreds of acres of al fresco opportunities, is the result of a recent mayor’s "urban wilderness" initiative to assure that nature is never far from city hustle and bustle.
"I am so thankful to be back in my home of East Tennessee," wrote Katy Stordahl, M.D., in a recent web site testimonial for East Tennessee Children’s Hospital (ETCH), where she has worked as a pediatrician in the emergency room since last July. "We are very blessed here to have the resources of the Great Smoky Mountains National Park."
Stordahl grew up in Gatlinburg, about 35 miles east, a descendant of a family that had lived, since the 1890s, in what is now the national park. "My mom was in one of the families that had to leave when it (was established)," she notes. "My husband’s family is all in Minnesota. They’re also outdoorsy people, because there are so many lakes in the state." One of the things her husband misses, she says, is the northern cold weather. "He says it’s not cold until the temperature is 0."
ETCH serves 16 counties in East Tennessee and provides care in at least 30 pediatric specialties, including several advanced procedures. It’s a center of excellence for cystic fibrosis, has one of the largest cochlear ear implant programs in its part of the state and one of the locale’s most comprehensive cleft lip and palate programs.
Although ETCH and several others have remained "untouched" in recent years, there have been a few dramatic changes in Knoxville hospital ownership. The former St. Mary’s Medical Center and three Baptist hospitals developed untenable financial problems and were forced to close a few years ago. Two of the Baptist institutions closed permanently, but the third, as well as St. Mary’s, was purchased by Tennova Healthcare, an area group whose title is a combination of "Tennessee" and "innovation." They now operate as Turkey Creek Medical Center (formerly Baptist) and Physicians Regional Medical Center (formerly St. Mary’s). Both have made impressive strides since the change. As spokesperson Lisa Stearns summarizes, "Tons of exciting things are happening."
One development: "Turkey Creek quickly became a technical center for our system - and maybe the area." Among current stars of the show: 1. MAKOplasty, a robotic and minimally invasive procedure to treat hip and knee pain. The hospital itself has become one of 24 hospitals nationwide designated to train other surgeons in the technique. 2. A unit dedicated to bariatric surgery, also using robotic procedures. 3. Use of the Parachute IV device to reverse congestive heart failure. As she summarizes, "Knoxville is now on the cutting edge of heart care."
The flagship service line at Physicians Regional is orthopedics. It was recently named a "Blue Distinction Center Plus" by BlueCross BlueShield. Tennova also holds an option on land to build a replacement for the now landlocked 1930 current facility. In addition, the former St. Mary’s Medical Center North, now North Knoxville Medical Center, which was opened as a boutique extension, is now being groomed to expand into full general-hospital status.
There are currently seven full-service hospitals serving the area. The largest, University of Tennessee Medical Center, holds the distinction, among others, of being the region’s first certified primary care stroke center, first dedicated heart hospital and sole Level I trauma center, with centers of excellence including brain and spine, cancer, women and children and a heart-lung vascular institute. Its medical staff is now developing plans to deliver high-quality, lower-cost care.
Knoxville’s business life has hardly been neglected. With memories of its successful 1982 World’s Fair still lingering, companies and organizations have been redefining the site. "There’s been significant new corporate investment," reports Doug Lawyer at the Knoxville Chamber. Among new arrivals are a large manufacturing facility of Green Mountain Coffee and ProNova, a manufacturer of proton therapy cancer treatment equipment. The Knoxville Museum of Art is also on the site, Scripps Network (HGTV, Food Network et al.) is expanding its corporate headquarters, and a new hotel is in the works. Another growth area is the Knoxville Oak Ridge Innovation Valley, which welcomes new "idea" firms to set up shop.
Meanwhile, Outdoor Knoxville offers opportunities for getting acquainted with the area’s many natural resources, including forests, park and greenway settings, fields of flowers, lakes developed from former marble quarries, creeks and bluffs to climb. And miles of hiking trails. A new nature center oversees activities and adventures open to all ages during all seasons.
The Ijams Nature Center may be the granddad of area outdoor sanctuaries. It was founded in 1910 by Harry Ijams, a commercial illustrator and dedicated birder, and his wife, Alice, who was known as the "First Lady of Knoxville Garden Clubs." Among its organized offerings, all aimed at spreading knowledge of nature, are field trips for kids and camps where they can learn crafts such as making bird nests.
Reports Jennifer Roder, the education program officer: "Our main goal is to get folks outdoors and learning about nature."
The southwestern Montana town of Bozeman is the northern gateway to Yellowstone National Park, but it seems equally well-known to sports enthusiasts for its outdoor opportunities, winter and summer.
