Requiem for a One-Doctor Town
PHOENIX MAGAZINE | Keridwen Cornelius | March 4, 2021
The solitary, satchel-carrying rural doctor is etched into our enduring fantasy about small-town Arizona. But such physicians are fading away. The doctors are gone, but the towns – and the medically underserved people who live in them – remain.
A few years ago, Dr. Molly Anderson – the only physician serving the verdant Southern Arizona village of Patagonia – was called for jury duty. As she sat in the small-town courtroom, each potential juror was asked if they knew anyone involved in the case. Anderson recalls looking around and thinking, “Well, the defendant is a patient. The victim is a patient. The witnesses are patients. The detective is a patient. And I can’t say this because of privacy laws.”
Fortunately, she didn’t need to breach confidentiality. One after the other, they all admitted to knowing her. The “everybody knows your name” phenomenon is one of the side effects of practicing in a one-doc town – a bucolic lifestyle immortalized in shows like Northern Exposure and Dr. Quinn, Medicine Woman.
But the solo family physician on the frontier is fast going the way of fiction. In 1983, 40 percent of the nation’s doctors practiced alone, according to the American Medical Association. By 2018, that number had fallen to less than 15 percent, underscoring a troubling fact: Arizona suffers from a huge shortage of primary care physicians (PCPs). To meet its needs, the state currently requires an extra 563 PCPs, plus an additional 1,941 by 2030, according to the Health Resources and Services Administration.
The scarcity is felt most acutely in rural areas, which struggle to recruit and retain physicians and are hemorrhaging hospitals and health clinics. According to an informal PHOENIX magazine study of Arizona Medical Board licenses and medical clinics statewide, only about a half-dozen true one-doctor towns remain. Most Arizona towns of 1,000 residents or less have no dedicated local physician – they’re zero-doctor towns.
That’s certainly a loss for people living in these “medical deserts” scattered around the state. And it may also be a loss for clinicians. Because some family docs in remote Arizona towns like Patagonia, Seligman and Safford say small-town medicine epitomizes the kind of personalized, caring experience that both doctors and patients desire. Unfortunately, that too is disappearing. But some country docs in Arizona are trying to keep the tradition alive.
It wasn’t blind fate that conspired to make Dr. Michael Druschel the lone physician serving the Route 66 outpost of Seligman. He grew up in a small town in Pennsylvania and has always gravitated to blink-and-you-miss-’em burgs. That’s not unusual. A rural background is the strongest predictor that a doctor will choose to practice in a rural location, according to the American Academy of Family Physicians.
A year and a half ago, Druschel moved to Flagstaff, where his wife and two daughters can enjoy urban amenities and he can pursue his passions for skiing, biking and running. Three days a week, he works at the North Country HealthCare clinic in Williams. And once a week, he puts on a podcast or audiobook and drives a little over an hour to the smaller clinic in Seligman (population: 776).
Again, that’s not unusual. In the past, solo country docs often hung their shingle in their hometown. But in today’s consolidated system, rural physicians are typically employed by a company that operates several full- or part-time satellite facilities. So practitioners may toggle between clinics in Green Valley, Arivaca and Amado, or Parker, Quartzsite and Bouse.
Rural populations skew older, and that’s certainly true in Seligman, which attracts retirees seeking an off-grid, nostalgic lifestyle. So Druschel, a family medicine M.D., does a lot of geriatric care. But in the absence of nearby specialists, he also has to be a sort of Swiss Army knife in scrubs, wielding a range of skills with aplomb. And that suits Druschel just fine. “I’m someone who likes variety,” he says. “I’m someone who also likes procedures. So if I can do something safely in my clinic, I usually like to try to find a way to make it happen.”
On one recent patient, Druschel personally performed an echocardiogram, plus a lung and abdominal ultrasound, then inserted an IV and ran the fluid, drew blood, and finally sent the blood via courier to a lab. He’s conducted a sleep study in a patient’s home, provides basic counseling and prescribes psychiatric medicine. “I feel I make deeper connections with my patients,” he says, “because they really come to rely on me… since I’m the one managing the majority of their medical issues.”
Since many older patients can no longer drive long distances, and some lack the transportation or inclination to leave town, frontier family physicians sometimes have to treat conditions that push them to the limits of their comfort zones. In Patagonia, Anderson recalls a patient who came to her clinic with a severe laceration. She recommended heading to the hospital. But the patient gave her an ultimatum: “Either you do it, or it’s not gonna get done.”
Unlike Druschel, Anderson comes from an urban background. The family physician grew up in Phoenix, attended college in Los Angeles and went to the University of Arizona’s College of Medicine in Tucson. The first 12 years of her career, she logged 80-hour weeks in urgent care at a Tucson clinic. When her husband retired, she decided she wanted a lifestyle that made room for her hobbies: hiking, serving on Democratic Party committees, volunteering with the Unitarian Church and writing bawdy limericks.
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