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April 10, 2020

Choosing the smaller side

After 17 years of practicing in Connecticut, Stephen Siegel, M.D., moved to Boulder to take advantage of the work/ life balance and outdoor activities. - Photo by Castner Photography
After 17 years of practicing in Connecticut, Stephen Siegel, M.D., moved to Boulder to take advantage of the work/ life balance and outdoor activities. – Photo by Castner Photography

Physicians choose to practice in rural towns and small cities for myriad reasons: They prefer to live among nature, they thrive at a pace that is lively but not breakneck, or they value having ample living space to spread out. For other physicians, perhaps a dream job or family draws them in. These areas do not have the hustle and bustle that congests city life, but they do have thriving communities, diverse entertainment, dining options, and of course, patient populations that are unique and varied, which offer physicians interesting opportunities to learn and grow professionally.

Boulder, Colorado

Thirty miles north of Denver, Boulder, Colorado is a quirky haven surrounded by breathtaking mountain ranges. Nestled in the foothills of the Rocky Mountains, Boulder has a population of 100,000, although that figure surges when the University of Colorado is in session. Boulder is also an interesting case study in urban planning. The city has unique zoning laws that prevent suburban sprawl around Boulder and maintain its character and strong sense of place.

Stephen Siegel, M.D., moved to Boulder in February, 2018, to practice urology at Boulder Medical Center. He previously practiced in Connecticut for 17 years, but the day-to-day life wore on him. "The commute was hard and the lifestyle was difficult," he says. He made a cross-country move to join the team at Boulder Medical Center, where he enjoys the work/life balance he had been craving. "Boulder Medical Center is a place that understands that the lifestyle of all of its physicians and employees is important. We all work hard, but we also make time to enjoy life outside of medicine," he says.

Patrick Menzies, CEO of Boulder Medical Center, says, "The group has a culture of work/life balance." Boulder Medical Center sounds like an inpatient hospital, but it is not. Says Menzies, "It is a 70-year old physician-owned multispecialty practice consisting of 84 providers in 18 specialties across five outpatient clinics in the region." There are also clinics at three hospital locations. "We are primarily an outpatient-centric organization with hospital relationships across all specialties," says Menzies.

This unique structure is attractive to physicians as it is a "high quality collaborative clinical environment that functions much like a mini-academic setting," says Menzies. Siegel echoes the benefits of Boulder Medical Center’s approach. "I enjoy being in a multispecialty clinic owned by the physicians. I enjoy having peers nearby to help care for my patients," says Siegel. "I appreciate that if a patient of mine has an issue that is outside of urology that there is a primary care doctor and specialists around the corner that can help provide the assistance that is needed. I get to work with great doctors who also are great people who care about our patients."

At Boulder Medical Center, culture is king and Menzies recruits physicians who will be a good match for the group’s balanced approach to practicing. Says Menzies, "We are not looking for candidates that want to work six to seven days a week and 12- to 15-hour days and look to earn the 90th percentile in compensation. While we do not begrudge anyone for seeking out this direction, it is simply counter to the underlying culture of the group… We are seeking people that understand and are attracted to the outdoor lifestyle and appreciate what it means to live in this incredible place inside and outside of their clinic."

"We live in a beautiful, highly educated, engaged, innovative community, with great outdoor activities like hiking, biking, climbing, skiing, etc., and terrific weather for much of the year," says Menzies. Boulder boasts 300 days of sunshine a year.

Thus, the people are a big part of what makes Boulder special. In 2017, National Geographic magazine named Boulder one of the happiest places to live in the world. Part of this is likely due to the athletic, health-conscious nature of the area. Says Menzies, "BMC [Boulder Medical Center] has a number of past and present elite class competitive athlete physicians. We tend to attract physicians that are seeking a healthy, active, outdoor lifestyle."

Siegel enjoys hiking on the "innumerable" trails around the city and cycling on the bike-only paths that run all across Boulder. Says Siegel, "I like walking my dog who is welcomed and given treats at stores and restaurants around town…. The vibe of the town is one in which people have pride in where they live and are excited about all there is to do. The energy especially picks up when the [University of Colorado] college students are in town, with more lectures for the public and sporting events to attend."

