Raising the next crop of rural care providers

When Dr. Roy E. Fell pulled onto the beautiful brick square of Mount Ayr, IA (pop. 1,800), on July 10, 1955, with family in tow, he was continuing a journey that would leave his bedside manner legendary, his community leadership invaluable and humility in check through it all.

With him on this special day was his wife of five years, Frances, an elementary teacher from Clarion, IA. In the backseat were their three kids: Fay, three; Paul, two; and myself, nine months. Roy “Paparoyo” Fell graduated from Des Moines Still College of Osteopathy and Surgery, Class of 1954, and had just completed an internship at Des Moines General and Broadlawns hospitals.

As a DMU alumnus myself, I was part of his remarkable journey as was he a huge part of mine. He died on Feb. 20, 2011, at 87, a mere seven months after his wife of 60 years passed at age 82. The highs and lows of his 30-plus years as a rural medical professional offer insights into the chronic difficulties of finding and training future rural medical providers.

Dad didn’t see it coming, but throughout his career he would also need to become a recruiter. Upon his arrival in Mount Ayr, there was no big shortage of medical staff. The Ringgold County Hospital was relatively new. As he settled his family into this beautiful town, however, a few hurdles began to arise. The local bank was reluctant to risk money to help start a new medical practice. The medical staff required an initial test period prior to hospital staff privileges being granted. Dad was granted privileges at a hospital 30 miles away; soon his inpatient practice became busy enough that the Mount Ayr hospital changed its requirements and granted him local access before his test period was over. To make financial ends meet, he shared a small office with another general practitioner.

Residents learned of Dad’s passion for helping others, his interest in obstetrics and his great OMM skills. He shared his leadership skills, positive outlook and moral compass as a volunteer on the school board, in church, at a local group home and on other community projects. Soon he needed a larger office to keep up with his popularity. Eventually, he built a larger clinic. He regularly saw 50 patients a day, and often as many as 100 checked in for the day. He continued a busy OB practice, made house calls and even found time to add three more kids to his family.

I didn’t realize it at the time, but we kids became his biggest challenge. Mom was his office manager and, as our sports activities became more frequent, Mount Ayr became our “village.” At Mom’s funeral, Dad – after sharing his sadness of his sweetheart’s passing – thanked the community for keeping an eye on his kids all those years.

Doctors bag
According to the Office of Rural Health Policy, 25 percent of Americans live in rural areas, but only 10 percent of American physicians do. How can we encourage and prepare future health care providers to embrace the challenges and rewards of rural medicine?

As physicians retired or left and Dad’s “call” went from every four nights to every other night, we saw him even less. One way we got to spend time with him was going on house calls with him. With this new shortage of providers, his work took even more time as he stepped up his recruiting efforts. Many came and many left, but a few began to stay. He often said that you really couldn’t learn to do rural primary care unless you were from a rural area. Then you needed to possess a strong passion for taking care of others, a commitment to keeping them healthy and happy and the ability to encourage people to remain productive as long as possible.

I told Dad about DMU’s rural medicine educational pathway program and the Iowa Area Health Education Center Program, established to recruit and retain Iowa’s health care workforce. Of course he already knew about these and encouraged me to keep looking for young people who would consider committing to rural practice. He also knew that I’ve been involved in interviewing potential D.O.s at DMU and that I look for his qualities in all of them. I don’t think any less of these bright, unique applicants when I don’t see those qualities, but when I do, I get very excited.

Dr. Fell died as an inpatient at Ringgold County Hospital, a new hospital that opened in the past year. Once again there’s no real shortage of primary care providers in Mount Ayr. Dad was very proud of this increase but disappointed a woman still must drive 30 miles to have a baby. We and the malpractice attorneys must work on this.

D.O.s from the “greatest generation” removed many hurdles for us to practice alongside our allopathic colleagues. A remaining hurdle will be recruiting and training the most capable and likely people to enjoy the challenging lifestyle of rural medicine.

John Fell, D.O.’88, is a retired physician and founder of One Fell Swoop Problem Solving in West Des Moines.

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