AMONG THE ANTIQUE ROSES TWINING around the 500-foot Old Brick Wall, the serene Butterfly Pond and Garden, and the graves of more than 2,200 Confederate soldiers at Old City Cemetery sits what is perhaps Lynchburg, Virginia’s best legacy: The Pest House Medical Museum.
One might assume that any site in the geographical center of Virginia contains battlefields, but not so Lynchburg. Its historical significance lies more in bottles than in bullets, quarantines instead of quartermasters. So today the Pest House - a recreation of Quaker doctor John J. Terrell’s office - serves as a monument to the town’s role as a major hospital center during the Civil War.
Venerable Lynchburg still hasn’t witnessed a major battle, even as the health-care profession in the rest of the country redefined itself this decade.
Physicians of all specialties can consider Lynchburg a haven for their practices. Here, as Augusta Thompson, the manager of the Lynchburg Convention and Visitors Bureau phrases it, "We regard
doctors as gods. They are wonderful people, and always have been from days of yore."
Naturally, outsiders need a bit more proof before accepting this conclusion. George Dawson, the president and CEO of Centra Health, offers as testament to the quality of Lynchburg’s health-care professionals the cooperation between the city’s two non-profit hospitals: 259-bed Virginia Baptist and 270-bed Lynchburg General. Although both were officially brought under Centra’s umbrella in 1986, the two hospitals voluntarily have waltzed since the early ’70s. What one has, the other politely declined to offer.
So Lynchburg General is home to emergency and critical care, neurology, neurosurgery, orthopaedic, and cardiology services, while Virginia Baptist, five minutes away, handles cancer care, ambulatory surgery, mental health and chemical addiction, women and children’s health, and home health.
"Any community with two hospitals developed an ’us’ and ’them’ mentality over the years, so there’s a residual hostility to address when they finally partner," points out Tom Urtz, Centra Health’s spokesman who moved to Lynchburg from New Haven, Connecticut, in February this year. "Here, they not only merged ahead of the national curve, but their tone was collaborative from the get-go."
Not to mention cost-effective. According to the 1998 Dartmouth Atlas of Health Care, which studies
Medicare costs and utilization nationwide, Lynchburg has the lowest Medicare reimbursements of any of the 306 hospital-referral regions it surveys. That shakes out to spending $2,887 per non-HMO Medicare enrollee; the national average is $4,878. The economical rate is due to the efficient provision of services; patients still receive quality care. "We serve our market and patients one at a time," Urtz insists.
With this track record, it’s no surprise the business segment’s own Lynchburg Health Care Coalition, also formed early in the managed-care game to fight rising costs for company owners, has become
a model of success. The group again credits camaraderie - rather than pit business against medicine, these leaders invited doctors, insurers and hospital administrators to join the team. The first product was a workers’ compensation claim process hammered out by human resource executives, orthopaedic surgeons, emergency room physicians, physical therapists, psychologists, and rehabilitation counselors that saved Weyerhaeuser nearly $100,000 the first year, reports Bill
Edwards of Virginia Business.
"The committee’s success came ainly from keeping employers actively involved in workers’ claims," orthopaedic surgeon Dr. Jay Hopkins said in Edwards’ article. And it started with something as simple as a workplace profile that details the elements of each job and outlines light-duty alternatives
doctors could sign off on for patients.
This stiff level of competition discourages outside corporate HMOs from even getting a toehold against Centra’s all-inclusive PHO (known as Piedmont Community Health Plan) this decade. "Mainly, we want to protect our patients’ right to choose their doctor. We don’t want them dictated to," says Mary Ann Tucker, executive director of Lynchburg Academy of Medicine, a component of the
Medical Society of Virginia. Medicare nd Medicaid, of course, do have doctor lists for their enrollees, but the restrictions stop there.
"When we get calls from companies looking to relocate, sometimes the executive will say, ’We participate in such-and-such HMO.’ I reply, ’That’s the same thing as telling me you’re wanting to bring a union in here!" Thompson laughs.
Economic stability is no joking matter in Lynchburg. As Mayor Druie L. "Pete" Warren detailed in his State of the City Address this year, unemployment rates hover at the 2.5 percent rate - among the lowest in the nation. Political leaders attribute this milestone to conservative planning that has attracted Frito-Lay and Tessy Plastics to join Ericsson, Wynn Precision, Weyerhaeuser, National TeleMarketing Services, and GE Capital Services as major employers. The new 450-acre Lynchpin Industrial Center promises additional growth. In fact, companies like Ericsson, Crown Simplimatic, and M&I Data invested $64.9 million dollars in the community in 1998 and added 550 new jobs. Since 1988, more than 11,000 new jobs have come on line in the area, with less than 10 percent
of the labor force card-carrying union members.
