Q&A: Rural Health Practitioner of the Year, Larry Rhodes, MD

West Virginia pediatric cardiologist Larry Rhodes, MD, speaks passionately about his work at three community outreach clinics. "It is always easy to hide under the guise of 'this is for patient care,' but the best days of the month for me are when I am in my truck driving to one of these clinics."

Larry Rhodes, MD, interim chair of the West Virginia University Department of Pediatrics is a subspecialist who enthusiastically takes his expertise into the field at outreach clinics across the Mountain State.

As director of the WVU Institute for Community and Rural Health, Rhodes has also played a key role in a program that has enabled 400 medical students to complete 2,700 weeks of rural healthcare training in 2012.

For his advocacy of rural health issues and efforts to improve access, Rhodes this month was named the 2013 Rural Health Practitioner of the Year by the National Rural Health Association.

Rhodes spoke this week with HealthLeaders Media about the challenges and rewards of taking his subspecialty skills to the people.

HLM: Talk about your work with outreach clinics.

Rhodes: I do three outreach clinics a month. I'm in Morgantown in the northern part of the state. I go to Parkersburg, which is about two hours away twice a month. And I do a clinic in Beckley, which is about a three-hour drive once a month. Each of our cardiologists do at least one outreach clinic a month. We have almost all areas of the state covered.

There are a couple of reasons why we do it. One is there are a number of children born in these rural communities who have congenital heart disease and we in Morgantown are the only center in the state that does surgery for kids with congenital heart disease. We have two doctors going to Beckley on Friday and we have 40 patients scheduled. We will keep that many patients from having to drive up here for a follow up.

West Virginia is almost all rural. The biggest town in the state in Charleston and it's only got 54,000 people. It's a big deal for some families to drive two or three hours and some of the patients are even five hours away. When I go to Beckley I will see patients that maybe have driven an hour and a half to get to the clinic.

I am primarily a pediatrician, but we do the same thing for adults with subspecialty problems. We have a doctor who does an outreach rheumatology clinic in the coal country in the southern part of the state. We have an ophthalmologist and a neurologist who go there too.

HLM: Why are there so few subspecialists venturing to these outreach clinics?

Rhodes: It's kind of an ivory tower mentality that 'I am here and they will come here.' Frequently when we think about rural healthcare, we think about primary care physicians, who are the cornerstone to the whole thing and who are very important.

But sometimes the patients with acute special healthcare needs are not lost in the shuffle, but we don't think enough about them at times. We just assume they will come back to the tertiary care center for follow up. I have patients who will cancel a clinic visit because they can't find the $50 to put gas in the car.

Or they may find that they can get a ride to an outreach clinic with a neighbor who is willing to drive them a half hour but they are not willing to drive two and a half or three hours and wait for the appointment and drive back.

HLM: Is sending subspecialists into the field a good use of limited resources?

Rhodes: That's true to a degree. You may need to bring the patients into the tertiary care center for the testing and expertise. But the patients I see in these outreach clinics I may be able to see three times before they need to come to Morgantown.

Once every one or two years I may have to bring a patient here, but I can see that patient every six months in their community. I can think of patients I haven't had to bring to Morgantown in five years. I can go and see the patient as a subspecialist. The family medicine guy is good at taking care of the patient in between.

But they get a little uncomfortable if they are watching the kid with the artificial heart valve. They may have the experience of 20 adults with that problem but what do you say to a 12 year old who has an artificial heart value in terms of his physical activities? There are certain things we can take to the community that are not necessarily things that they need to come to the tertiary care hospital for.

HLM: Are you urging other subspecialists to do outreach work?

Rhodes: I think so, very much. I personally prefer going to the communities because I love it. I love going out and seeing the patients in their home communities. I pride myself in knowing where almost every patient of mine is from. If I have not been to where they are from I will drive there sometime to find out.

There are always resources issues. If you only have one neurologist in your practice it is a little harder to say 'go do a clinic once a week somewhere else.' But it is a great public service. It helps the patients. It helps with compliance. It is very rewarding. I am old enough to realize that what I used to think I was doing for the patient I am really doing for myself.

It is always easy to hide under the guise of 'this is for patient care,' but I can tell you the best days of the month for me are when I am in my truck driving to one of these clinics.

HLM: Does clinical outreach make you a better physician?

Rhodes: Yes. It forces you to do things sometimes without all the technology. [Like] when I go to a clinic where I don't have an echo machine or some of the advantages I have here. If I am seeing a patient here and I am a little confused, I can send them for a test. Frequently I can't do that in outreach clinics. I can arrange a test and have it done the next week, but I can't just send them out of the office and tell them to 'go get this test and I will see you.'

We have taken residents and med students with us to the clinics and they love it. It's like practicing medicine the way you were taught to practice—using your physical exam abilities, using simple tests like an EKG or an X-ray. It gives you a rapport with your patients.

HLM: How does the outreach experience help you better understand better patients' perspectives?

Rhodes: Look at a map of West Virginia and you see there are interstates going through the state and you say there can't be anyone who lives more than three hours from here. I have a slide that I use when I talk to medical students about rural health.

I can show you the interstates and I will ask 'how long will that take you to drive?' and a lot of them will say 'it's three hours.' Well it turns out it's five hours, because it takes almost an hour and a half to get to the interstate.

You can't see that on the Google map, but when you drive out to these places and you realize where these people are coming from, you are not angry when they miss an appointment or when they come 25- or 30-minutes late.

I never refuse to see a person who is late and I won't let anyone in my division refuse to see somebody who is late because I have been there. I know where they are coming from. It may not be snowing in Morgantown, but an hour from here they may have a foot of snow.

You get mad because a family doesn't get a prescription filled and then you realize that the closest drug store to them is 45 minutes away and it closed at 8 p.m. and they didn't get back from the hospital until 9 p.m. There are things like that that you don't think of if you don't go out and do this type of stuff. It is that type of stuff that makes you appreciate what they are going through.

HLM: Is clinical outreach a good prescription for doctor burnout?

Rhodes: It is a great cure for burnout. The person who was my boss who is still in our division is 73 years old and he still works and he is the one who started the outreach clinics for pediatric cardiology.

He is not burned out and we will do a clinic together on Friday when I go to Beckley. I have another practitioner in our group who is 71 and another who is 65. They are all cardiologists and none of them are burned out. I have said a number of times; they will drag me out of this building feet first. I will not retire. I will work until I can't walk. And part of it is the passion for doing this.