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September 26, 2014

Physician profiles: life away from the crowd

Thanks to state-of-the-art technology and high-rated hospitals, many physicians have found that "isolation" is no longer a synonym for small-town living. Daily amenities are conveniently located, the internet offers access to the world, patients are friendly and grateful, there’s often surprising prosperity, and nature isn’t far from the front door. Here are four examples of these small-town gems: Gillette, Wyo.; Batesville, Ark.; Fishersville, Va., and Hanover, N.H.

Chris Steel, M.D.

Chris Steel, M.D., returned to his hometown three years ago and is now director of anesthesiology for White River Health System. He and his family enjoy camping, fishing, hiking and - a favorite activity of the 2-and-under set - throwing rocks into the river.

Where the White River flows Batesville, Ark.

In America’s earlier days, transportation spurred the founding of many cities. In Arkansas, Batesville’s raison d’etre was the White River, a perfect avenue for transporting people and products. As a key port on the river, the town would also be influential in the settling of the Ozark Mountains region.

Eventually, the area’s natural beauty and outdoor recreational possibilities would be became an irresistible lure, and services for tourists would thrive, too.

These days, the city’s mainstay tourism and agriculture businesses are sharing the profit spotlight with several other enterprises - especially, but not exclusively, the poultry industry, which has helped develop the area into a regional manufacturing and distribution center. The Batesville Motor Speedway has also become a huge business and tourist enterprise, attracting as many as 8,000 spectators for its largest races.

The successful business climate was a serendipity for Chris Steel, M.D., who returned to his birthplace three years ago after attending medical school at the American University of the Caribbean and clinical rotations in Baltimore, Brooklyn and Pennsylvania State Medical Center in Hershey, Pa. The return to Batesville has been a happy one. He’s now director of anesthesiology with White River Health System, he’s near his family again, and he can enjoy the small-town feel and nature almost at his doorstep.

"The position gave me a lot of leeway to do the critical care stuff that I enjoy, regular anesthesia and a lot of administrative tasks," he says. "I wanted to do all these things instead of being in the OR all the time."

So far, he’s capitalized on other professional opportunities, especially the chance to be involved with Lyon College, a small liberal arts institution, where he can have a direct impact on student career choices - and help them decide if a medical career path is the right one for them. "We like the collaboration and hope to do more projects in the future," he says. On a personal level, he adds, "I love teaching and trying to figure out how to do things better. I find different ways to explain things and how to answer questions. It always makes me learn better, too."

In keeping with this philosophy, and as a regional referral center for north central Arkansas with service locations in nine counties, White River Health has its own student program. Partly with an eye on future employee recruitment, the administration offers clinical rotations for students in nine area colleges and universities. It has also established the Community Health Worksite Wellness program, which takes health education programs to various companies. A soon-to-start "health coach" program, also in cooperation with the college, will train students to make home visits to patients at high risk for readmission, assuring medication compliance, setting up home care assistance and taking note of readmission risk factors.

Steel’s variety of interests seems compatible with hospital policies. Some other examples: "I like talking with other physicians, trying to help them when they’ve got issues with patients and illnesses. I like projects that improve efficiency. And (of course) keeping up with new developments in physiology and pharmacology." In addition, he’s been making presentations to various church groups to promote a community care network. He finds added satisfaction in these activities because, he says, "The administration has been nothing but supportive."

Steel’s heavy work and community activity schedule leaves him a bit short on recreation time, but "every weekend without exception" he spends time camping, fishing, hiking and "throwing rocks in the river," the latter a favorite activity for his children, ages 2 and 1.

Possibilities, both outdoors and indoors, expand greatly for the non-toddler age group, including a car show, the putt putt tournament, chicken wing cook-off, lawn mower race, annual Winter Carnival and the White River Water Carnival.

There are parks on both sides of the river with a new walking/biking trail, plus fishing and flat-water paddling on a nearby bayou. A golf course overlooks the river, there’s a shooting sports complex, and two baseball parks for kids’ games organized by the county Youth Athletics Association. Coming soon: a community center and aquatic park, complete with a gym.

When it comes to fun time, it seems there’s no lack of originality in the upper reaches of Arkansas.

