Small Town Doc Talks Healthcare with White House

Tim McKnight, MD, a family physician from Dennison, OH, believes government has a role in healthcare delivery, but not necessarily a big role.

"I think the less government is involved the better off we are," says McKnight, who is not a supporter of the Affordable Care Act.

So when McKnight and three dozen other healthcare providers were invited to meet with cabinet-level members of the White House Rural Council this month, he was skeptical, but he accepted.

"I thought they would be more about promoting their policies and give us very little if any time to express our concerns," McKnight says of the May 1 meeting in Washington, DC, which was hosted by Health and Human Services Secretary Kathleen Sebelius, and Agriculture Secretary Tom Vilsack.

"Two-thirds of the meeting was about them listening to us and I was impressed with that. I felt like they were listening intently. A lot of topics were discussed," he says. "They said they were going to take this back, discuss it, and rehash it, and come together and decide their next step. Let's see what happens."

To be clear, McKnight is not anti-government. He just doesn't believe that all of the problems that plague healthcare delivery in this country can be solved with a government fiat.

In fact, McKnight says he is the product of successful federal healthcare policy. He had no plans to practice in a rural area when he graduated from medical school in 1997 until he tapped federal government debt forgiveness and scholarship programs that situated him in this eastern Ohio town of 2,650 or so souls.

"Traditionally, the problem has been the new docs go to the rural site, you do your time, and you move back to the suburbs or where your ideal practice is. They weren't able to retain them," he says.

Rather than plot an escape, McKnight, his wife, and their three children have made Dennison their home. 

"I did thank the council for the scholarship and the loan repayment. I told them I felt like this was a successful placement because in my case, I fell in love with the area and I am committed to [it]  and to my patients," he says.

And that commitment to his patients prompted McKnight, a PhD in nutrition, to establish a federally funded 12-week "Fit-For-Life" wellness initiative in Dennison that has improved the health of more than 1,200 people over the last six years through exercise, better nutrition, and knowledge.

McKnight says he was driven to build the program because "I was very dissatisfied with the way we delivered healthcare. In primary care, the way you survive is on volume. You see a lot of patients and that does not allow you to educate them on healthy lifestyles."

He concedes that Fit For Life would not exist without the more than $750,000 in federal grants it has received over the past six years, along with a new $375,000 Rural Health Care Services grant this year to expand the program.

Rather than railing against government, or being overly dependent upon a subsidy, McKnight wants to strike that balance.

"The message I had for Washington was number one, thank you for the support. Number two was that while legislation and policy have a role in delivering healthcare, we have to empower people individually. We have to instill in them hope and give them information and model for them what good health looks like," McKnight says.

The family practitioner told the Rural Council that the nation suffers from a "poverty of hope, belief, and empowerment. I told them we needed to at the local level help empower people and motivate them and show them what they need to do to take control of their health," McKnight says.

"The allopathic approach is failing miserably. It's not healthcare. It's disease management. What is really frightening is if you look at the obesity and diabetes maps, the healthcare crisis we are anticipating in the next five or 10 years is going to be mind boggling. It will break us economically if we don't do something different," he says.

Prevention is the best and most cost-effective weapon against this epidemic, and McKnight says the 1,300 graduates of his Fit For Life program are sending the message that people want to be empowered.

"They are tired being told there is a pill for every problem, but they're not given alternatives," he says. "The primary care docs don't really know better. They're saying 'no, you can't reverse this. This is the way it is going to be.' So people are taking pills. They're suffering through side effects. They are spending a lot of money, but they are still having heart attacks and they're feeling disempowered."

McKnight says improving health outcomes for patients means that primary care physicians have to understand their patients' belief systems, emotional state, and family dynamics at a granular level. That's a task he feels is ill-suited for policy wonks, however well intentioned.

"Washington has the ability to do some things, but this change needs to be at the grass roots where we address the whole person," he says. "It's the message of hope and empowerment that has made this program successful."