Country Doc of the Year a 'Dinosaur,' Motivated by Community

A sole practitioner who works long hours in rural Virginia, Rob Marsh, MD, values both his independence—and his community.

John Otho "Rob" Marsh, MD, is not a complainer—he's a doer. Toughened by years in the military, he calmly looks for solutions where others would simply throw in the towel or panic. But being a primary care physician in private practice in a rural area isn't easy for anyone, even a stalwart former soldier like Marsh.

The long hours, vast distances, increased regulation, and Internet connections that never seem to work right all make his job a Herculean task. Marsh, 59, at least has been recognized for his work. He is the recipient of the 2014 'Country Doctor of the Year' award, bestowed by the physician staffing organization Staff Care annually since 1992.

Though the job is tough, he says can't let his patients down. "These are the people I take care of. That's what motivates me... My patients are my friends. I couldn't sleep well at night if I closed the door at 5:00 and was closed for the night, even if a patient needed me."

Marsh's career began as an Army medic. With assistance from the military, he went to medical school, then became a physician and served in the Army's Delta Force unit. After Operation Desert Storm, he intended to become a family doctor, but couldn't stay away from the service. He completed a third tour of duty that took him to Mogadishu, Somalia, where he was injured in the line of duty.

After his injury he moved back to his hometown of Middlebrook, VA to work at the nearby University of Virginia, but he soon realized he preferred the independence of private practice.

Country Life
Getting to a doctor's office can be a challenge for people who live in the Shenandoah Valley farming community Marsh calls home. "I have patients who will wait two or three hours to see me," he says. He himself has to drive half an hour each way to get to the hospitals where he does rounds.

He keeps two offices—his original clinic in Middlebrook and a newer office at a truck stop in nearby Raphine. Truckers frequently stop by for Department of Transportation physicals or if they need care during a haul.

"The truck stop is busier, and has a great Internet connection," says Marsh. It's become his de facto primary office—partly for the quality of its broadband—and partly because he enjoys meeting new patients through the trucking population. He also practices at two local hospitals in Augusta and Fishersville.

Marsh's day usually begins at 7:00 AM, with an hour of rounds at the hospital in Augusta. He usually arrives at one of his offices between 10:00 and 10:30, where he stays until around 7:00 PM. He then goes home to have dinner and spend time with his family for a few hours, but his day does not end there.

"I usually round at the hospital later that night, at 10:00 or 11:00, and stay for a couple hours" says Marsh. If no patients in the hospital need his care, he'll visit his patients in nursing homes.  

Somehow, Marsh also finds time to update his EMRs, keep abreast of new healthcare legislation, care for the animals on his family's small farm, and manage his staff.

The End of an Era for Rural Healthcare?
He insists that he loves his work. "I do it because I want to do it. No one forces me to do this," he says. "It's very rewarding and fulfilling work." He says he is thankful he had the option to work in private practice, and acknowledges young physicians face hurdles different than his own.

"It's difficult for a young physician to start a practice on his own," he says. It's difficult for a private practice physician to stay on top of billing, coding, manage staff and implement EHRs. Plus, most newly minted MDs today carry heavy student-loan debt.

"Your financial reward may be greater in an urban area," Marsh admits.

And yet, he is not entirely pessimistic about the future of the rural physician. He believes that government or community sponsored rural healthcare initiatives that would incentivize young physicians to practice in rural areas could keep rural areas well-served.

He does recognize that fewer physicians are willing to put with the hours he keeps. "I [can] tell you of numerous doctors in my area who do the same thing. I guess it was just the older generation…. I consider myself a bit of a dinosaur in that regard," he chuckles.

Rural communities make up a quarter of the American population, but only 10% of doctors practice in rural regions. Americans who live in rural areas are, on average, older, poorer, and in worse health than their urban counterparts. And, as solo practitioners like Marsh approach retirement age, the question of who will care for rural Americans looms, unanswered.

For Marsh, the appeal of his job runs deep. "I've always been a loner, a rebel. That's why I'm in a rural area. We live here because we want to be more independent."