Dr. Mansell

After training and practice, then military service and time abroad, John Mansell, M.D., and wife Dona landed in Gillette, Wyo. They’ve taken to the area well - and even own a farm.

A tale of cowboys and coal Gillette, Wyo.

Like many other American cities, Gillette came into being as a railroad stop - and was named for Edward Gillette, who surveyed the territory for the Chicago, Burlington and Quincy Railroad. Not long after 1892, lured by open land, farmers and ranchers began arriving. Today, herds of cattle and sheep still roam huge ranches and are a major source of revenue in the area.

Cowboy and western traditions are also alive and thriving, as rodeos one weekend after another prove­ - not to mention bid calling contests, trade shows and rodeo dances. "We have a great western bar and dance hall, the Boot Hill Legendary Steak House & Nightclub," says Mary Silvernell, executive director of the Campbell County Convention & Visitors Bureau. "There’s live national-quality talent here every week, with line dancing and lessons as well."

But the current stars of the economic show come from beneath the ground. The boom came gradually, first with a 1909 "traditional" underground coal mine, followed in 1924 by surface mining, which was well-established and lucrative by the 1970s, when two other energy sources - oil and natural gas - joined the group. Today surface mines abound in the area.

Operators of 13,470 producing wells ship 7.5 million barrels of oil a year, and the area’s natural gas yield is enough to rank second in the U.S. Little wonder that Gillette has assumed the title "Energy Capital of the Nation."

The boom has increased population from 29,000 in 2012 to its current 32,000 in the city, with a countywide total of 47,000, and housing has kept pace with the resulting demand. Still some residents worry about losing their hometown flavor. Not so, responds Silvernell. "We’re still small, and we have the wonderful benefits of a small town. But we also have a lot of great amenities because of our energy income." Wyoming itself, she points out, is a wealthy state with a surplus in state coffers. There’s a sales tax, but no state income tax, and property taxes, she says, are "low, low, low."

The new Campbell County Recreation Center, she says, is "another outward sign of the energy bonanza."

"As you walk in, there’s a climbing wall that’s a mini-replica of the Devil’s Tower (the state’s spectacular national monument). There are two swimming pools, two flume rides and (all in all) it’s a premier multi-use sports facility."

For John Mansell, M.D., now affiliated with Northern Plains Anesthesia Associates and  Campbell County Memorial Hospital (CCMH), the wide-open plains and in-town convenience of work, stores and restaurants make for a haven of calmness after years of an often-frenetic lifestyle. A degree from the University of Southern Alabama College of Medicine and residency experience in New Orleans was followed by work in Texas and Illinois. Military service, both regular and National Guard, saw him posted in Iraq and Kosovo - and loaned for two years to the Emirati government. His eclectic education, which included a degree in electrical engineering, made him a good candidate to digitize thousands of military medical records.

In the meantime, his wife was leading an on-the-run professional life. Work assignments took her across the world. Mansell can’t forget "a couple of times when she’d get off a plane (inbound) and I’d get on the same plane (outbound)." He adds, "The day I moved here (September 2011) was the day I retired from the Army Guard. We’re just happy to be on the same continent most of the time now."

To complete their transition, the Mansells now own a farm. "I do the plants," he says, "and my wife does the animals." When the getaway urge beckons, top-notch ski areas aren’t far away, including Vail, Aspen, Big Sky and Park City.

But the small-town ambience continues to entrance the new physician in town. "If I need to go to Walgreen’s, Walmart, Office Depot, Home Depot, the grocery store and the dry cleaner, they’re all within 150 yards of each other. I dare you to do that in suburban Chicago." Even more refreshing: "There are two stop signs and one red light between me and my office - and another stop sign and red light between the office and the hospital."

A third aspect of Gillette life has made its own indelible stamp on Mansell’s approval list is the positive work ethic. Colleagues tell him it’s not unusual for a patient to say, "C’mon, Doc, you’ve got to get me better. I need to work overtime."

Those who need hospital services find a comprehensive care system approved by district voters in 1977, with a public board of trustees and partly funded by tax dollars. CCMH recently has undergone a $68 million expansion, which upgraded the surgical service department and especially the operating theater. "We went from three teeny ORs to four, plus two separate procedure rooms, and from eight outpatient beds with curtains to 14 (regular) rooms," reports Karen Clarke, the community relations manager. The health system itself includes 14 specialty clinics and an ambulatory surgery center.

