"We used to talk about being in the middle of nowhere. Now it’s the middle of everywhere." That’s how Joseph Bisordi, MD, describes the demographics in southern and central Pennsylvania. In fact, he says the whole state is unique, at least in one way: "It has the most people living in places with less than 2,500 population, the U.S. government definition of a rural town."
Scores of towns in this area fit the description and are often named for their founders, such as Wernersville (pop. 1,934) and Campbelltown (pop. 1,609). Comedians like to joke about going through Intercourse (pop. 1,200) to get to Paradise (pop. 1,043).
There are "big sisters," too. Harrisburg, Reading, and York add a metropolitan flavor to this region that’s been described as an area of fertile fields, rolling hills, and sparkling streams. The Appalachian Mountains rise along the western part of the region.
In Danville, population 4,897, Bisordi, a nephrologist and the chief medical officer at Geisinger Health Center, believes he’s found the perfect setting for his practice and his life.
Bisordi well remembers his first encounter with Geisinger, a huge complex complete with 394-bed hospital, extensive residency program, and state-of-the-art research facilities. "A friend from Georgetown was coming here for an orthopaedics residency. He said, ’It’s one of the places you ought to think about, a different model, a full-time clinical faculty dedicated to patient treatment.’ I really was surprised at the opportunity to learn directly from specialists. And the interview wasn’t a perfunctory session with one physician, but a whole day with five or six. It was clear to me that I wanted to be in this kind of high-clinical setting."
Thirty-two years later, he’s still convinced it’s the right place for him. "I wanted to be, in New York vernacular (he’s a native), a maven, an expert, and to be in a place that had a critical mass of specialists who could provide care for my patients."
Often likened to the Mayo and Leahy Clinics, Geisinger reached its current zenith gradually, but it all started with a gift from one woman. Abigail Geisinger, the 88-year-old widow of iron magnate George F. Geisinger. The hospital opened in 1915 with one operating room, seven nurses, and 70 beds. Geisinger Health System now encompasses three hospitals, 38 community practice sites, and some 12,000 employees. Physician recruiter Elaine Tomaschik jokes, "Geisinger employs more people than there are living here (in Danville)."
John Bulger, DO, a Geisinger hospitalist, makes a distinction, though: "We’re rural, but we’re not frontier."
The sophisticated rural environment suits these physicians. Bisordi says, "I spent the first 20 years here raising a family. I coached my son’s soccer team for 13. I could go to a game and be back at the hospital in five minutes if I was needed. I love the commute!" Not only that, "In New York (my son) would have had to be a top college prospect to make a high school basketball team. Here he could participate without that kind of competition keeping him off of a team."
Bulger grew up in rural Martinsburg, PA, but got his fill of dense
population while studying at the Philadelphia College of Osteopathic Medicine and completing a residency in that city. "In Philadelphia," he grimaces, "every time I get on the Schuylkill Expressway I thank my lucky stars that I’m here. And, by the way, I can see the stars here at night."
Harrisburg is 50 miles to the southwest, but for Bulger and his colleagues, culture, entertainment, and sports are a mere 20 minutes away at Bucknell University. It’s one of three colleges in about a 30-mile radius that provide diversion for residents. There are also interesting things to see and do in some of the nearby villages.
In contrast to more southern Appalachia, with its isolated mountain towns and challenging practices, the Pennsylvania network of small municipalities and productive farms is considered more of a refuge than a hardship posting by these physicians.
"Rural is a bit of a misnomer," says Kimberly Skelding, MD, an interventional cardiologist now going into her third year with Geisinger. "It makes me think of country doctors and primary care," she says. In contrast, practitioners in these 41 counties "just have to make one phone call, the helicopter is there and tertiary, if not quaternary, care is provided in Danville.
"Within 40 minutes patients can be treated (at Geisinger)."
The overriding lure of Geisinger for Skelding is its blend of research and patient care. "I have been working with the National Institutes of Health (NIH) since 2001 on a genomic project. Geisinger was supportive and gave me time to go to Bethesda to continue my research. The unique health records here gave me an opportunity to perform research that cannot be done elsewhere. I could bring new device research to my practice and I could be involved in program development. As a young faculty member, you often don’t have the opportunity to do any or all of these things."
Skelding also reports that this is the only Pennsylvania site now offering a gene therapy protocol, AWARE, for women with angina but without options for revascularization, thus attracting people from all over the state and parts of Ohio for treatment. "The resources available here, the altruistic patients who enroll in these trials, and the support for researchers (are invaluable)."
Physicians and patients in other small communities have their own facilities close by. On November 18th, McConnellsburg’s 1,106 residents are opening the brand new Fulton County Medical Center on 22 acres of farmland donated by local businessman D.A. Washabaugh. The independent Critical Access Hospital, south of Danville, obtained almost 40 percent of its funding donated by the 14,000 citizens of the county to replace a 1950 facility.