For James Loeffelholz, M.D., it’s the capital of mountain climbing and backpacking, activities that have consumed his leisure time since his high school days. And when the snow gathers on the nearby Bridger Range and Spanish Peaks, he’s ready for cross-country and downhill skiing. Among popular destinations for the snow crowd is the Big Sky Ski Resort about 40 miles south, created by one-time renowned network newsman Chet Huntley. The Bridger Bowl, opened in 1955, was Bozeman’s first public ski area. According to Daryl Schleim, president/CEO of the area chamber of commerce, "A nice thing about the area is that you can ski four different types of slopes in a three-day time period. They’re within an hour and a half of each other."
Alternative winter sports include ice skating, snowmobiling, ice fishing, Nordic and cross-country skiing. Warm-weather possibilities also abound, such as hiking, biking, horseback riding, fishing, rafting and golfing. Loeffelholz was no stranger to the locale. "I have been coming out here for years," he says. He had considered relocating several times, but the clincher was an opportunity too good to ignore.
Surprisingly, considering the dramatically different natural environments, he discovered an unexpected comfort zone in his new location, a certain Midwestern flavor not unlike Iowa City, Iowa, where he grew up and earned his medical degree.
He moved to Bozeman eight years ago to join a group of internists and subspecialists. "Then we sold the practice to the hospital and now have 52 physicians and about 65 providers." It’s now the Bozeman Deaconess Health Group, and Loeffelholz is the president. His clinical practice, he says, is "old-time internal medicine," and that’s what he likes, although treatment is 21st-century state-of-the-art, and several top-line specialists have joined the practice in recent years.
Bozeman Deaconess Hospital celebrated its 100th anniversary two years ago, growing from a small 1911 sanitarium to a modern hospital in 1986 with 86 all-private rooms. In recent years, Deaconess has been renovated, and more specialists and treatment centers have been added, including a wound clinic, and centers for sleep disorders and diabetes. A health partnership has been formed with 16 area school districts, and a new Community Care Connect bus travels to three counties providing health screens and vaccines. In recent years, the hospital has also received several high-grade awards.
Plunging down mountainsides on long, skinny wooden boards was not what John Bozeman had in mind when he made his way west in the early 1860s to join the Pike’s Peak Gold Rush. The trail that would be named for him was a new northern offshoot of the Oregon Trail. It provided the easiest access to the Montana gold fields. He was a key founder of his namesake city in 1864, but didn’t live to celebrate its incorporation 19 years later. He was murdered along the Yellowstone River in 1867 at age 32.
Eventually the open and fertile land attracted settlers. The arrival of the Northern Pacific Railroad in 1883 also helped. So did the founding 10 years later of the land grant college that would become Montana State University. Today its student body of 14,500 is equal to almost two-fifths of the city population. Local residents are welcome at concerts and Bobcat sports events, as well as MSU’s Arboretum and Gardens and its Museum of the Rockies with the largest collection of dinosaur remains in the U.S. and the largest Tyrannosaurus skull yet to be discovered. (Prehistory aficionados can also follow Montana’s Dinosaur Trail, with 14 museums, state parks and other attractions in 12 communities.)
By the early 1900s, farmers were planting more than 17,000 acres of peas for processing by major area canneries. The one-time label of "Sweet Pea Capital of the Nation" soon segued into an annual Sweet Pea Carnival. It was short-lived but was resurrected as a three-day arts festival in 1977 and is one of the state’s largest events of kind.
The city also offers a good variety of children’s activities as well as, according to Loeffelholz, "fantastic public schools." The elementary school attended by his three children is considered a Blue Ribbon School nationally, he reports.
Bozeman’s modern-day prosperity is also fueled by a variety of businesses from laser and biotech companies to three breweries using local barley seed in its beer production. One of the country’s three Gibson Guitar facilities strums along in the city, and, for fine liquor connoisseurs, there’s the RoughStock Distillery, creating "pure mountain whiskey," from homegrown grain and pure mountain water.
Daryl Schleim, president/CEO of the Bozeman Area Chamber of Commerce, notes a major upswing in area highway construction, allowing better traffic flow to Yellowstone. A $38 million airport renovation is also underway. Adds Schleim, "For a community of our size, we could end up with three or four large airlines."
Loeffelholz himself has noticed a considerable amount of change, such as an increasing population, since he settled into the Bozeman environment. "The hospital," he says, "has been transitioning from a primary-care-based community to a regional care center and gradually increasing services. We’re still in the awkward stage of ones and twos (in terms of patients needing specialty care), so it’s hard to offer 24/7 service from certain specialists." But with an increasing population, that problem is likely to resolve itself before long. He calls it an evolutionary stage.
