MD Recruits Face Culture Shock in Appalachia
Appalachia faces mountain of challenges: stoicism, drugs, early death.
Oct. 2, 2008 — -- For 25 years, Dr. David Avery has been practicing medicine "solo" in West Virginia -- the only state entirely situated in Appalachia, the heart of America's rural poor. Until recently his caseload was 4,000 to 5,000 families across 40 isolated towns.
But today, because of a campaign to recruit new primary care physicians, Avery has more help, working alongside a growing number of foreign doctors at the Ritchie County Primary Health Group in Parkersburg.
Lured by "exchange visitor" visas, these doctors -- hailing from Pakistan to the Philippines -- are often greeted as "rock stars," but in the isolated hollers ofAppalachia, they face a mountain of cultural and medical challenges.
"It's very hard," Avery told ABCNews.com. "These people don't want to trust anyone who hasn't lived here for years. It's hard enough for U.S.-trained physicians to come to a little town. They are very protective, and if you are not one of them, they can chase you out of town. You're not accepted."
With doctors like Avery, 54, who are approaching retirement, and medical students choosing lucrative specialties, the nation as a whole faces a shortage of primary doctors. In Appalachia, a federally declared Health Professionals Shortage Area, the need is particularly acute.
Foreign doctors may obtain a J-1 visa if they relocate to an underserved area for three years. After that, they can practice anywhere in the U.S.
'People Won't Go to Them'
"We find more and more of these places are filling up with foreign doctors who don't have as much debt as the American ones," said Avery. "Doctors come to these small towns, and there are language barriers. The problem is that people won't go to them, even if they are perfectly well-trained."
The new doctors encounter a proud and protective population that is used to "taking care of their own," according to Avery, who serves on the board of the American Academy of Family Physicians.
Nowhere is the need for medical care more striking than in Appalachia -- a 200,000-square-mile swath of mountains that touches on 13 states from New York to Mississippi. The region of 23 million people, which has been vilified in stereotypes, is one of the most historically neglected in the nation.
"They are hardworking people, some of the friendliest in the country, with a strong sense of community and strong sense of purpose," said Louis Segesvary, a spokesman for the Appalachian Regional Commission, which for the last half century has addressed the region's economic depair.
Avery acknowledges some of the stereotypes -- including incest. "Some of that's real," he said. "There are a lot of social issues in small-town families -- domestic abuse and a more isolated redneck attitude."
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