By Taylor Knopf
Floyd Scott started a health care practice about nine miles outside of Burlington in a one-room office 100 years ago.
“That’s all he needed because health care was delivered at home,” said his son Samuel Scott at the 100-year celebration of the Scott Community Health Center last month. Everyone called the elder Scott, “Dr. Floyd.” He passed the practice to his sons, “Dr. Pete” and “Dr. Sam.”
Samuel Scott said his father got into some complicated obstetrics because no one wanted to drive all the way to a hospital to deliver their babies.
“People didn’t go to the hospital, because that’s where you go to die,” Samuel Scott said.
That one room medical practice evolved to a bustling medical center today with 20 employees, including specialties in behavioral health and nutrition. Piedmont Health received a grant from the Duke Endowment and bought the practice in 2002, according to Samuel Scott.
Linda Miles Siggers-Bey has been a provider at the center for 10 years with Piedmont Health. She grew up outside Baltimore but said she felt called to practice in rural North Carolina after attending medical school at Wake Forest.
“It just felt like this is where I should be,” she said at the 100-year celebration. “The history of the community makes it enjoyable. I like being a part of the history.”
Evolution of rural health
Samuel Scott said the timing of the sale to Piedmont worked out for him because he was ready to retire and his employees at the time got to keep their jobs.
“Today, the story is not about a family of doctors. It the evolution of the delivery of health care in a rural setting over 100 years,” Samuel Scott said.
Under his elder brother, Dr. Pete, the practice evolved with two-way radio systems and written medical records, he said. Then Samuel Scott watched as electronics such as pagers, computers and cell phones changed the nature of medical practice under his direction.
Being the only doctor in a rural town meant a grueling seven-day work week for their father, Dr. Floyd. When his eldest son, Pete, went into the Air Force, people in the community didn’t think he would come back, Samuel Scott said. Dr. Floyd rarely took a vacation and when Pete left, he hired his first and only employee, a nurse named Nancy Kistler.
Dr. Floyd had delivered Kistler when she was born and the two were close.
Kistler couldn’t remember how many years she worked for Dr. Floyd as she mingled with former patients and guests at the 100-year celebration last month. Kistler came to work for Dr. Floyd after she completed nursing school in 1948 and said she was the only registered nurse at the practice at that time. She trained other lay people at the time who had an interest in helping, she said.
Kistler is still a patient at the Scott Community Health Center. The staff said she refuses to be seen anywhere else.
The eldest son did eventually return from the Air Force and take over the practice. Pete Scott had two conditions: no more home birth deliveries and no more seven-day weeks. He wanted a day off. Pete Scott passed away in 1998.
The Scott family collection of memorabilia is housed in Alamance Community College about five miles from their ancestral home. Peggy Boswell curates the collection and said she probably knows more about the Scotts than they do about themselves.
Floyd Scott, founder of the rural medical center, was one of 14 children. One of his brothers, William Kerr Scott, became governor of North Carolina from 1949 to 1953. His son, Robert Scott, also served as governor of North Carolina from 1969 to 1973. Robert Scott’s daughter Meg Scott Phipps resigned as state Commissioner of Agriculture and went to prison after being convicted in 2003 of campaign finance fraud. Other Scotts have served in the NC state House and Senate.
One of Dr. Floyd’s sisters, Elizabeth Carrington, was a nurse who helped start the UNC Chapel Hill School of Nursing. Carrington Hall is named for her.
Samuel Scott said he was always expected to go into medicine, by his family and the community. He graduated from the UNC Medical School in 1963 and ran his father’s practice for 35 years.
Samuel Scott said he still visited the homes of patients, even after the center opened. In 1978, he and two other employees made 444 house calls. And in 1988, he said he made 70 house calls.
He enjoyed seeing old patients at the celebration. He said he likes going to the grocery store because he usually sees someone he knows and has treated.
And he’s seen several generations of patients, up to four generations in some families.
“I knew their family histories better than they did,” Samuel Scott said. “Sometimes the patient’s father had diabetes and the patient didn’t know it.”
Primary care deserts
He admitted that it would be hard for a physician today to do what he and his family members did. His son went into medicine as well but chose to practice in an urban area where he wouldn’t have to be on call so frequently.
“One of the problems with modern medicine is reimbursement and income for the rural physician,” Samuel Scott said.
Samuel Scott said his clinic was always self-supporting and didn’t receive subsidies or grants.
“If you come out of medical school with loans of a couple hundred thousand dollars, you can’t afford to do it,” he said. “A person couldn’t come out of medical school now and do what I did. There’s not enough money here to do that.”
Rural hospital CEOs echoed the retired doctor saying their communities are turning into “doctor deserts” when they met with state officials last month about Medicaid expansion.
“I am sure I’m speaking to the choir here. It is really hard with current reimbursements to recruit physicians, especially primary care physicians,” said Michael Nagowski, CEO of Cape Fear Valley Health System.
“So the burden falls on hospitals and health systems. We recruit the doctors. I didn’t poll anybody, but I’m sure we all lose money on our employed physicians. We just do. But we don’t have a choice, because who else is going to bring physicians to rural areas?”
Nagowski said he is looking forward to more primary care providers so he can move people who frequent his overcrowded Emergency Department into more appropriate settings for care.
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