One challenge that Boulder transplants may encounter is the cost of living and competitive housing market. City planners are aware of how special their community is and they have enacted legislation that prohibits the development of suburban subdivisions and limits new building within city limits. Additionally, 1990s local lawmakers created a "green belt" of 33,000 acres of public parks that essentially enclosed the city and prevented acquisition of this land by real estate developers.

This has had the effect of preserving the intimate, low-key "vibe" that Siegel described, but it has also driven up real estate prices. People want to live in Boulder, and the intentionally limited supply and high demand puts the cost of living on par with more metropolitan areas. (The average home price in Boulder is $660,000.)

Still, those who want to relocate to Boulder make it work. Menzies says that there are a large handful of BMC physicians whose spouses work for top echelon companies with offices within commuting distance. "We tend to see physicians with family members in tech, sciences and academia due to our proximity to global companies such as Google, Amazon, Apple, Twitter, University of Colorado and a number of scientific labs," says Menzies. Menzies is currently recruiting physicians in internal medicine, family practice, endocrinology and neurology.

Siegel is very happy that his career brought him to Boulder. "The size of Boulder is one that is big enough to provide at least one of everything. If you are looking for a specific cuisine, it is here. If you are looking for art or culture, it is here." Red Rocks Amphitheatre, an internationally recognized outdoor performance venue, is a mere 20 miles away.

"My only complaint is that I wish I had moved here years ago," says Siegel.

Hagerstown, Maryland

If you’re looking for a high quality of life with a hint of southern charm, look no further than Hagerstown, Maryland. With a population of 40,000, Hagerstown is the sixth largest city in Maryland. Its picturesque downtown makes for a lively gathering place for this tight-knit, quasi-southern community.

Victoria Giffi, M.D. became familiar with Meritus Medical Group when her husband took a position there a few years before Giffi finished her training. In fact, there are a number of happenstances that led Giffi to build a career as a hematology and oncology specialist.

Says Giffi, "I come from a medical family, so as a young adult, I resisted a medical career for as long as I could. My undergraduate degree is actually in music, but I quickly realized that I was not talented enough to make a career out of music. I started to volunteer at the hospital next to my college and realized that I enjoyed getting to know people and found it rewarding to help them feel better. I took a job as a phlebotomist and nurse’s aide."

Around this time, Giffi’s father developed bladder cancer. Giffi felt the anxiety and grief common among families with a loved one battling cancer, but it was also a watershed moment for her: she was fascinated by her father’s cancer treatment. "He received one of the earliest generations of immunotherapy and was cured of his disease. The concept that putting an irritant into the bladder to cure cancer intrigued me. Having realized by this point that I liked both the social and the scientific sides of medicine, I decided to apply to medical school."

Giffi has been deeply loyal to the University of Maryland School of Medicine, located in Baltimore. After finishing medical school, she stayed for a residency in internal medicine and a chief residency and fellowship in hematology/oncology.

When Giffi interviewed at Meritus Medical Group in Hagerstown, she clicked quickly with the oncology group. She says, "I appreciated the humor and support of my prospective colleagues, as well as what seemed like a collegial relationship with other specialists. Physicians cannot work in a bubble. No matter where you work, you have to have the ability to discuss difficult cases with those around you. The tumor board at Meritus, along with the oncology group - which is comprised of physicians of various levels of seniority - was attractive to me."

Today, Giffi and her husband are settled in Hagerstown, where they are raising a family. Says Giffi, "I enjoy being in an area small enough to have a community feel. My children can see that their contributions can make a difference, both at school and volunteering. I enjoy having access to the outdoors and large cities at the same time." Giffi says that, having moved from Baltimore, she has a special appreciation for the lighter traffic.

"I refer to Hagerstown as a ’Goldilocks’ location, in that it is not too big, not too small, it is just right," says Amy-Catherine McEwan, a physician recruiter for Meritus Health. "Hagerstown has all of the benefits of living close to major metropolitan areas without the higher costs of living. Our physicians can find anything from a Victorian farmhouse to a brand-new custom-built home at a fraction of the cost [found] in other areas of the country."

Hagerstown is also known for its distinct architecture. Many buildings and churches were constructed with "Stonehenge Limestone," which was readily available in nearby quarries in the 1800s. Stonehenge Limestone is unique to Maryland. According to Betsy DeVore with Visit Hagerstown, "Much of the architecture in downtown Hagerstown dates back to the pre-Civil War era and also includes some mid-century modern, as well as newer, more current designs."

