A new practice in rural Western North Carolina fills the traditional family doctor role, adding a few ‘bells and whistles.’
By Taylor Sisk
Dr. William Burch wasn’t a big talker. Rhee Williams recalls that when you’d ask him what your blood pressure was, he was likely to respond, “Well, it’s higher than it was.”
But Aunt Rhee, as she’s known to her western Rutherford County community, says Burch was a good doctor. Her most vivid memory of him is the time she had a hurting in her side. “Couldn’t even stand my clothes to touch me,” she said. “I went to him and he says, “You’ve got the shingles.” His early diagnosis spared her some considerable pain.
“He done good,” Aunt Rhee said.
Burch – a World War II and Korean War vet who helped form the local fire and rescue squads – was 90, a year older than Aunt Rhee, and had been practicing from his Lake Lure office for a half century when he retired last spring.
He passed on a month later.
“He worked seven days a week,” said Kate Sloss, who had the only other practice in the immediate area. That was in Bat Cave, a half-dozen miles down Hwy. 64, about 25 miles southeast of Asheville. “After hours, the phone from his office would go to his home. He did house visits. He was amazing.”
Though not open seven days a week, Sloss has now opened a new practice, the Lake Lure Medical Center, as part of the Mountain Area Health Education Center network. Sloss joined up with Grey Tilden, a graduate of MAHEC’s Family Medicine Residency Program, which trains doctors to live and work in rural areas.
Close to home
Tilden is from Alabama. Back when he was mapping his path into medicine, he got a piece of advice from a family physician: If you want to go into family medicine (which he did), don’t do your training in a big city, because there are so many specialists there that you won’t get to do as much as you would in a rural program.
He liked what he learned about the Family Medicine Residency Program in Hendersonville. It was the most innovative in terms of, for example, tracking chronic illnesses.
While a resident, Tilden worked alongside Sloss in Bat Cave. He completed his residency in July 2013, and he and Sloss opened their doors in Lake Lure on Sept. 29.
When Dr. Burch had reached his 90s, the town of Lake Lure decided it needed a plan in place in the event of his retirement. Upon Burch’s death, Tilden and Sloss were the perfect fit, dedicated to working in the area. MAHEC was the ideal host.
Lake Lure is a resort. Rumbling Bald, on its shores, attracts well-heeled seasonal and year-round residents. But veer off the highway and you can very quickly find yourself in deep Appalachia.
Tilden estimates that close to two-thirds of his practice’s patients live in poverty, driving in from remote areas of Polk, Rutherford and Henderson counties. Many are still in farming, at least part time. The practice offers a sliding-fee scale.
Tilden, the father of two young kids, sees his role as being very much that of the traditional family doctor, which entails putting into practice most of those things for which his residency prepared him.
It’s not just that there are few specialists in the area, but, Sloss explained, a good share of locals aren’t too fond of straying far from home.
For many, she said, “Asheville is like a foreign country. They don’t want to drive there; they don’t want to be there.”
And even if specialists were easily accessible, she said, rural folks would still be reluctant to see them. They’re partial to what they’re familiar with. As a result, she ends up treating conditions that in a less remote area she’d never encounter.
“We see some very complicated chronic medical problems,” Sloss said. “So that’s interesting; it’s never boring. But at the same time, it’s also sometimes that you’re stretched a little thin trying to keep up with everything.”
That “everything” often includes being perhaps the only professional to address behavioral health issues.
Tilden said he generally saves his psychiatric referrals for more severe cases, of which there are many.
“[T]here’s a tremendous burden of undiagnosed, potentially undertreated mental health issues in rural North Carolina,” he said.
According to the North Carolina Institute of Medicine’s “North Carolina Rural Health Action Plan,” rural areas experience more “poor mental health days” than cities. (The report also found that depression is associated with a 50 percent increase in the medical costs for other chronic illnesses.)
Some days the work can feel overwhelming, Tilden acknowledged.
“If one person is hurting or has some tragedy befall them, that affects so many people, a significant percent of the population, in a small town,” he said.
But the vast majority of days, his work rewards: “I feel very well respected, and I definitely try to show that mutual respect.”
Tilden accepts that he’s taking a financial hit with a rural practice: perhaps $15,000 to $20,000 a year less than if he were practicing family medicine in an urban area. He’s only recently applied to the state Office of Rural Health and Community Care for assistance repaying his medical school loans.
ORHCC offers repayment to health professionals who commit to practicing two to four years in a health professional shortage area.
Sloss said that being a part of the MAHEC network offers a number of benefits: Her inbox fills with the back-and-forth exchange of ideas and observations, the sharing of new theories and procedures. And the plan is to have MAHEC specialists rotate through the practice and to incorporate in-network telemedicine.
Tilden and Sloss also intend to get creative in their approach to integrated care, with a plan to introduce meditation, for example. Tilden admitted that will require a bit of salesmanship.
“If I tell people that it comes from an Eastern Buddhist tradition, that’s going to put a wall up,” he said. But if they’re told the Veterans Administration uses it with soldiers returning from Iraq, it becomes more “compatible with them culturally.”
“I do know that they trust us, and that they would be willing to try,” Tilden said, “that they would give it an effort, and not a half-hearted one, because they know that we really want what’s best for them.”
In that respect, Tilden and Sloss agree they’re maintaining a tradition, building a practice that, like Burch’s, is founded on trust.
“There may be some new bells and whistles,” Tilden said, “but, ultimately, that provider-patient relationship that’s held in the highest esteem is maintained.”
“The actual practice of medicine to me is what happens in the room talking with the patient,” Sloss said. “That hasn’t changed.”
Bragging on her
“I love it here,” Aunt Rhee said on a recent Friday afternoon visit with Dr. Tilden. “He’s friendly with you and he explains things to you” – a bit more interactive than Dr. Burch.
This was just a regular checkup. She feels pretty good, all things considered. More than 40 years of mill work “just wore out” her shoulder; hauling firewood takes a further toll. But, she said, Dr. Tilden has “bragged on me just about every time I’ve come in.”
Tilden plans to stay where he is till he retires. Dr. Sloss has been a great inspiration: “She’s showed me just how rewarding it can be.”
“A lot of times in our lives, we don’t really know that everything we do has that much impact, personally and professionally,” Tilden said. “I think I could be working somewhere else and I would never be missed if I retired or died.
“But in this community, I still talk with patients every day about Dr. Burch…. He’s still missed and loved and adored.”
“He’s a good doctor,” Aunt Rhee affirmed of Tilden.
“I hope I’ve got a few more years,” she said as he measured her blood pressure.
“I believe you do,” her doc replied.[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]