Using the stethoscope dangling over his Western-style shirt, Dr. R. David Hill leans in and listens to Riley Patterson's heart at his clinic in South West City, Mo. (pop. 855).
In for a checkup and a chat, Patterson, 31, talks about horse trading before their conversation turns to high school football. "Those Mustangs are shaping up pretty well this fall," says Hill, 60, of McDonald County's team. The tall, lean doctor should know. Through the years, he's provided free examinations to many young athletes, including Patterson during his school days.
For nearly 30 years, Hill has been the heart of health care in South West City, serving much of that time as the only physician in a town with one cafe, a post office, lumber company, grocery store and no traffic lights. Before his arrival in 1980, the town was without a doctor for seven years after his predecessor retired. "People drove for more than 25 miles to see a physician," says Mary Lou Shaddox, 67, former director of the McDonald County Health Department.
In 1979, Hill was finishing medical school at Oklahoma State University and looking for a small town to work in for two years to fulfill a scholarship obligation. Leaders in South West City invited Hill and his wife, Megan, to visit, and residents welcomed the young couple with a community potluck picnic at the home of Bob and Bertha Nichols. "The backyard was full of people who wanted to meet the doctor," recalls Bertha, 84, whose family owned a clothing store in town at the time.
The hospitality apparently worked. Earning a salary of $16,000 that first year, Hill set up shop in back of a downtown pharmacy and used equipment purchased with proceeds from a community rummage sale, a cakewalk and other fundraisers. There, he set broken limbs, delivered babies, and stitched up cuts and gashes. He treated infants who weren't breathing, adults with farming and hunting injuries, and heart attack victims of all ages. "In a rural setting, you see a diversity of medical problems," he says.
To supplement his pay, Hill worked weekends in emergency rooms at five regional hospitals and treated residents at nursing and group homes. While his medical school classmates couldn't understand why he'd settle in a small town, Hill and his wife opted to stay put after two years. "It was always my intent to be a country doctor," muses Hill, who grew up in Vian, Okla. (pop. 1,362).
Today, Hill is known around town as "Doc" and works at South West City Community Clinic, built in 1982 on land donated by a local businessman. He and Megan have raised two daughters in South West City and opened three more health care clinics in the area. Beyond his practice, the doctor has served as a forensic examiner, medical director of both the local ambulance service and health department, and on the child death review board. In 2006, the National Rural Health Association named him rural health practitioner of the year.
Townspeople say Hill has been a godsend. "He's a blessing to the community and me," says Randy Chandler, 47, holding up the hand he broke while working on a water tower in Colorado. "I wouldn't let any other doctor examine it," recounts Chandler, who waited until he could return home three weeks later to see Hill.
Shouldering McDonald County's health care needs has come at a price, though. "One of the challenges of rural medicine is the isolation," Hill says. "The reward is the love, respect and appreciation from families because I helped them through traumatic and tragic times."
About 50 million Americans live in areas without access to basic medical and dental care, according to the National Health Service Corps (NHSC), which Congress established in 1970 to recruit health care professionals to medically underserved areas.
To remedy this disparity, the NHSC provides scholarships and forgives loans to primary care physicians, physician assistants, nurse practitioners, dentists, certified midwives, mental health professionals and dental hygienists in exchange for at least two years of work in those settings. About 4,000 recruits work in the field at any given time, logging 4 million to 5 million patient visits annually. Once their obligation is fulfilled, more than half opt to stay on or serve in similar areas, says Rick Smith, NHSC's head of clinician recruitment.
Patrick Armstrong, 52, is a perfect example. Since graduating at age 35 from the University of Iowa's Carver College of Medicine, he has worked as a physician assistant in rural Montana, beginning at Phillips County Hospital in Malta (pop. 2,120). "We wanted to raise our family in a small town," says Armstrong of he and his wife, Kathy, who have three children.
Intermittently, he was the town's only medical provider, giving him broad experience and long days and weeks on the job. After nine years, Armstrong moved 90 miles west to Chinook (pop. 1,386), where he works with a pediatrician and physician assistant at Sweet Medical Center. Once a month, he travels 150 miles to Glasgow, Mont., to work a long weekend at Frances Mahon Deaconess Hospital.
"The rewards," Armstrong says, "are the gratitude of patients. They tell my children, 'Your father saved my life.'"
A desire to serve low-income, uninsured and underinsured people drew Margaret Flinter to join the 10-member staff of the Community Health Center in Middletown, Conn. (pop. 43,167), after graduating in 1980 as a nurse practitioner from Yale School of Nursing.
"The center had a real sense of drive and passion for creating a community-oriented primary care center," says Flinter, 56.
That mission has kept Flinter in Middletown through her career as she helped the center grow from a single location to 12 sites in central and southeastern Connecticut.
Nurse practitioners are licensed to provide health care services similar to those of a doctor in a variety of settings.
"The challenge is understanding the stress, difficulties and economics that patients face," she says. "The reward is the satisfaction of having made a difference in their life and health."