Growing prosperity has spawned enough higher living standards to support at least one luxury housing development called the Yellowstone Club. And the outdoor opportunities have attracted celebrities temporarily escaping the Hollywood razzmatazz. Among them, Loeffelholz himself has spotted Dennis Quaid, Johnny Depp and Jane Fonda.
"The interesting thing about practicing here," Loeffelholz notes, "is that one afternoon I can see a farmer, and the next day a retired president of Paramount Pictures. People in other parts of Montana are beginning to call this city Boze-angeles."
As long ago as the 1790s, Americans were hearing about the healing effects of the Appalachian Mountain areas, none more than the town of Asheville, nestled among the Blue Ridge and Smokies. Thousands of hopeful patients made their way to the picturesque North Carolina town, where many grand facilities were built to accommodate them. The trend finally petered out in the 1950s and the advent of antibiotics. But some of the "hospitals" survive today as homes, offices and apartment buildings.
One wealthy patient was George Vanderbilt’s mother. He himself is well remembered today, thanks to his celebrated home, the Biltmore Estate, with more rooms, even today, than any other private home in the U.S.
Another remnant of the "TB era" is the 6,000-square-foot, 29-room boarding house where many of the patients lived and ate. It was owned by Julia Wolfe, whose famous son, writer Thomas Wolfe, lived there and later fictionalized in the novel, "Look Homeward, Angel."
The rush for "nature’s cure" ended, but the lure of Asheville did not, thanks to its magical scenic ambience and almost unlimited outdoor adventure possibilities. Two major rivers, the Swannanoa and the French Broad, converge at the city, providing boating opportunities from whitewater rafting to placid float trips. The demand for kayaks alone is great enough to support a local manufacturer. Within an hour and a half, winter fanatics can get to some of the highest peaks east of the Mississippi River and enjoy gliding down more than 30 slopes. Children’s tubing slopes are also available. Less snowy pursuits seem endless, including hiking, biking, camping, tennis and golf.
According to the Convention and Visitors Bureau, "Mild winters are the norm, and they go hand-in-hand with snowy slopes, while downtown remains cozy, dry and romantic." As for the city’s lure, spokeswoman Cat Kessler adds, "People visit here for vacation, wellness and recreational purposes and decide they want to come back. I’ve heard of people who have gone home, sold their houses and moved here, some in just a few months’ time."
Christopher Sander, M.D., fits into another category - people who move away and then pine to come back. "I had lived in Watauga County, about an hour from here," he reports. "My mother and brothers live in Raleigh, and I wanted to be near them." Not to mention that the mountainous area is "a very special place." He got an undergraduate degree from Appalachian State University in nearby Boone, but interrupted his education with a volunteer stint in Angola. "I was an average student," he says, "and I wanted to see another part of the world, so I did that. I returned a different student."
His life from there included medical training in Puerto Rico and residency with the Lehigh Valley Health Network in Allentown, Pa., interspersed with another volunteer stint in Africa, this time in Kenya. He had met his Spanish wife, Susana, in Angola, and she had joined him in medical school. They now work together in nearby Arden at Vista Family Health, an affiliate of Asheville’s Mission Health. They recently moved into a home in Asheville with their 6-month-old son.
"We used demographics to make our decision," Sander reports. "Basically, there was one place where we wanted to live, and this was it." Bottom line: "We just called Mission Health and asked what they could offer us - a cold call." It worked.
The result, as he explains it: "I love where I work. I couldn’t have landed myself in any better place. I took over more than 2,100 patients from a guy who had opened a bilingual practice coming out of his residency. He was a well-respected and loved member of the community. It made for a rocky transition, but I think I’ve won over the hearts of these people, so it feels good." Not only that, "Everyone I work with is young and vibrant and always looks for new things to learn."
Sander loves outdoor opportunities and savors tennis, camping, hiking, mountain biking and "all things outdoors." The Blue Ridge Parkway and well-kept mountain roads also beckon for spins on his Harley-Davidson.
Sander’s employer is affiliated with Mission Health, which has roots dating back to 1885. Asheville is home to Mission Hospital, its flagship institution. The hospital is known as the second busiest surgical center in the state. It recently expanded services to two outlying total-service clinics in a program titled Mission My Care Plus, where comprehensive care, X-rays, lab tests, pharmacies and physical therapy facilities are available for the whole family.
Nature and health care have combined as cordial hosts for several related Asheville industries, especially the Bent Creek Institute, whose research materials are found in the large variety of plants and flowers growing in the nearby North Carolina Arboretum and in many local species.
Among other medical-related Asheville manufacturers or branches are Thermo Fisher Scientific (immense production of lab equipment, research supplies, chemicals, etc.), Emdeon (computer programs for health care systems) and G3Medical (sterilized medical equipment).