A combination nursing home, acute care hospital, and full service 24-hour emergency room, it is in a truly bucolic setting, says A. Misty Hershey, the marketing and business development director. "You can look out of the ER window and see corn growing, cows grazing, and fields of grass." Not far away, mountains fill out the scene. Although only 10 physicians are in attendance, the hospital now has four new, up-to-date diagnostic machines and an on-site helipad. "Before," Hershey says, "the helicopter had to land on a parking lot in another area, with patients transported by ambulance from FCMC to the nearest trauma or heart center."
The smaller hospitals do compete with larger institutions in the cities for physicians and other providers. For recruiter Marie Royce at Summit Health in Chambersburg, with 248 beds, the good news is, "Sometimes young residents want to go to bigger cities, but, after practicing there for a while, they realize they want a quieter place to raise children."
There is some competition for patients as well. Summit Health, according to its Web site, "reaches across greater Franklin County to provide health-care services where once there were none." Chambersburg’s distance from Harrisburg and Danville, 50 and 100 miles respectively, gives credence to the claim. But, besides being a "high-quality community hospital, it’s a regional center for selected medical specialties."
Royce adds, "We’re 65 miles from the famed Hershey Medical Center, but everyone seems to think he has to go there, or to Johns Hopkins, for advanced treatments we have here." That includes stenting and angioplasty, as well as 3-D imaging and precise targeting of tumors with the TomoTherapy Hi-Art system and intensity modulated radiation therapy (IMRT) which allows specialists to attack breast tumors with radioactive seeds from a balloon catheter."
Raymond F. Kostin, MD, the chairman of the Department of Surgery at PinnacleHealth System in Harrisburg, sees the other side of the coin. Since Pennsylvania’s certificate of need requirement expired in 1996, he says, "every small hospital started putting in sophisticated machinery. For whatever reason, in this state people don’t want to go to other places for medical care." But, adds Kostin, a thoracic surgeon, "they don’t understand that diagnosis is becoming more and more complicated. It’s also a matter of finding technologists who know how to interpret the machine results." While this is a problem for hospital administrators, it’s encouraging to job seekers in the field.
Larger hospitals in the cities provide the services that the smaller hospitals do not. Facilities such as PinnacleHealth System, the Milton S. Hershey Medical Center and Children’s Hospital just east of Harrisburg, York Hospital, and Reading Hospital and Medical Center and St. Joseph Medical Center in Reading support the southern part of the state. And there seems to be need enough for all.
As the population gets older, physicians are in demand, says Kostin. Bisordi says it is the same at Geisinger, "This year we hired 112 doctors and are looking for 43 more."
Harrisburg, the state capital on the Susquehanna River, is notable thanks in large part to an astounding 25-year renaissance that’s transformed it from America’s second most "distressed" city of the late 1970s into a thriving business and entertainment hub.
Kostin, a Philadelphia native who joined the PinnacleHealth staff after graduating from the Creighton University School of Medicine, has weathered the ups and downs of Harrisburg since 1969. He was involved in the arduous cleanup after the never-to-be-forgotten day in 1972 when Hurricane Agnes overwhelmed the city with five feet of water. Located across the street from the river, the hospital was one of the first casualties. A year later the hospital marked its 100th anniversary amid the cleanup that would take seven to eight years to complete.
Kostin was also on hand in March, 1979, for the reactor meltdown at the Three Mile Island nuclear power plant. The plant is just 14 miles from the capital. Although 140,000 people fled the area and a few were hospitalized, there’s still disagreement over the legacy of the "disaster." A 1996 study linked erythema, hair loss, vomiting, some increase in cancer incidence, and pet deaths to the incident. One local man, labeled "Mr. TMI Alert" by skeptics, insists that "TMI is an accident without an ending." But a recent letter writer to Fortune magazine asserted that "no one died, no one even got hurt, and there was (only) a small amount of radiation."
That debate over the long-term effects aside, the two events exacerbated Harrisburg’s already distressed economic condition. The city had prospered first because of river transportation, then as a hub for several railroads, which transported goods from its anthracite blast furnaces, a textile mill, iron mills, and machinery factories. But manufacturing declined, affluent residents and retail businesses moved to the suburbs, school quality declined, crime increased, and downtown all but died.
Harrisburg has rebounded by assuming more and more importance as a center of state and federal government, and through the efforts of Mayor Stephen R. Reed, who took office in 1982. Like a modern-day Lancelot, with a cadre of willing "knights," Reed took on the demons of urban blight - en masse.
Soon after Reed took office, there were mayor’s initiative, enhancement, improvement, redevelopment, economic development, and regional partnering groups for everything from street cleanups, park and waterfront revitalization to flood control, major construction projects, and entertainment venues. Reed was a major force behind neighborhood block parties, some 200 annual entertainment events and festivals, and the building of two major new hotels, with more to come.
