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'Hillbilly Doc' Provides Population Health in Rural Kentucky

Analysis  |  By John Commins  
   February 22, 2017

Fresh out of medical school and residency, Van Breeding, MD, could have gone anywhere to practice his profession. The son of a coal miner returned to his home in Eastern Kentucky.

Eastern Kentucky has acquired some dubious distinctions over the years. The rugged corner of Appalachia has some of the nation's highest rates of obesity, tobacco use, diabetes, high blood pressure, cardiovascular disease, various cancers, and respiratory illnesses such as black lung and emphysema.

Not coincidentally, the region is also one of the nation's poorest, and prospects have gotten bleaker with the demise of the coal industry. Unemployment in Letcher County, nestled on the Virginia state line, stands at 9%, nearly twice the national average, the poverty rate is above 28%, and local healthcare workers say that many of the 500 or so annual births at Whitesburg Appalachian Regional Healthcare Hospital are delivered by women addicted to opiates and other drugs.

As a newly minted physician fresh out of medical school and residency at the University of Kentucky in 1991, Van Breeding, MD, could have gone anywhere. He chose to return to his hometown of Whitesburg and a career that beckoned with an irresistible call for 16-hour work days, few vacations, scant resources, and low pay.

"Going somewhere else was never ever a thought," says Breeding, 55. "I grew up in this town. I went to high school in this town. All of my family is in this town. My patients are either family or friends of mine."

As a child, Breeding witnessed the societal costs that the coal industry exacted upon the people who worked in the mines and lived in the surrounding area. His father was a miner who was disabled and blind by age 50. At age 7, Breeding watched as his grandmother nearly died from lack of access to care after suffering a heart attack. His good friend, a former high school quarterback, has black lung.

With the coal industry in decline, Breeding, a self-described "Hillbilly Doctor," is dealing with a new set of population health problems that center around poverty and a lack of access to care, including obesity, cardiovascular disease, diabetes and malnutrition. In 2009, one of Breeding's colleagues was murdered by an addict desperate for pain medication.

Breeding practices with Mountain Comprehensive Health Corp. in Whitesburg, one of more than 1,600 government-subsidized community health centers nationwide. His patients are mostly poor and uninsured.

On an average day Breeding works 16 hours, starting with 5 AM rounds at the hospital. He sees about 40 patients a day at the clinic, and then rounds at the nursing home at night. He also makes house calls.

There were only five practitioners at MCHC when Breeding arrived more than 25 years ago. Now there are more than 40 clinicians, and the clinic has expanded from two to seven sites.

Thanks to the Affordable Care Act, Breeding says MCHC has the funding to provide dental and optometry services, and even venture into population health.

Obamacare's Impact
Proactive community outreach efforts by MCHC have created pioneering programs to address diabetes through a "Farmacy Program" that improves access to fresh fruits and vegetables. A colon cancer initiative that improved screening rates from 18% to 60% was lauded by the Centers for Disease Control and Prevention.

Breeding bristles when he hears Kentucky's political leaders vow to repeal the ACA "root and branch."

"It drives me crazy, because I feel in my heart that at Mountain Health Corporation we have the blueprint of what healthcare should be," he says. "If you can practice healthcare like this anywhere in the United States, you are going to have great outcomes."

"There are a lot of drawbacks on stopping Obamacare because these people need preventative care," he says. "If this goes away, we will have to discontinue dental and optometry and we won't be able to have extended hours because we won't have the funding."

"It is going to make a huge difference for healthcare here in an area where we have the highest rates of diabetes, heart disease and high blood pressure and local forms of cancer in the coal fields here in East Kentucky. We rank poorly but we definitely made progress on improving those numbers in the areas where we have a clinic and we have the proof."

Breeding's work has not gone unnoticed. Earlier this year he was named Country Doctor of the Year by Staff Care. Breeding says he will decline the two-weeks of time off that comes with the award, and will ask Staff Care to donate $10,000–the value of the temporary physician services that would have covered his absence–to 20 local charities.

"I don't trust my patients with anyone else," he says.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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