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June 3, 2016

Live & Practice: Small Towns 2016

Paul Caruso, M.D., has lived in Cape Girardeau, Missouri, since 1999. "Southeast Hospital is a great place to work," says Caruso. And he would know. After spending time away from southeastern Missouri, Caruso couldn’t wait to get back. "I took five years off from working here to move to California to complete my fellowship in neonatology. After practicing in California for one year, my wife and I decided to move back. We both preferred living in the Midwest."

Family-friendly Southeastern Missouri

Cape Girardeau is very family friendly. In fact, Caruso says, "That’s one of the main reasons we wanted to move back. It’s a great place for children to grow up. There’s a full array of private schools for all the religious denominations, but the public school system, Cape Girardeau Public Schools, is very good. Our kids go to the public schools and they’re getting a great education."

Paul Caruso MD

Paul Caruso, M.D.

Both personally and professionally, Caruso has a passion for helping children. Today, he is the medical director of neonatology at Southeast Hospital, and he and his wife have nine children.

"My wife and I became involved in foster care when we moved to southeast Missouri," Caruso says. "Kids are my life. I spend most of my free time at home with my wife and kids. If you’re going to catch me in the evening, I’m going to be sitting on the floor playing with the kids or playing cards with the older kids."

Working at Southeast Hospital

Caruso’s wife also works for Southeast Hospital. She is a psychiatrist who works weekends for the hospital’s inpatient mental health unit.

"SoutheastHEALTH is definitely a family-oriented organization," says Tatianna Parham, a recruiter for SoutheastHEATH, which runs Southeast Hospital, many outpatient clinics and three smaller hospitals in the southeastern Missouri area. "People are welcoming and warm," she says. "People take time to get to know each other."

Cape Girardeau has a population of 40,000 and a daytime population of 100,000 from people commuting to work from other parts of southeastern Missouri. The hospital has an even wider geographic draw. "We are the largest medical market between St. Louis and Memphis, Tennessee, right along the Mississippi," says Parham. "Our medical population is 675,000 individuals. It’s everybody just north of Memphis and south of Saint Louis, plus people from Illinois, Arkansas and Kentucky. We get a lot of regional pull. We serve five different states’ residents."

The hospital has 11 neonatologists, two NICUs, two cardiac centers and two cancer centers. Caruso says, "We have state-of-the-art equipment. We have PET scanners. Most surgeons use the da Vinci robot."

"Not many cities that have a population of 40,000 have the high level of medical expertise that this city has," says Caruso.

Stacy Lane, director of public relations for Visit Cape Girardeau, says Cape Girardeau combines a small-town friendliness with big-city amenities. That combination extends beyond health care.

"You get to have your cake and eat it, too," she says. "You get to enjoy a lot of culture and things to do, but you don’t have any of the negatives of living in a city." Lane notes that young professionals in southeastern Missouri are often able to buy homes. "The cost of living is really affordable. It’s not a barrier to entry for younger folks. My husband and I have a lot of friends in the St. Louis area, and they’re shocked at what we can afford. But if you don’t want to own, there are really neat apartments and condos in the downtown area if you want to enjoy downtown life."

Cape Girardeau’s historic, upscale downtown

Paul Caruso with children

Southeast Hospital medical director of neonatology Paul Caruso, M.D., couldn’t wait to get back to the Midwest after completing his fellowship in California.

Cape Girardeau’s downtown scene is both historic and upscale. "We have a thriving downtown with shopping on our historic riverfront. You can park your car on the street and see the neat historic buildings, shop at locally owned boutiques or just enjoy the beautiful banks of the Mississippi River. You can walk right down to the river," says Lane.

According to Caruso, the area’s high quality of life and low cost of living encourage residents to engage in philanthropy and volunteerism. He says, "It’s amazing the experiences you can have here. . . . There are a lot of people who are involved in local and national causes. I have friends who are really into medical missions. There’s always a group going to Guatemala or Ethiopia and Haiti that provide health care. There are three or four trips to Haiti a year. There’s also a local organization called Room for One More [Child] that helps families adopt locally and abroad."

Caruso even has his own nonprofit organization on a mission that hits close to home. He explains, "Five years ago, my wife asked me if we might be interested in starting a home for foster children. This is just one of those things that you feel is possible if you live in Missouri. So we started Hope Children’s Home Jackson, a group home for foster children in Jackson, Missouri. The home has more of a family atmosphere as opposed to an institutional feel. We are able to do this because of the support of our community. There are so many things you can do here that you feel are possible - that in a larger city you may not feel that way."

Sangeeta Khetpal, M.D., is not your average Oklahoman. She attended medical school in Sindh, Pakistan, at the Peoples University of Medical & Health Sciences for Women, and before moving to Oklahoma, she lived with her cardiologist husband and their two young children in Saint Louis. When Khetpal finished her residency in internal medicine, she landed at the University of Oklahoma Health Sciences Center.