A growing work force equals a healthy patient load for Dr. Gail Ganser, a pediatric and neuro- ophthalmologist who joined the Piedmont Eye Center in February 1998. A single woman who received her medical degree from Vanderbilt University in Nashville, Tennessee, and completed
fellowships in Miami and Iowa City, Ganser was footloose to choose any place that struck her fancy. Lynchburg won in large part because she found the medical community of 300 doctors large enough to represent all specialties yet still small enough to foster physician relationships and collegiality.
In just 12 months, she has met each of her fellow physicians at least once.
"And I’ve really been impressed with the cases referred to me," Ganser says. "I’m constantly sent challenging cases, and rarely do I need to send a patient out of town for any advanced testing or
evaluation. Lynchburg has the diagnostic equipment I need for most cases." Ganser also ranks physicians’ input into Centra Health’s direction as a plus.
She cautions that those who crave a fast-paced lifestyle might not adapt well to Lynchburg’s overall atmosphere, but it’s an asset for her. "The more I’m in this relaxed environment, the more I
appreciate how important it is to me as an individual," she says. "Training is always so hectic for everyone, and yet some people just move right into a hectic job somewhere. Certainly I see a big
change in how I feel overall - my happiness and security - since I moved here."
Thompson, who has lived in Lynchburg most of her adult life, agrees. "We’re an old city, and we have to talk about things a long time. But we get there," she says. Indeed, the city that sprung up in 1757,
thanks to a ferry service established by Charles Lynch, has enjoyed a colorful past. Although it wasn’t incorporated as a town until 1805, it already boasted a tobacco warehouse, stores, homes, taverns, a church, and even a Masonic Lodge. Thomas Jefferson even built a second home, Poplar Forest, on the western reaches of the growing community. A contemporary mansion, "Point of Honor," also stands in Lynchburg. This mansion was the home of Dr. George Cabell, Sr., who counted among his patients the Revolutionary War orator Patrick Henry.
Throughout the 19th century, with the help of the James River which flows through the city, Lynchburg established its reputation as a progressive Southern transportation hub with an innovative water works system. In the years after Reconstruction, the region reaped prosperity from the iron works, blast furnaces, and steel mills which blossomed into the manufacturing atmosphere
the city enjoys today.
Among the community projects taking shape in 1999 is a renovation movement to restore historic buildings along the river, one of which will include a new children’s museum. Lynchburg also hopes to achieve membership as a "Community of Promise" in General Colin Powell’s national program for
youth, and develop a new $11 million four-mile stretch of highway.
Opened in late 1998, the Johnson Health Center is the brainchild of Centra Health officials. To discourage people who don’t have a personal doctor from misusing the hospital’s emergency room, the organization funds an 800-square-foot facility to serve as a downtown primary-care center. Patients benefit from contact with a doctor who gets to know them rather than their momentary
illness. "And they didn’t just slap up a cinderblock building and put a door on it. This is a beautiful brick Colonial building," Thompson notes.
To run this new clinic, Centra officials chose Lynchburg native son Dr. Peter Houck. A pediatrician, Houck agreed to accept the reins as the clinic’s medical director after 28 years in practice here. "What attracted me most was that I wouldn’t just be a doctor seeing patients in the downtown area," Houck
explains. "I’m being asked to develop programs that will benefit the community." And true to the spirit of the physician for whom the clinic is named - Dr. R. Walter Johnson, an African- American who practiced 30 years in the area and trained tennis great Arthur Ashe - Johnson Health Center defines community beyond medical situations.
That’s why Houck’s Stars for Success initiative tickles his sense of accomplishment. The first group to attend this computer/life skills program are teen-age moms who need the boost to their employment marketability. Lynchburg College provides the computer training; Alliance for Families supplies the resumé, dress for success, and job interview instruction; the Junior League of Lynchburg springs for
babysitting services for the students’ infants.
"We’re the envy of most people in the state as they deal with the HMO and managed-care turf wars," Houck says. "While I can’t scientifically say that Lynchburg is the ideal community in the nation because I don’t have all the data, I do know from talking to others in the state that we’ve done a
good job of working together as a medical community to provide the services patients need."
