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.
John Commins is a senior editor at HealthLeaders.