I remember the circumstances under which I first called Todd Stephens, M.D. "Dr. Todd," as he is known, is a faculty member with the Via Christi Family Medicine Residency in Wichita, Kan., and the director of its International Family Medicine Fellowship, a one-year, post-residency program geared to providing health care in developing countries. Via Christi is a national leader in training full-scope family physicians to practice in rural areas, and we had no doctors living in Ashland, our small town in the remote and vast prairie of southwestern Kansas. As the new CEO of Ashland Health Center, a 24-bed hospital and 21-bed nursing home, my job was to find a physician, and I thought Via Christi was the place to start.
Despite having a warm culture with friendly people, Ashland Health Center struggled to recruit and retain qualified health care staff. The community of 855 people had seen seven administrators and 11 providers come and go in less than 20 years. For more than two years, our sole physician assistant, supervised remotely, faithfully worked around-the-clock, five days per week, and we attempted to piece together weekend coverage for the emergency department through myriad traveling medical providers.
Eventually, we were able to get the PA some help one day per week from a nurse practitioner living 50 miles away. It was difficult to know how to stabilize our medical staff. We knew our PA was committed to our community, but he badly needed on-site physician support. Still, it seemed improbable that we could find a physician who would live in a community that was an hour from the nearest Walmart.
Almost immediately, Dr. Todd responded by saying that we could not recruit just one doctor. If we wanted any success, we must get two, because good physicians do not want to practice alone. In other words, the days of the solo community doctor were over. He suggested the following job description: four-day work weeks in the clinic and no more than one night per week and one weekend per month in the ED. The most important piece: eight weeks off per year to allow for international mission work. Though compensation commensurate with regional averages would be appreciated, it would not be a primary decision-making factor.
Dr. Todd's idea was that people willing to care for the sick and suffering in underserved countries might be willing to do the same in underserved counties, specifically in a small town like Ashland. My first question: How many of these physicians really exist? I was surprised to discover that the majority of residents at Via Christi are interested in international work. One-third of them are choosing elective rotations in hospitals in developing nations. This is a growing national trend beyond Via Christi. In fact, millennial physicians (age 31 and younger) are more driven toward social justice than any other living generation in American history. We knew these people were out there. We just needed to get their attention.
Our Mission Recruiting mission-focused health professionals requires being a mission-focused organization. After a fruitful board retreat through the Kansas Hospital Association, our board brought in a strategic planning consultant to help us redefine our mission and vision statements, core values and goals. In our mission was the responsibility to provide equal, excellent, compassionate care to all who entrust us with their lives. Our plan was a unique recruitment model that would attract the people who would help fulfill that mission. Within six months, we had two impressive candidates, both drawn by our encouragement of overseas service. They understood that we wanted people in our hospital and community who also wanted to serve the most vulnerable people in the world.
Our first success story was Dan Shuman, D.O., a 43-year-old family physician who was working with a multi-specialty medical group in Georgetown, Texas. Although he was comfortable caring for well-insured retirees, he missed his past medical work in places like Haiti and Mexico. Last year, Shuman brought his wife, a social worker, and their five children to Ashland. Since that time, we have received interest from at least six other legitimate physician candidates. One of them, Brianne Clark, D.O., who is bilingual and has ties to our area, will begin her practice in Ashland this summer through a partnership with Harper County Hospital's satellite clinic in Laverne, Okla. Clark has done mission work in South America and plans to continue doing so. When hosting these physicians, we altered the conventional red-carpet approach.
In addition to showing them the traditionally attractive aspects of our community, such as our low crime rate and nationally recognized schools, we also chose to highlight the disparities they could address, such as the health needs of our growing Hispanic population. This approach was effective. I recently asked Clark about her expectations for housing. Her lighthearted response: "I just spent two weeks sleeping on a cot on a boat in the Amazon. I'll take what you've got."
Faith and Medicine
We now have a stable of full- and part-time providers, including two physician assistants, one nurse practitioner and a physician. In the last year, we also have recruited two medical technologists, a nursing director and other nurses using this approach. All of them share the same mission and vision to care for vulnerable people. But as we receive inquiries about this model, we are open about what some people consider the elephant in the room: Where is the line between faith and medicine?
Ashland is a secular, tax-supported hospital district, and we do not require some sort of spiritual commitment in exchange for healing a physical wound. Our mission statement says that compassionate care is unconditional. It is unethical to violate the trust between patients and medical providers or exploit a patient's vulnerability through coercion or intimidation. That said, it would be disingenuous to ignore the needs of the whole person (mental, emotional, physical and spiritual), and patients who ask a provider to pray with them likely will be granted that wish.
There is more to the challenge Dr. Todd first posed. After he explained the mission-focused model, he asked me how serious I was in implementing it. I told him I would do whatever it took to prove to physicians that I was serious about their commitment to mission work. "Then come to Africa with us," he replied. I had never been overseas, but Dr. Todd was giving me an opportunity to demonstrate my support of mission work.
One year and six immunizations later, I found myself flying over the Atlantic Ocean on my way to a rural village in Zimbabwe to build window screens to keep mosquitoes and cobras out of the homes of missionaries. The lessons I learned were profound. I expected the vast differences between rural Kansas and rural Zimbabwe. What I did not expect were the similarities: Access to care and affordable housing are challenges in both places. Kansas is not the Third World, and I am not called to live in Africa. My wife and I belong in the wonderful town of Ashland. But I am fascinated by how meeting the needs of people in another part of the world can open our minds and hearts to the needs of our neighbors here at home. Perhaps our responsibility is to erase disparities everywhere.
Benjamin D. Anderson, M.B.A. (firstname.lastname@example.org), is chief executive officer, Ashland (Kan.) Health Center.