That made all the difference in the world to Drs. Robert and Stephanie chose Lynchburg to raise their family. Stephanie came from the still smaller town of Camden, South Carolina; Robert from Georgia, so they narrowed their job search in the summer of 1997 to the South. Lynchburg’s F. Read Hopkins practice was the final place they interviewed. "It was an automatic click for us. We didn’t even have to do a second look. We just knew it," she recalls. Again, it was the professional congeniality that clinched the couple’s decision.
"When an idea comes to mind - as in hey, this is something we’re missing - lots of citizens in the community rally around and make things happen," Stephanie Sullivan says.
"Physicians are very well treated in this town; there’s a lot of support for us," she says. "I don’t know how to define that, it’s just something you feel in little things." The Sullivans feel those little things strongly enough that they both are relocating their parents to Lynchburg to enjoy retirement with
the couple’s 2 1/2-year-old daughter and six-month-old son.
Neither side of the family put up much resistance. Because Lynchburg sits at the foothills of the Blue Ridge Mountains, hiking - ophthalmologist Ganser’s activity of choice - skiing, fishing, and boating opportunities abound. Wintergreen Resort provides what Skiing Magazine labels "the best advanced terrain" in the Mid-Atlantic region while Smith Mountain Lake yields more than 20,000 acres of water surface and 500 miles of shoreline. Both are within a 45-minute drive. And because Lynchburg falls at what locals call "the fine weather line," the city’s temperatures are mild with little snow in the winter. Fall brings glorious color to the region, along with visitors to gaze at Mother Nature’s painting.
Such outdoorsy settings drew John Carmack, a 39-year-old family practice physician, to the area for his residency in 1989. His choice for practice was a simple matter of pros and cons. The high school football player whose orthopaedic injuries spurred him to study medicine in the first place grabbed a sheet of paper and listed everything he wanted in life: a town with population between 50,000
and 100,000, mountains, a group/hospital practice that also worked with sports and colleges … Carmack put the pen down. He was already there. He stayed to join the 20+ physicians at Central Virginia Family Physicians and says he’s never regretted the decision. Today he lives out his dream with a wife and two children on a farm complete with dogs, cats, and horses.
"On a scale of 1 to 10, with 10 being the best, I’d rate Lynchburg a 10 as a good place to practice," Carmack says. "Most of the doctors are younger and well respected in their chosen fields. I’d stack our medical community with any other in the nation and we’d be hard to beat!" The low cost of living excites Carmack as well: Mini-farms with four bedrooms, four fireplaces and 21 acres list for $195,00; $259,00 buys you a custom brick ranch with 12-foot ceilings, marble hearth fireplaces, hardwood floors and 3.4 acres; $399,000 fetches the quintessential Southern mansion complete with bay windows, pillars, verandas and water gardens. Overall the cost of living index reported by the American Chamber of Commerce Researchers Association for the first quarter of 1998 shows Lynchburg’s housing costs fall at 99.1 percent of the national average - cities like Atlanta, Philadelphia and Boston score well above the 100 mark. For that matter, Lynchburg weighs in below the national average in groceries, utilities, transportation, and health-care costs as well.
Cultural events include Lynchburg’s own volunteer symphony orchestra performing Beethoven’s
Symphony #6, Tschaikovsky’s Sleeping Beauty Suite, and Sergei Rachmaninoff’s Piano Concerto #2.
The Jefferson Choral Society, the Lynchburg Fine Arts Center, Ellington Fellowship Playhouse, Cherry Tree Players, and the Regional Ballet Theatre round out the scene for performances and
dance. Those wishing to take in performances at the Kennedy Center drive 3 1/2 hours to Washington, DC. "If it’s a matinee, we drive back the same day," Thompson says.
Such a lifestyle pulls many physicians to settle in this region, notes the medical society’s Mary Ann
Tucker - yet there’s plenty of room for more.
Ask anyone associated with Lynchburg’s medical profession to describe the market and all answer
in one voice: competitive. Tucker says the city is always on the look-out for primary-care physicians, including internists, family practitioners, and pediatricians, thanks in part to the number of doctors retiring this decade. In fact, the Sullivans joined their group practice just a year after another pediatrician jumped aboard - less than 24 months later, F. Read Hopkins has extended the welcome
mat to yet another primarycare doctor, bringing the total there to more than 20.
