Guest Contributor

In Georgia, as elsewhere in the World, there is a primary care provider shortage, and by some estimates it may not be filled in the near and distant future, consider this:

“In a real sense all life is inter-related. All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be, and you can never be what you ought to be until I am what I ought to be... This is the inter-related structure of reality.”

With this quotation by Dr. Martin Luther King Jr. in mind, I would like you to consider this story of a primary care physicians’ struggle to provide healthcare in the State of Georgia. In the summer of 2012, I arrived in Albany, Georgia with my wife, and daughter from Baltimore, Maryland. In Baltimore, I had recently completed a 2 year Geriatric Med

icine and Gerontology Fellowship, at Johns Hopkins Bayview Medical Center. And, during my final year of the fellowship, worked concurrently, full time, at probably one of the busiest Federally Qualified Healthcenters in Baltimore, Total Healthcare, Incorporated. “Total,” as it was loving called, is located in West Baltimore, in the same community where “The Wire,” was filmed. I worked with a dedicated, and “hard working family,” of physicians, including Dr. Christine Fleurimond, and others. Soon after obtaining my job there, where I was fulfilling the National Health Service Corps (NHSC) Obligation, we started working on a Patient Centered Medical Home (PCMH) project, which was under the leadership of the new CEO, a charismatic, Faye Royale-Larkins, and led directly by Mrs. Bessie Bailey-Weaver, of the University of Maryland Medical Center.

I was directly responsible, for introducing the utilization of the Wisconsin Star Method in the care of nonelderly, indigent patients, and taught the PCMH team the appropriate utilization. Which, Mrs. Bessie, eventually demonstrated that she had learned it better than me! The PCMH team included a Nurse Care Coordinator, Clinical Pharmacist, Community Health Workers, and a Social Worker, whom, I can’t help but recall, Mrs. Ingrid Paymar, who was quite impressive. During my short time there, I was excited about the PCMH, and it’s potential to impact healthcare, in the community, and in society at large. Shortly before transitioning from “Total,” I accepted a full time fellowship at Georgetown University, in Washington, D.C., to complete a nephrology fellowship. Where, I hoped to carve out a ‘microniche’ in the area of geriatric medicine and gerontology, so-called, “geriatric nephrology.”

And, I thought that it would be Continued on page 6

6 RuralLeaderMagazine.com | July 2018 Primary Care, Continued from page 5 useful to have such a sub-specialization, in general, and in the rural practice setting in Georgia, where I was eventually to go.

I had previously reached out to the State Medical Education Board of Georgia (SMEB), to request a repayment deferral of the “Country Doctor Scholarship,” to complete my Geriatric Medicine and Gerontology fellowship, when I declined a Massachusetts General, 1-year Geriatrics Fellowship, although Dr. Hammond Claus would have been an excellent mentor. The SMEB, agreed to allow me to complete a 2-year fellowship. However, when I informed them that I had been accepted to nephrology fellowship, they declined to approve the training, and insisted that I return to Georgia, immediately, to complete the “Country Doctor” Scholarship. I obtained a full-time clinical position, at Albany Area Primary Healthcare, Inc. (AAPC), at the Lee Medical Arts Center, in Lee County Georgia, a county with a population of 29,159. At this facility, I met, Dr. James Hotz, a local, and national legend, who was responsible for forming the National Health Service Corps (NHSC), which scholarship program I had recently completed. At AAPHC, my duties included outpatient, and inpatient primary care, and nursing home rounding at Lee County Health and Rehabilitation. I also participated in clinic meetings, and internal medicine meetings which included providing teaching to my colleagues. I acquired faculty at Philadelphia College of Osteopathic Medicine (PCOM), Georgia Campus, and A.T. Still University College of Physician Assistant Studies. My duties included precepting a PCOM student in the outpatient clinic, and nursing home, and providing 70 hours of clinical instruction to a nurse practitioner student from Auburn University.

During their internal medicine board meeting, I presented on the topic of Alzheimer’s Disease treatment, and this included an discussion with a pharmacy student. Following my yearly chart review, I received excellent feedback from their administrative physician. My meaningful use statistics were at, or above average. I thought that things were going well, however, close to the end of my 1-year contract, during the “change of the guard,” when their CEO was retiring, and being replaced by someone new, I was approached by their CEO, and one of their adminstrators who informed me that they would not renew my contract, and provided an official letter that stated “without cause.” Then, in the same meeting they stated that I was “not a good fit.”

And mentioned, that I was not participating in hospital rounds. And, I would be remiss, if I did not say, that during my in hospital training at Phoebe Memorial Hospital, that the “geriatrician came out of me,” during a discussion with a hospitalist colleague about an elderly patient’s care. And, this seasoned colleague, in our discussion about the patient became upset, and was rude, both verbally, and using offensive hand gestures, and walked away from me in the middle of our discussion regarding patient care. I reported this incident to the adminstrators at AAPHC, however, never received formal apology from the physician, or the healthcare administrators. However, from that point onward, I was not asked to round in the hospital, which later seemed to influence their decision to discontinue my contract. Interestingly, one of the physicians from AAPHC, who signed my separation letter, gave me a verbal reference to obtain a full-time job in the Ethica nursing home, which included continuing to work at the Lee County Health and Rehabiliation facility which I had worked at for 1-year under the supervision, of the excellent geriatrician, Dr. Bernard Scoggins, who was a kind, and thoughtful physician.

This position, which I obtained, was that of Medical Director, and involved rounding at 5 nursing homes: Lee County Health and Rehabilition, Wynfield Park Health and Rehabilitation, Dawson Manor, Zebulon Park, and one other.

I suggested to the director of the facility, that instead of the once per month clinical evaluation required for nursing home residents, that we try more frequent visits, based on the clinician’s assessment, that might be a new model for nursing home patient care. While providing these more frequent visits, some of the nurses questioned why I was seen so frequently at the bedside. To say the least, during a 1-month review, with no prior notice of conflicts, or concerns, I was informed by the director, that he “suggested that I resign,” for “conflicts with staff.” So, I did.

Soon, thereafter, I interviewed at Primary Care of South West Georgia, Inc., was offered, a contract, but decided instead to accept a full time clinical position, at the Miller County Hospital, R.E. Jennings Clinic, in Arlington, Georgia, in Calhoun County, population 6,431, where there were two primary care clinics. I learned, at Primary Care of South West Georgia, Inc. that the CEO of Miller had worked, and/or trained at Continued on page 11