Public evidences of all this progress are a 20-mile hiking/biking Greenbelt looping around the city through beautiful parks and past the Capitol Complex; a resuscitated Riverfront Park running five miles along the Susquehanna; a minor league baseball team (bought by the city) playing at a ballpark on City Island; Restaurant Row along Second Street downtown; new and renovated performance halls, and the huge new National Civil War museum on a hilltop east of the capitol.
The new Harrisburg University of Science and Technology provides engineering and technology education to help feed the city’s - and the nation’s - insatiable hunger for technical experts. Graduates might even find work at some local firms. Dozens of corporate headquarters are now in town, and unemployment rates are under three percent.
After 25 years in office, Reed is still full of ideas and plans. In April, his 16-page report to the Harrisburg Regional Chamber of Commerce listed no fewer than 19 recent new accomplishments and 31 works in progress.
Kent Wissinger, the marketing director for the Harrisburg Symphony Orchestra, notes what this means to just one important area. "Downtown is almost like the Mardi Gras," he marvels. The symphony itself presents Masterworks and Pops concerts in the Forum, a spectacular theater complete with a glittering planetarium-like ceiling. It’s in one of several attractive buildings on the 65-acre complex dominated by the 272-foot golden-domed capitol, a replica of St. Peter’s Basilica in Rome.
Besides the much-used Greenbelt, the great outdoors throughout the area offers excellent opportunities for hunting, fishing, and skiing. The river attracts canoeists and kayakers. Sports lovers flock to Penn State football games at State College, 90 miles away.
Harrisburg International Airport serves the region’s travel needs, offering nonstop flights to 14 destinations. And it is one of America’s safest airports thanks to the fact that its previous occupant was Olmstead Air Force Base, which built the second longest runway in the U.S. to accommodate its huge C-130 cargo planes. Jorge Scheirer, MD, an internist in West Reading, says, "I’ve flown out of there a few times." Even more astounding these days: "It’s actually a nice experience."
Scheirer, an 11-year resident of the area, has a large office in Wyomissing, population 7,332, but, as a "hospital-based" doctor, he spends four days a week at Reading Hospital and Medical Center in West Reading. It’s a 22-acre building complex on a 36-acre campus with satellite facilities at 19 other area locations.
"People we have recruited have always been surprised at what is here," Scheirer says. "Most people know about Reading as one of the railroad names on a Monopoly board or because of the outlet malls." Neither impression is baseless. The city has been a hub of the real-life Reading Railroad, and it’s also known as the original outlet capital of the world. One super-giant location, the VF Outlet Village, is home to more than 700 stores.
"This is a nice restaurant town," says Scheirer, and, "it has one of the longest-running symphonies." He also enjoys pop concerts at the Sovereign Center, not to be confused with the Sovereign Performing Arts Center, home of the symphony and venue for sports and other events.
Scheirer lives in suburban Exeter Township, "a place," he says, "where we don’t lock cars and where we let the kids play in the yard." As a matter of fact, he often uses this more pleasant lifestyle as a recruiting tool. "One reason for not coming here is that it’s not perceived as a singles area, although it’s less that way now. But it does appeal to doctors with families."
One important benefit to life in these areas, particularly Reading, is the low cost of living. "Reading and Berks County are very interesting. We are on a little island protected from home price inflation," says Scheirer. Not far away, a mere 30 to 40 miles, towns are close enough to Philadelphia, DC, and Baltimore so that the cost of housing is 30 to 40 percent higher. He adds, "A recent doctor recruit from Boston was just amazed!"
In York, James Lease, DO has found a small comfort zone in a sizeable city. He’s one of two pathologists at Memorial Hospital. "It’s like a marriage," he jokes. He says he and the other pathologist "seem to have the same thoughts at the same time."
The feeling of neighborliness is actually hospital-wide, Lease adds. "Almost everyone knows everyone, and patients seem to enjoy the collegiality, too."
With 100 beds, Memorial is a community hospital with a collegial mix of MDs and DOs. Says Lease, "We’re the David, as opposed to the large York Hospital as Goliath. We offer a choice, an option."
York Hospital is a 460-bed facility operated by Wellspan, which also owns Gettysburg Hospital in nearby Gettysburg.
Lease, a native Yorker, has now been at Memorial Hospital for almost 18 years. "It was not necessarily my intent to come back (after training), but jobs in pathology at the time were a little tight. There was an opportunity here, so I said, ’Sure, why not?’" It’s been a good match, he says, with salary and benefits "more than fair."
The proximity to big cities and Maryland and Delaware shores is also appealing. Lease and his family get to New York several times a year, and Philadelphia more regularly.
Danville cardiologist Skelding admits she enjoys urban amenities, but doesn’t miss the urban hassles. "It would be lovely to live in Chicago with no traffic," she says, "but I think there’s very little that’s missing here. And you can easily go to New York, Philadelphia, or Baltimore for a weekend." UO
Eileen Lockwood is a freelance writer based in St. Joseph, Missouri