LivThanks to a 2003 partnership with an orthopedics and spine practice, Clarke adds, "We now have one of the most comprehensive orthopedic outpatient surgery and rehabilitation facilities in the state."

Keeping up with prosperous times, the Campbell County Chamber of Commerce has signed on for seminars that can help professionals create businesses and established business leaders to develop a code of ethics.

Prosperous industry and civilization aside, those who yearn for a Wild West respite don’t have far to go.

Between the beautiful mountains Fishersville, Va.

Testimonials in a recruitment brochure published by Augusta Health in Fishersville make it hard to resist at least a visit to this town in the Shenandoah Valley between the Blue Ridge and Appalachian Mountains. One especially compelling comment: "I love waking up." The reason: "The most beautiful view in the world from our family room window." The home just happens to be located on 21 acres "backed up to the George Washington National Forest," where the lucky owner can view deer, bears, foxes, coyotes, bluebirds and "a billion" hummingbirds.

But landscape alone does not a livelihood make, and though tourism is a big industry, Fishersville can claim a surprising number of thriving businesses. Not to mention the hospital itself, with 2,300 employees and a 230-acre campus.

As director of a new occupational health and lifetime fitness program started by the hospital in 2012, David Krieger, D.O., has familiarized himself with several of the large employers in the area. Krieger reports that several companies, large and small, have signed on to the Augusta program, which includes employment exams, wellness programs and help for drug and alcohol problems.

The combination of highly regarded health institution, location and natural beauty - with many streams amenable to his fly fishing hobby - helped to clinch Krieger’s decision to get on board. He was mustering out of the U.S. Army at Fort Belvoir in northeastern Virginia after serving as a physician for 27 years - and hoping to find meaningful work within a reasonable distance of the base. Among other considerations, his wife was reluctant to move very far away because of a tightly knit connection with the Korean community there.

Following a biochemistry degree from the University of Iowa, Krieger earned a medical degree from the Kirksville College of Osteopathic Medicine, followed eventually by master’s degrees in public health from Harvard and in business administration from Colorado State University. In his new job, he’s been putting all three pieces to good use. His military experience added to his capabilities. During an overseas assignment, he was commander of the military hospital in Heidelberg, Germany, and in the U.S. he served as chief of staff for a hospital at Fort Knox.

In his new life phase, he says, "I didn’t want to go where I would be just another doctor. I wanted a chance to mold a program into what I think a great occupational medicine program should be, meet industry leaders and tell them what we were expecting to do - and get their support. It’s been challenging, especially trying to put together a program under one roof where you have bits and pieces throughout the hospital’s framework. But it’s been really fun to do, and the people have been great."

Augusta Health’s reach includes all of Augusta County and parts of two others, with two urgent care centers and three convenient care clinics, and it provides care in traditional areas, plus wound care, a sleep center and pain management center. A new Heart and Vascular Center opened last year, as did a joint center complete with the newest recovery practices.

As for leisure possibilities, Krieger says, "This is a real gem in the area, to tell the truth. There’s a lot to do." The great outdoors awaits, with almost 2 million acres of trails (including the famed Appalachian Trail, which also meanders for a few blocks along Main Street in town) for hiking, biking and camping, plus trout streams and boating areas. There’s no shortage of golf resorts in the area, either. Not to mention spelunking possibilities in some of the U.S.’ best-known caves.

Nearby Staunton is also home to the American Shakespeare Center’s Blackfriars Playhouse, the world’s only recreation of London’s renowned Globe Theater. In addition, there are many performances of various kinds at Gypsy Hill Park. And architecture devotees can take in Staunton’s well-preserved historic buildings, plus the Woodrow Wilson Presidential Library. A little farther afield, but not too far away, over the mountain, lies the fascinating historic - and busy - city of Charlottesville, where the main historic attraction is none other than Thomas Jefferson’s Monticello.

A welcoming medical and intellectual center Hanover, N.H.

