The Rural Life September 2011

Home Remedy

A small town solves its physician shortage.
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Nishant Choksi

Residents of Albany, population 1,730, in northwestern Missouri, aren’t shy about talking up their town. They point to its scant crime, good schools, and tidy, Victorian-era downtown, where handsome red-brick buildings whisper of an affluent past. Beyond its family-friendly movie house and nine-hole golf course lie farm fields—wheat, corn, and soybeans mostly—and woodlands with abundant hunting and fishing.

Yet for all of Albany’s charm, trying to entice doctors and nurses to resettle there, an hour northeast of the nearest city, St. Joseph, has proved extremely difficult. Nearly 25 percent of Americans live in rural places like Albany, but only about 10percent of physicians practice in those areas. And as more and more country doctors retire, the rural health-care shortage grows, because so few newly minted physicians have been willing to fill their shoes. Albany’s only hospital, the nonprofit, 25-bed Northwest Medical Center, used to employ a full-time recruiter who advertised and sent out mailers to lure health-care providers from midwestern cities like Omaha, Kansas City, and St. Louis. Response was tepid.

“You pretty much took what you could get,” says John W. Richmond, who retired last year as Northwest Medical Center’s president and CEO. “I mean, it’s kind of like sex if you haven’t had any in a long time. You’re in a bar and it’s 1:30; they just keep getting better-looking.”

All told, about a dozen physicians agreed to give Albany a try. Some, Richmond confides, turned out to have spotty résumés or shaky work habits. Few lasted long. “They’d give you a lot of reasons why they didn’t want to stay,” he says, “but when it came down to it, they didn’t like the rural lifestyle.”

By 2000, Albany’s hospital had become so short-staffed that registered nurses like Donna Walter were putting in 24-hour shifts. “We were exhausted,” says Walter, who today serves as the medical center’s vice president of patient services.

Richmond was at his wits’ end. “You’re doing everything you can to get somebody, and you have nobody to choose from,” he says. “Pretty soon, a light goes on: Hell, I’m not getting anywhere. If I’m going to have stability on the medical staff, I’m going to have to do it with people who are from here, who want to be here. Either we grow our own, or we starve to death.”

Richmond began speaking in local schools about the rewards of caring for family and neighbors. He orchestrated “pipeline” events, allowing kids to shadow medical staff on their rounds. He gave them paying jobs at Northwest Medical Center, even when there was no real work for them. And to those who showed potential, he awarded financial assistance to attend vocational or medical school, so long as they promised to return one day to work. They signed letters of intent to practice locally after finishing their studies, for a minimum number of years, contingent upon how much money they had received. Albany natives interested in a second career could also apply for financial aid from the hospital and return to school—again, on condition that they would agree to come back to work in Albany.

To date, at least 23 nurses, two medical technicians, and a certified registered nurse anesthetist have received financial assistance. So have two family-practice doctors who will soon finish their residency training and begin serving full-time on Northwest Medical Center’s five-physician staff.

Dr. Katie Dias is among those who have benefited from Richmond’s vision. Her family ties to Albany date back to the 1800s, and she started out at the hospital as a teenage candy striper. By the time she graduated from Missouri’s Central Methodist University, she’d scrubbed in to observe surgeries and learned on models how to suture wounds.

“I was a sophomore in college,” she says, “and Mr. Richmond was already calling me ‘Doctor.’”

Dias, 28, went on to earn her degree in osteopathic medicine from Kansas City University of Medicine and Biosciences. After finishing a family-practice residency this summer in Kansas City, she returned to work at Northwest Medical Center for at least five years in exchange for the $60,000 forgivable loan the hospital gave her. Another osteopath, who was raised in nearby Grant City and is currently finishing his residency in Jefferson City, Missouri, is expected to join her next year. “We’re just a small town, but we believe we’re an exceptional small town, with exceptional people,” says Jon Doolittle, a Harvard honors graduate who came home to Albany last year at age 35 to run the hospital.

Dias, for her part, has no plans to move after her five years are up. “This community,” she says, “has invested more in me than I’ll ever be able to give back.”

David Freed is a screenwriter and former investigative reporter for the Los Angeles Times, where he shared in a Pulitzer Prize for coverage of the 1992 Rodney King riots.
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