Oklahoma’s economic upswing

Now Khetpal is a strong proponent of practicing medicine in Oklahoma. She believes the area is on an economic upswing. "Oklahoma offers more than a skilled workforce," she says, adding that the area has a strong business environment.

Texoma

Lake Texoma is a recreation hub for both southeastern Oklahoma and northern Texas, and is the country’s 12th largest lake.

The business climate is important to Khetpal because she is an entrepreneur as well as a physician. She runs her own private practice, The Heart & Medical Center. "I never thought that I would be an entrepreneur and work as a self-employed physician," she says. "I wanted predictability and a structured environment in my job setting, which is very difficult to achieve in a small, self-run practice."

The Heart & Medical Center

Still, business is good. In addition to its flagship facility in Durant, Oklahoma, The Heart & Medical Center has facilities in nearby Atoka and Kingston. The staff of 20 includes Khetpal and three other full-time physicians: two internal medicine specialists and Khetpal’s husband, Vivek Khetpal, M.D.

Physicians who don’t share the entrepreneurial gene, or who want to work on a larger team, can find still plenty of other job opportunities in southeastern Oklahoma.

The area’s several major healthcare systems include Universal Health Services, Inc. and Mercy. Mercy operates 32 hospitals and nearly 300 outpatient facilities in four states: Arkansas, Kansas, Missouri and Oklahoma. In southeastern Oklahoma, Mercy operates Mercy Hospital Tishomingo, a 25-bed facility.

The Chickasaw Nation Division of Health is another area healthcare employer. The division serves Oklahoma’s Native American population at several facilities, including Chickasaw Nation Health Center and Ardmore Health Clinic.

"Most of what I recruit for is primary care," says Ronnie Shaw, a recruiter for the Chickasaw Nation Division of Health. "We don’t have all specialties - not the comprehensive amount that you’ll find in larger facilities - but we do have quite a few." He recruits for psychiatry, general surgery, obstetrics and gynecology, pediatrics and endocrinology in particular.

Shaw says that although his job is challenging, he knows living in rural Oklahoma has rewards for physicians. Those who are willing to take a chance can live comfortably and learn about themselves.

Shaw explains, "So many doctors gravitate to the sexy states: Florida, Texas, California. Eighty to 90 percent of doctors want to live in an urban or suburban metro area. It’s a small percentage of doctors that are entertaining going to a more rural area. It has its own challenges, but of the doctors who have recently joined us, if they come on board, they love it. There are a lot of things to be gained if you give it a chance."

Working in a rural community

Some physicians who come to work for Chickasaw Nation Medical Center embrace their latent rural selves, says Shaw. "I have people say, ’I’d like to have a little land.’ I get people who just want a couple of acres or some people who want a ranch situation. I have a doctor who bought horses. It’s the benefit of being in a more rural area." And Oklahoma City makes a great day trip for those itching for a pro sports game or a shopping spree.

That said, Janet Reed, executive director of the Durant Chamber of Commerce, says you don’t need to leave the area even if you want an exciting Friday night out. "We have a five-star property called the Choctaw Casino Resort. They have a grand theater which hosts a variety of household name stars on tour," says Reed.

"Our economy is growing. It has been for the past 10 years," says Reed. This good economy encourages a philanthropic spirit. People who live in Durant and greater southeastern Oklahoma tend to devote free time to volunteering, she says. "We have 48 nonprofits within Bryan County," she says. "They all provide different services throughout the community. I am very fortunate that the chamber of commerce has a membership of 550, and with that 550, those companies motivate their employees to get involved however they can. We have a very involved community."

Reed says the community-oriented spirit of southeastern Oklahoma extends to residents’ upbeat temperaments and welcoming attitudes. She says, "It’s a very friendly community. Everybody is welcoming and very open to new people moving in. That’s one of the comments I get from throughout the community. People are very gracious when they have visitors in the area or when new people are moving to the area."

Khetpal agrees. She says her favorite thing about living in Oklahoma is its people. She took a chance on southeastern Oklahoma, and now she glows as she describes life there.

"Southeastern Oklahoma is great place to live, to enjoy both your work and your family life," Khetpal says. "The quality of life is excellent. The state has a low cost of living and offers an abundance of recreation, family, education, tourism and volunteer opportunities."

It would be an understatement to say that Ryan Wagner, M.D., likes athletics. He has built his career and his life in north central Ohio around them.

"I’m a primary care sports medicine doctor," he says. "What I do - it’s a specific subspecialty. We do the nonsurgical care: muscular-skeletal care and orthopedics. The common thing most people are aware of about our work is concussion management."

Sports health program in Ohio

At Galion Community Hospital in Galion, Ohio, Wagner has been able to specialize in that passion. He also started a sports health program to teach athletic trainers - the licensed health care providers who help injured athletes recover, rehabilitate and return safely to playing their sports. Wagner’s sports health program works with 15 high schools across north central Ohio, and its graduates help scores of students in the area.