Physicians are attracted to Hagerstown often because of the cutting-edge nature of Meritus Health’s facilities. The flagship Meritus location is Meritus Medical Center, a 257-bed facility that achieved Magnet Recognition status in early 2019. While not technically an academic medical center, the Meritus Family Medicine Residency Program offers opportunities for physicians to be involved as faculty members or lecturers.

Meritus also operates dozens of outpatient facilities, with special services ranging from behavioral health to digestive health to pediatric medicine. Meritus also operates several cancer centers. McEwan is currently recruiting specialists in endocrinology, gastroenterology, internal medicine, pediatrics, family medicine and psychiatry. When McEwan speaks with physician candidates about the area, she emphasizes that it’s family-friendly and replete with entertainment options.

Hagerstown has a number of popular annual events. One is "Augustoberfest," held annually in August. Says DeVore, "The event was created to celebrate our official friendship with our sister city of Wesel, Germany. Much of the population of Hagerstown is of German descent. Authentic food, dance, music and lederhosen are features of this festival."

Another one of the area’s most popular events is the Fort Frederick Market Fair, held annually in April at Fort Frederick, which dates back to the French and Indian War.

Perhaps the most defining aspect of practicing in Hagerstown is the kind and easygoing nature of the citizens, which in turn creates a pleasant patient population. Says Giffi, "I learn new things from my patients every single day. Sometimes it’s unrelated to medicine, like how to hunt bears, how to can peaches, and how to make kefir. Other times, they share advice to help me with potty training one of my stubborn children! Many times I am inspired by the grace and bravery with which people take bad news or make the most of every day knowing they don’t have very long."

Regarding the practice itself, Giffi appreciates that her team has a shared affinity for getting to know patients and their families. Says Giffi, "I feel privileged to work in a place large enough to have this team, but small enough to feel like a family."

Florence, Alabama

Florence, Alabama, is a scenic, small city in northwest Alabama that sits on the banks of the Tennessee River. This means that the area has all the amenities and charm of a southern town, plus ample water sports and outdoor activities. Florence has a historic downtown area, which hums with activity when the University of North Alabama is in session. Area physicians have the special opportunity to practice at a new medical center facility that opened in December 2018.

Nicholas Darby, M.D., has built his career around the importance of providing quality medical care to rural areas. "After graduating from college, I entered the Rural Medical Scholars Program, a program of the University of Alabama School of Medicine that allowed me to obtain a one-year Master of Science from the University of Alabama focused on Rural Community Health," says Darby. He subsequently attended medical school at the University of Alabama. When he completed medical school, he headed about 50 miles south to Centreville, a small rural town in Alabama, to join a program called the Cahaba Family Medicine Residency Program. Darby says, "I spent about two-thirds of my time at a large federally qualified health center and the local, rural county hospital and the remaining third of my time at the large urban tertiary care centers associated with the University of Alabama at Birmingham health care system."

When Darby finished his residency, his internal compass pointed him home: Florence, Alabama. Darby says, "As I was completing residency, I knew that I wanted to return to an area that was fairly rural and to a location where I could provide traditional outpatient and inpatient care. As I looked at several locations in my region, I found the ideal location right in my hometown of Florence, Alabama: North Alabama Medical Center."

The facility is sparkling new. North Alabama Medical Center opened December 6, 2018, replacing Eliza Coffee Memorial Hospital. North Alabama Medical Center has 263 beds and serves as the primary referral center for northwest Alabama, southern Tennessee and northeast Mississippi.

Says Tina Holt, a physician recruiter there: "North Alabama Medical Center has a very strong diverse medical staff in all specialties including but not limited to cardiothoracic surgery, neurosurgery, oncology and one of the best orthopedic trained groups in the United States." With a new facility comes brand-new, often state-of-the-art equipment. Says Holt, "They have all new equipment in imaging and the surgical services to include endoscopy lab as well as cardiovascular lab. NAMC has the Stealth Navigation and O-arm for neurosurgery."

Says Darby: "It is a privilege to have the opportunity to be one of the physicians at a very new facility with physical infrastructure that rivals any of the hospitals that I trained at in the urban tertiary setting." The new facility has 14 operating rooms and two dedicated cardiovascular operating rooms. North Alabama Medical Center also operates 15 clinics for specialist and medical care.