Specialists are seeing the same patient activity levels. Family practice physicians’ sons and daughters, fresh out of medical school, are returning to their roots to practice ob/gyn, urology, and psychiatry according to the medical society’s membership rolls.
The steady patient supply can be credited to the Region 2000 project, a public/private partnership the Greater Lynchburg Chamber of Commerce formed to promote regional economic development in the mid-’80s. By rolling together the counties of Amherst, Bedford, and Appomattox, and the cities of
Altavista and Bedford with Lynchburg to form a tight metro area, surrounding areas naturally look to that center as their hub. The Sullivans have patients who drive between 90 and 120 minutes for appointments in their office.
And what’s good for physician practices is also good for hospital expansion. Virginia Baptist recently
renovated and expanded its medical oncology unit to provide chemotherapy and specialized care. A new radiation oncology center offers up-todate technology, including a linear accelerator. It has also added The Assessment Center to the mental health services department, and free referrals for people troubled with personal work, marital, or family problems. In addition, a $15.5 million construction project will add a dozen new LDR rooms and an ambulatory surgery center, as well as renovate the intensive care nurseries.
The hammer and nails balance Lynchburg General’s extension, begun in 1990, that expanded its emergency, radiology, and dietary departments. In addition, The Stroobants Heart Center of Virginia, a 180,000-square-foot cardiac center, opened in 1994 thanks to a staggering financial gift from local industrialist and cattle breeder Alphonse Stroobants. After his doctor diagnosed severe blockages in his coronary arteries in June 1992, Stroobants experienced medical care in Lynchburg first-hand. He relates his story on the hospital’s Web page: "I had the means to go anywhere in
the world, but I chose to stay here because the cardiac team in Lynchburg has such an excellent, well-deserved reputation."
Such luxuries come with a price, however. In Lynchburg, it boils down to not just a commitment to the community but also to the profession. Through the medical society, physicians have spent their leisure time pushing through a state law that caps medical malpractice damages - a law the Supreme Court of Virginia upheld on January 8, 1999. Now, the society is aggressively pursuing legislation
that provides for continuous payment directly to patients in the rare and unfortunate instance where
a patient incurs ongoing expenses that exceed the cap amount. "Our doctors want to make sure the money goes to the victim, not a lawyer’s pocket," Tucker explains. "It’s hard to practice medicine anywhere today. There’s a lot of politics, which doesn’t prevent them from taking care of patients, but it does make it more difficult."
Four colleges dot the city’s broad avenues - Lynchburg College, Randolph-Macon Woman’s College,
Sweet Briar College and Liberty University - keeping educational levels high and the city supplied with health-care professionals. Lynchburg College’s science departments in particular have prepared students for entry into medical schools for decades. In fact, many of the city’s health professionals received their start at the school, notes Dr. Jim Carico, the science chair at Lynchburg College.
But it’s the excellence in the elementary and high schools that first makes doctors like Carmack and the Sullivans take note. Lynchburg Public Schools educate more than 10,000 students annually, spending $4,251 per child compared to the national average of $5,212 - perhaps one of the best bargains in a town known for them. Nearly half of this revenue stems from state sources, the rest from parent government. Property tax contributes zero to the pot.
The low expenditures are the result of thriftiness - not corners cut on facilities, however. Every K-12 regular education and special education classroom contains a multi-media computer and printer, with direct Internet access over a 32-mile private fiber optic network. Further, each elementary school has a 25-station networked Macintosh LCII computer lab. Technology modules in each
middle school include problem solving, bridge engineering, rocket technology, desktop publishing, electronics, flight technology, robotics, power and energy, communications, and fiber optics.
Schools within the system won the 1997 Virginia Association Partners in Education "School Community Partnerships" award and were recognized as the best comprehensive high school in Virginia in the Redbook Magazine School Award in 1996. No less than 36 teachers in the system are listed in Who’s Who Teachers, and student-teacher ratios are an impressive 13:1.
Considering the lifestyle, opportunities, cost of living, and educational resources, Reader’s Digest placed Lynchburg, Virginia, in its report of the top 50 best places to raise a family. Physicians here appreciate their Southern Eden.
"Anyone who is looking for a similar experience, come on down," Carmack invites. "Hopefully you’ll
find the same happiness I have."
Julie Sturgeon wrote "What’s That, Doc?" in the January/February 1999 issue of UO.