Ryan Wagner MD

While interviewing with Galion Community Hospital, physician Ryan Wagner, M.D., talked about wanting to start a sports health program. The hospital supported his efforts, and today the program is running strong.

"For a lot of these kids, their sport is how they identify themselves. That’s a major thing for me. We want to help athletes be safe, recover quickly and get back into their sport," says Wagner.

"The sports health program starts and ends with the athletic trainers being out in the schools. There’s an integration between what they do, what I do, what the family doctors do and the ER. We’re involved at all levels of the healthcare system, making sure that everyone is on the same page."

As an undergraduate at Ohio Northern University in Ada, Ohio, Wagner was a three-sport athlete. He played football and competed in indoor and outdoor track. He then attended medical school at the University of Toledo College of Medicine and completed his residency at Aultman Hospital in Canton, Ohio. He completed his sports medicine fellowship at Akron City Hospital, part of Summa Health System.

Wagner expressed interest in starting a sports health program while he was still interviewing at Galion Community Hospital, part of Avita Health System. The recruiters told him the hospital would support him, and they kept their word. "They really helped me quite a bit with getting the sports health program underway," says Wagner.

Working in rural Ohio

Myles Creed, director of physician development and recruitment for Avita, says it can be challenging to start a conversation with physicians about coming to rural Ohio. Avita does whatever it can to attract and retain top talent. "Someone like Dr. Wagner could go anywhere in the country. One of our joint specialists went to Harvard Medical School. He could go anywhere in the country," says Creed. "One thing that makes Avita so attractive is our culture. We have a collaborative, can-do attitude with our physicians."

Avita Health System

Avita Health System is relatively new, founded just five years ago. Before that, Galion was a standalone facility. "We brought on Bucyrus Hospital. The CEO formed Avita Health System to manage both hospitals," Creed says. Since then, Avita has added a third hospital: Avita Ontario in Ontario, Ohio. "When it was just Galion Hospital, there were 14 employee providers," Creed says. "Now we’re 100 employee providers."

Fisher-Titus Medical Center

On the more northern end of the region sits Fisher-Titus Medical Center, which became the first all-digital, "smart" community hospital in the nation in 2010 and has been named one of the nation’s "most wired" for four consecutive years, according to HealthCare’s Most Wired survey.That focus on technology remains strong.

"There are things here that the average person wouldn’t expect in a 99-bed, nonprofit community hospital," says physician recruiter Don Prince. "Fisher-Titus has a strong tradition of investing in the latest medical technologies."

For example: Outside each room, screens allow staff to see - even from down the hall - if a room is occupied or if there’s a provider with the patient. As they get closer, they can even access helpful information such as patient allergies and fall risk potential. And as the provider walks in the room, technology relays to the patient’s television screen the clinician’s name and credentials. Even the room itself is smart, relaying EMR information to the hospitalist’s computer as they enter.

"This just makes it very comfortable for everybody," Prince says.

In the last 10 years, Fisher-Titus has seen many new additions: a new rehab center, cancer center, heart and vascular center, "convenient care" services and more - plus surgical services, imaging services, ER, admitting and registration areas.

"I’ve been in a lot of facilities in my career," Prince says. "This is by far the cleanest facility I’ve ever been in, and it’s friendly and welcoming."

Physicians find the area welcoming, too, with nearby wineries, Cedar Point amusement park, and just an hour’s drive to either Cleveland or Toledo.

Deer

A photographer’s lucky shot - but a landscape worth the photo in north central Ohio.

The physicians who work at Fisher-Titus, says Prince, may vacation somewhere warmer in the winter, but tend to stay put in other seasons. "In the summer, there’s way too much to do here," he says.

"Sometimes the spouses are afraid to live in a rural area," says Avita’s Creed. "But we are 45 minutes from Columbus and an hour from Cleveland. You raise a family in a smaller community with smaller school sizes. Then you can hop in your car, and in less than an hour, you’re in the city. It’s not an all-day trip."

Lee Tasseff, president of Mansfield/Richland County Convention and Visitors Bureau, says, "There’s way more to north central Ohio than anyone would ever imagine," he says. Popular pastimes include biking, hiking, canoeing, zip-lining, boating and golfing.

The low cost of living is also a major draw. "The average price for a home is just under $132,000," says Tasseff. "The median price is $90,000. Your money can buy a great deal here."

Wagner and his wife may have settled in north central Ohio, but their lifestyle is far from settled down. Their two daughters are three-sport athletes like their dad. "Both girls do taekwondo, soccer and basketball," says Wagner. "My oldest is thinking about doing volleyball. We’re members of a community track program that lets adults and children participate, so I do that with them."

Whatever sports his daughters decide to focus on, Wagner and his wife will be there to support them - and run alongside them.



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