Texas Doc of the Year Builds Rural Care Network

Jasmine Sulaiman, MD, started a rural clinic in an old flower shop a decade ago. Today she supervises four clinics covering a three-county service area. The next goal she's set for herself: Improve access to mental healthcare through a tele-psychiatry program.

When Jasmine Sulaiman, MD, was interviewing for a job as the only primary care physician at the nascent Health Center of Southeast Texas, she couldn't help but look toward the heavens for guidance.

That's because there was no roof on the Cleveland, TX bank where the interview took place. It was 2005 and Hurricane Rita had just blown through the small town of 7,707 souls located 45 miles north-northeast of Houston.

Coming from Ivy League-affiliated St. Elizabeth's Medical Center in Utica, New York, and with a family practice specialty, Sulaiman, 54, knew she could have her pick of jobs in physician-starved rural Texas, where she and her husband had relocated to escape winter's grip.

She picked Cleveland, where the local hospital was in financial straits (it closed in 2014), and where she hired on as the sole physician, earning considerably less than the market could demand, and working at a health center that as yet didn't exist. The hospital served a patient mix that included 70% uninsured.

"I was interviewed by a group of people all from the community," she says. "They formed a board to start a clinic because the hospital was losing a lot of money through the ER. This is one of the poorest counties in Texas. When I came, they held hands, about 10 of them, and they prayed, and I was thinking 'OK, I really want to be here and see if I can make it work.'"

"They didn't have a clinic. Actually, they didn't have anything. They had one person from the hospital to help set up the clinic," Sulaiman says. "I said 'OK. I'm going to take this job.' My husband said 'it's a 40-mile drive.' I said 'I don't mind. I want to take this job.'"

Within a few months, a clinic opened in a converted flower shop. Sulaiman began seeing 40 patients a day, and remained on call 24/7 as the center's sole physician. Not surprisingly, the federally qualified Health Center of Southeast Texas quickly grew to meet the urgent demand. Today it includes seven physician assistants and nurse practitioners, all of whom rotated through her practice during their training. The center moved out of the flower shop and now operates in a 6,300-sq.-ft. building with nine exam rooms.

But that's not all.

"I work more hours than usual, but I don't have any complaints. I really enjoy what I do." -- Sulaiman

In addition, HCST expanded to include three additional clinics in a three-county service area, all supervised by Sulaiman, who also continues to see patients in addition to her administrative tasks. She also created a program to upgrade medical care at the county jail, led the movement to designate HCST as a Level 2 Patient Centered Medical Home, helped develop an educational program that exposes local high school students to careers in healthcare, and volunteers once a year to provide free care in Mexico.

The newest challenge for Sulaiman is improving access to mental healthcare through a tele-psychiatry program.

"We have no psychiatrists practicing in this county or the adjacent county," she says. "We serve a population that is 70% uninsured. There is a lot of mental illness, a lot of substance abuse. We see it more and more. We couldn't afford a psychiatrist, and so we got a grant from HRSA for behavioral services. We hired a counselor. We just signed a contract with a tele-psych services and that should be operational in a couple of months.

Sulaiman has to provide diagnostic services for mental health "every single day" because there is no other path to treatment. "It's not fun at all. Yesterday a patient was verbally abusive to me because I couldn't help her," she says.

Recognition
"If they don't have access to care, then they don't have access to treatment. It affects these individuals, their families and their communities. Even when we are here providing access to care, often they don't have the money to pay for the medication. That's a gap in treatment and continuity of care. It's frustrating. I feel helpless, they feel helpless, and some days I wonder what am I doing here!"

Frustrations aside, Sulaiman's accomplishments have not gone unnoticed. In 2012 she was named Texas Family Physician of the Year by the Texas Academy of Family Practice. This month she was named the 2016 Country Doctor of the Year by physician recruiters Staff Care, which is providing HCST with a temporary physician for two weeks, so that Sulaiman can take a vacation. She plans to use the time off to travel to India, where she was born.

"I work more hours than usual, but I don't have any complaints. I really enjoy what I do," Sulaiman says, when asked if she worries about physician burnout.

"This is the two-sided coin," she says. "I knew that what I was getting into was going to be totally different than a regular cookie-cutter practice. It is not time equals money. There are a lot of frustrations, but at the end of the day you've helped someone or you've started some new program, and you've provided access to care for people who otherwise have none."