Over the years, Asheville’s general atmosphere has made it a mecca for artists and other free spirits. These days, tree-lined brick streets are alive with buskers, bars, boutiques, cafes and more than 30 galleries featuring frequent art walks.
Today, the city has more Art Deco structures than any Southeastern city but Miami Beach, including City Hall with its unusual octagonal tower and the Grove Arcade with its open hallways, high atrium and "greenhouse" roof. Its current lineup includes 38 shops, plus offices and apartments.
Joseph Yu, M.D., was in private practice in the New Haven, Conn., area when he received an out-of-the-blue letter from the recruiter for Mercy
Hospital in Portland, on Maine’s southern coast.
"I’d never been up to (that area of) Maine, so I said, ’Let me just check this one out.’ I really liked the place," Yu says. "It has many beautiful surrounding areas, and a lot of natural beauty - and I liked the city itself." Bottom line: "My wife and I decided to make the move." As of February 2012, he’s been part of Mercy Gastroenterology at Casco Bay.
Getting to work now is an easy commute across the Casco Bay Bridge, and, unlike the New Haven area, Yu says, "There’s no traffic." This also means somewhat easy going if he decides to visit his son and daughter in New York, where he grew up. "I can leave on Friday evening, get to Connecticut on Saturday, then to New York, and on Sunday I can come back to Maine."
Since their move, Yu and his wife have savored the outdoors, the culture and restaurants known, of course, for their abundance of fresh-from-the-sea fare. They’ve discovered picnic areas in parks and on beaches, as well at lighthouse sites, especially the Portland Head "sentinel," which dates back to 1791.
"You can picnic there and visit the museum and watch the ocean hitting the rocks," Yu reports. "At one park, you can bike or hike all the way to the Bug Light." (It’s actually the Portland Breakwater Light, but got its nickname because it’s so tiny.)
It’s a short trip from Portland to other interesting locales, such as Freeport, home of the celebrated L.L. Bean store.
Portland is actually a collar-shaped piece of land jutting between two bodies of water: Casco Bay, formed when the Fore River reaches the ocean, and Back Cove. The setting creates irresistible opportunities for sailing, canoeing, kayaking, seal watching, plus lobster catching expeditions. Yu also mentions daily ferry rides to some of the Bay’s 108 islands. "I took a boat last summer," he says, "and it was nice, very nice!"
Portland’s location has also made it a mecca for cruise lines. At least a hundred ships now make stops there. Nearby, entrepreneurs and shopkeepers have transformed a once-seedy wharf area into a thriving shoppers’ haven.
On the more practical side is the cost of living. Yu reports that property and income taxes are lower than those in Connecticut, where he practiced for 20 years, and in New York, where he grew up. Another serendipity: a much lower crime rate than in either location.
Before establishing his previous practice near New Haven, he had been educated at Yale University and the Albert Einstein College of Medicine, followed by a GI fellowship at New York-Presbyterian Hospital and four years of treating inmates at Rikers Island, a payback to the National Health Service for his medical education.
As for Mercy Hospital itself, it’s much smaller than in his previous location. "The hospital there was kind of impersonal. You were just one among thousands of people. But in this hospital, everybody knows you right off the bat. I think the patients are also very friendly people. When I first came here, I told my wife, ’This place kind of reminds me of the U.S. in the 1960s when I was a little kid.’"
But neither of Portland’s two hospitals fall into the 1960s category, although their roots go back as far as 1872.
Maine Medical Center today is the state’s premier referral hospital. It’s rated fourth safest in the U.S. and its nursing staff is rated among the top 3 percent in the world for excellence. It’s also the largest hospital in northern New England.
Mercy Hospital recently became part of the Eastern Maine Medical Center group headquartered in Bangor, which includes seven hospitals plus nine nursing homes and retirement communities. In 2011, Mercy was the first all-private-room hospital in Greater Portland.
Portland’s ethnic complexion has also changed considerably in recent years when the city became an official refugee resettlement location. With newcomers from African countries as well as Vietnam, Cambodia and China, the locally spoken languages have increased to 59 or more. Schools, hospitals and other institutions have adapted well to the changes.
About 20 years ago, when an economic slump brought Portland’s downtown to its knees with a vacancy rate of 40 percent, city leaders decided on a new tactic, turning the long main artery, Congress Street, into a haven for the arts. Today designers of all kinds are ensconced in former store spaces. There’s a law firm concentrating on the arts, the nearby Museum of Art, offices and performing spaces for arts organizations and antique shops.
Eileen Lockwood is a frequent contributor to PracticeLink Magazine.