Some 40,000 people live in several clustered towns including Hanover, Lebanon (where the hospital is actually located) and Norwich, Vt. And the go-to place for in the entire upper Connecticut River valley for patients needing sophisticated care? Dartmouth-Hitchcock Medical Center, which provides conveniently located cardiovascular surgery for a wide population swath, as well as most other procedures usually associated with big-city institutions.

Dartmouth-Hitchcock was founded in 1893, but Hanover’s best-known establishment, Dartmouth College, preceded it by more than a century. In 1769 it would be one of the nine Colonial Colleges founded before the American Revolution. Today, the combination of the two institutions has made the area a center of intellectual and medical renown, with great interchange of services.

The hospital benefits from the college’s Audrey & Theodor Geisel School of Medicine, and the college benefits from having a convenient supply of practicing physicians as teachers, not to mention intern opportunities at the hospital. (Yes, Theodor Geisel is the given name of the internationally known Dr. Seuss.) And the community benefits from the many cultural events sponsored by the college, including concerts featuring world-famous musicians.

As the hospital’s media relations manager, Mike Barwell, says, "There’s a lot of flowback between the school and the hospital." He adds: "One of our hallmarks is the incredible research that we do here, including an enormous amount of studies on patient outcomes. In fact, the whole idea for the Affordable Care Act came out of the research institute."

The Dartmouth Institute for Health Policy and Clinical Practice, its full name, was founded in 1988. Its projects have included research on ways to improve health care methods and determining efficiencies that can make it possible for physicians to take on millions more patients per year.

The hospital itself operates both the state’s only Children’s Hospital Association-approved full service children’s hospital as well as its sole Level 1 trauma center.

Scott Rodi, M.D., MPH, now a 14-year area resident, is the emergency medicine section chief as well as medical director of the Center for Rural Emergency Services. He’s also an assistant professor of medicine at the Geisel School. He himself is a Dartmouth graduate, but his medical education took him literally from one end of the country to the other, first for a medical degree at Weill Cornell Medical College in New York City, then back to Dartmouth for a master’s in public health, followed by a surgical internship in Santa Barbara, Calif., and finally residencies at hospitals in Ithaca, N.Y., and Los Angeles.

Thanks to Dartmouth-Hitchcock’s air transport system - two helicopters and three ambulances - Rodi and his staff may treat patients from several states, and patients from local areas in need of specialty care can be flown quickly to or from rather far-flung areas. "We can cut a multi-hour transport time to minutes," Barwell notes.

On the other side of the coin, adds Rodi, is the fact that area patients can now stay near home for intricate procedures like heart surgery instead of having to make the long trip to Burlington, Boston or Portland, Me.

After experiencing life in big cities during two of his post-degree tours, Rodi and his wife had "formulated the idea of raising a family in a rural location with access to an academic medical center and a good academic college. We’d have all the benefits that (they provide) to a community, but still a rural setting. It turns out that there are not a lot of places like that in the country." They now have three daughters, ages 15, 13 and 10, and live in Lyme, a tiny community bordering Hanover. "In the town," Rodi says, "there’s a lot of focus on children, they learn to appreciate the outdoors and there are excellent public schools."

After eighth grade, students must choose out-of-town high schools. His two older daughters are now enrolled at Hanover High School. One downside, as Rodi puts it, since there’s no school bus, "Every day we have a circus of trying to figure out how to get them there." Ditto for extracurricular activities such as swimming meets and basketball games.

But he and his wife are enjoying the ambience of "a really nice community," not to mention the fact that "you can get to everything within 10 to 30 minutes." Then he corrects himself: "Actually, most are within two minutes. When I trained in New York and Los Angeles, it took two or three hours to get errands all done."

The nearness of off-duty activities also enhances life, such as a close drive to enjoy Rodi’s current favorite, cross-country skiing. "There are lots of places all over for downhill skiing, at least six that are within an hour’s drive. One is about 10 minutes from my house," he says.

In other seasons, the outdoor possibilities include biking, hiking, fly fishing and golf. A warm-weather passion for Rodi’s family is kayaking. "I have a boat I keep on a pond near my house." What could be more convenient?

Eileen Lockwood is a frequent contributor to PracticeLink Magazine.



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