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Physician, Aviator

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When he was a senior in high school, David B. Nichols, M.D., took an aptitude test that identified two potential career paths: medicine and aviation. Nichols “always wanted to fly,” yet healthcare seemed like a profession that could help him make a difference in people’s lives. “I wanted to have a calling,” he says.

So he did both.

Nichols is one of three physician partners at White Stone Family Practice near the Chesapeake Bay in eastern Virginia. But the town of White Stone constitutes only part of his patient base. For almost three decades, Nichols has made a weekly 25-mile flight to care for the residents of tiny Tangier Island, a remote community of less than 700 people in the middle of the bay. A longtime pilot, Nichols began flying his small plane to Tangier a few months after opening his White Stone practice in 1979. “I called the mayor of Tangier and asked if they needed anybody. They opened their arms to me,” he says.

The Canadian-born physician was recognized for his rural healthcare contributions when he was named the 2006 Country Doctor of the Year by Staff Care, a physician-staffing company based in Irving, Texas. Nichols calls the award a “total surprise,” but his commitment to community medicine in Virginia is a longstanding one. Raised in Winnipeg, Manitoba, Nichols says his fondness for the Chesapeake Bay region began with a trip to see his parents in Virginia during his third year in medical school at Montreal’s McGill University. The area so impressed Nichols that he decided to do his residency at Riverside Hospital in Newport News, part of the Medical College of Virginia, and ultimately launch his practice in the region. “I wanted to be in a rural area where they needed someone. There was no physician in White Stone at the time,” he says. “I didn’t want to go to a city. Even though there’s a need in the city, I think there is a greater need in rural areas.”

It was during that visit to his parents that Nichols first took a boat to Tangier and discovered an isolated community of residents who still speak an Elizabethan dialect largely unchanged from the days of English colonists. Most of the island’s residents are part of a handful of families that stretch back for generations. Only 4 feet above sea level, less than 3 miles long and 1.5 miles wide, the island is inaccessible by car and lacks many basic services like a pharmacy or a bank.

Nichols was the only physician making the weekly trip to Tangier until his White Stone practice added another doctor in 1986. The practice added a third physician five years ago, and the three doctors now rotate their Tangier visits—although Nichols is the only pilot and has to shuttle his colleagues in his new helicopter. When bad weather makes flying too risky, the White Stone physicians drive more than 20 miles north to Reedville, where they catch a boat for the two-hour trip to the island.

“A lot of patients depend on us. They’ll wait several days with broken bones or pneumonia,” Nichols says. “It’s very important that we commit ourselves on a regular basis.”

Tangier’s only medical facility is Gladstone Memorial Health Center, a small bungalow house built in 1957 with three exam rooms and only basic equipment—Nichols and his colleagues bring many of their supplies with them from the mainland. There is one registered nurse on the island, and another Tangier resident was certified as a physician assistant earlier this year. But Nichols and his partners are the only physicians serving a community that struggles with what Nichols calls “an incredible amount of complicated medical disease,” including a rare genetic disorder called Tangier disease that prevents the body from eliminating excess cholesterol from cells and causes unusually high rates of heart disease.

Caring for Tangier’s residents while maintaining a practice in White Stone has posed logistical problems over the years, particularly when Nichols was a solo physician. Bad weather has even forced Nichols to occasionally stay on the island overnight. “It was difficult, but my patients in White Stone knew I was committed to Tangier,” he says. “They’re very understanding.”

The White Stone practice, which moved into a new office in 2000, offers a typical array of primary care along with some traditional “small-town” services, such as house calls and nursing home visits. But the group’s services also reflect Nichols’ broader contention that contemporary family practice has relinquished too much patient care to specialists. White Stone performs procedures such as colonoscopies and bone density scans that Nichols believes more family practices should provide. “People can bounce around like Ping-Pong balls between specialists,” he says. “It’s much better to have a medical home for a patient, someone who knows them well. Too many physicians just do coughs and colds and scabby holes. We’re trained to do much more than that.”

Although his hectic schedule can be draining, Nichols says he has no intention of relaxing his commitment to either of his communities anytime soon. In fact, his involvement on the island continues to expand; his latest role is as a board member of the Tangier Island Health Foundation (www.tangierclinic.org), a nonprofit organization raising funds to replace Gladstone Memorial Health Center with a fully equipped primary-care clinic. Virginia Gov. Tim Kaine designated a matching grant of $200,000—which the Virginia legislature subsequently raised to $300,000—to the foundation in the 2007 to 2008 state budget, says Nichols, whose impact on Tangier’s residents is evident in the country doctor award nomination letter written by E. Inez Pruitt, the island resident recently certified as a PA. “He has sacrificed his time and on occasion risked his life to get here when people are sick,” Pruitt wrote of Nichols. “He sincerely cares about our well-being—not just physically, but emotionally and spiritually as well.”

Despite the demands of caring for two communities and the technological, logistical and financial frustrations of rural medicine, Nichols says he has never looked to move to a more urban setting. “Growing up in Winnipeg, in the winter it would be 30 or 40 below. I remember thinking as a kid, ‘There’s no way I’m going to live in a city,’” he says. “I feel blessed being a country doctor. You can call me a lot of things, but don’t call me a city doctor.”

—Jay Moore