Holt is currently recruiting specialists in gastroenterology, pulmonary, neurology, neurosurgery, primary care, palliative care, OB-GYN, pediatrics, endocrinology, radiology and rheumatology, as well as hospitalists. Says Holt, "Most all these positions are due to patient volume growth with the new facility being more of a tertiary center for surrounding hospitals."

Holt says that the people of Florence are "the nicest people in the world," which makes for an easygoing patient population and a team of employees who are friendly to newcomers (Darby has been at North Alabama Medical Center less than one year). Says Darby, "I have already quickly grown close to many of my patients. I am honored to have the opportunity to provide care to people who remind me of the great people that raised me and that I grew up around, and at times, quite literally knew me as a small child…. Equally as important, the staff and fellow physicians at both the hospital and my clinic have been superb - welcoming me right in, exemplifying an exceptional level of professional care, and creating a great environment for me to do the same."

Darby greatly enjoys his life in Florence outside of work, too. Says Darby, "I love being outside on my kayak on one of the creeks - one runs behind my house! Some days I’m soaking up the beautiful remote nature around me and other days I’m trying to catch a trophy smallmouth or load up on redeye bass for the day. During the summer, I will enjoy riding around the lakes, proving to myself that another year has passed and I can still wakeboard and slalom ski."

Darby and his wife also enjoy the collegiate atmosphere of downtown Florence. Says Darby, "In town, the college and historical yet trendy downtown area bring a certain unique energy to our rural community. My wife and I love to visit the University of North Alabama lion [statues], Leo and Una, together. They are where I asked her to marry me!"

Iron Mountain, Michigan

"This is a great place to raise a family," says Adam Ryan, M.D., about Iron Mountain, Michigan. – Photo by Mark Hawkins

Iron Mountain is a city of approximately 8,000 located on Michigan’s Upper Peninsula and hugging the Wisconsin border. Naturally, the area is a haven for outdoors enthusiasts, and sports are a big part of the culture: ice hockey, skiing, hiking and biking are popular activities. One of Iron Mountain’s most notable features is the sense of community. Because the nearest cities are either 90 miles north or 90 miles south, residents have a strong sense of kin. This makes practicing in Iron Mountain especially pleasant for physicians, giving them the opportunity for more depth in their relationships with patients and their families.

For Adam Ryan, M.D., coming to Dickinson County Healthcare System was largely about coming home. "I am originally from the upper peninsula [of Michigan] and I wanted to come back. The area is beautiful and has great schools." One of the things Ryan appreciates most about Iron Mountain is "the schools for my kids - this is a great place to raise a family." Ryan attended medical school at the Michigan State University College of Human Medicine in East Lansing, located in the center part of the state. Ryan chose to specialize in OB/GYN, as he was attracted to "the unique combination of hospital and office practice."

Ryan’s new professional home, Dickinson County Healthcare System, is a rural, non-profit community hospital with 49 beds. Dickinson County Healthcare System offers a wide range of outpatient facilities, including primary care, family practice, podiatry, orthopedics, occupational medicine, urology, urgent care and OB/GYN.

Says Ryan, "I like that my work is a combination of primary and specialty care. Delivering babies creates a close relationship with my community." What Ryan appreciates about his work at Dickinson County Healthcare System is the team he works with. "I most enjoy feeling like I work with a family. We have great teamwork and wonderful administrative support," he says.

Jacki Courney, a physician recruiter at Dickinson County Healthcare System, agrees that the geniality of the people of Iron Mountain make it a special place to practice.

Says Courney, "It’s a great place to raise kids - they can still ride their bikes down the street. We have good educational systems. We turn out a lot of professionals and students have the ability to earn college credit in high school, giving them great scholarship potential." To foster community, "there is an active young professionals group with couples and family activities," says Courney.

Courney is currently recruiting for family practice, pediatrics, orthopedics, internal medicine, urology, emergency medicine and ENTs.

For those who embrace the rural lifestyle, Iron Mountain will not disappoint. Ryan is one of the people who thrives in a rural environment, and he keeps busy outside the hospital. "I most enjoy the outdoor activities: skiing - alpine and cross country - ice hockey, trail running, mountain biking and swimming." Ryan and his family also enjoy biking, hiking, kayaking and camping during the warmer months. "We have four seasons of recreation."



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