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Kane and his colleague, Richard Klee, MD, started practicing in Columbus 18 years ago and have stayed the course. Both work at Stillwater Community Hospital, with 13 critical access and skilled nursing beds. “We serve all the small cities around us,” Kane says. “Some patients come from all over, and they will come back. One, the father of a local resident, flew here for treatment.” All in all, the patient population ranges in age from infants to centenarians. Kane’s oldest patient lived to be 105.

It takes a special person

Like Kane, Klee, and Anderson, many physicians are strongly devoted to their state with its aura of freedom and independence. In fact, Brian Zins at the Montana Medical Association office proudly cites at least one two-generation practice in a tiny village in one of the remotest areas of the state.

Zins indicates that the practice of medicine itself is no different than anywhere else, but the difference, of course, is in the territory. “You might be in a town of 1,000 in Tennessee, for instance, but 30 miles away from a big city. In Montana, the nearest city is often 400 miles away.” The elating news: “The unique opportunity of practicing real medicine is there.”

Nevertheless, some small hospital administrators lament that, for all too many physicians, city amenities and other considerations trump the lures of wide-open space. “I do a lot of physician recruitment,” says Lee Rhodes, the CEO of Roundup Memorial Healthcare in Roundup, 40 miles north of Billings with a population of 1,800. “One recruiter shared a survey with me showing that 1-to-2 percent of physicians want to live in this size of a town.”

Even then, other considerations can come into

play, such as wanting to be near elderly relatives in other places or better opportunities for the doctors or their spouses.

Rhodes himself recently lost not one but both MDs in Roundup. One went to Boston because his wife was accepted at Harvard Medical School. “He gave six months’ notice, so I brought in a replacement, but the replacement didn’t work out.”

The second, an Egyptian, was in Roundup on a J-1 professional visa from the U.S. government and might have stayed even longer but for the fact that he wanted to be near a mosque where his children could be educated in the Muslim faith. He found a position to his liking in Tennessee, leaving Rhodes empty-handed.

Rhodes does have a couple of replacement prospects: He is hoping to bring in one couple “who can be excellent fits, but the advantage for them and the disadvantage for us is that they have lots of options.” He’s also interviewing a former Marine now living in Alaska. The good news: “He and his wife have decided they want to live in Montana. In the meantime,” he says, “we’re bringing in a temp, but that’s expensive. Also, temps aren’t as busy as the regular physicians because people don’t know them.”

Not all administrators have staff problems. CEO Scot Mitchell at Wheatland Memorial Hospital in Harlowton is happy to say, “I haven’t had to look for doctors for 15 years. We’ve been very lucky.”

In some ways, Anderson, Kane, and Klee are anomalies because they chose to practice in the Big Sky Country as young physicians. They’re not daunted by travel distances, as are some recent city-slicker arrivals. Kane can’t help chuckling when he cites arrivals from “the coasts” who are surprised to learn that it’s a 50-mile drive to see a movie.

According to John Schroeck, the director of the Montana Primary Care Office in Helena, “Doctors who want quality of life and beautiful environment, and who have already made their money and are not concerned about that, like it here.” He adds, “We call it the scenery tax.” Current statistics indicate that 94 percent of the state is deemed a “primary care health profession shortage area (HPSA).” State quotas allow 30 foreign doctors on J-1 visas to practice in a given year. Three to five usually apply. There’s no limit on the number of Americans fulfilling government student loan repayment and tuition obligations. About 50 of them are currently practicing in the shortage areas.

For primary care physicians, that could mean a bonanza of jobs that, in context, might equal the draw of the gold, silver, copper, manganese, zinc, uranium, palladium, oil, coal, and other minerals that have lured prospectors and mining companies over the years. In fact, early arrivals nicknamed this huge territory “The Bonanza State.” Its current moniker has been refined to “The Treasure State.”

Filling the gaps with technology

Thanks to today’s fine-tuned technology, isolation means something different than it did a century—or even 50 years—ago. Grizzlies, moose, bighorn sheep, and mountain lions may be more prevalent than people, and colleagues may not be next door in places like Big Timber and Harlowton, but diagnostic help is as close as the telephone and the Internet, and more and more small hospitals are installing sophisticated imaging devices.

In Harlowton, for instance, Mitchell says, “Our hospital is probably one of the best-wired small hospitals in the state. It’s completely wireless, and now we’re working on electronic medical records.”

The system offers “all the latest automated equipment,” including CT scan services, ultrasound procedures, and bone densitometry. Results from digitized scans transmitted to a radiologist in Wyoming come back in 30 minutes. Other images are checked by specialists elsewhere.

Also thanks to technology, there can be an almost split-second response in emergencies, especially in trauma cases. “All employees,” says Mitchell, “have alpha numeric pagers. A nurse can activate radio communications with ambulance, sheriff, police, and fire departments.” With a push of the button, he adds, “people come running. By the time patients actually get to the hospital, there are six, eight, 10 people waiting for them. Before, it would be the nurse.” When all else fails, helicopters rush patients to Billings.

City fare

In turn, the two large hospitals provide for the smaller facilities in several ways that have dramatically improved health care in the hinterland, reassuring local practitioners that while they may be isolated, they are not alone. In fact, says Mitchell in Harlowton, “Most (rural) hospitals have management contracts with larger health-care organizations.”

For instance, five are affiliates of Billings Clinic, one of the city’s two major hospitals that includes a 200-doctor multi-specialty group practice. Benefits to the rural hospitals can include management assistance, purchasing, paying administrator and lab personnel salaries, specialist training sessions, telemedicine linking, and technological equipment. More than 50 doctors in 18 specialties also put some 260,000 miles on their odometers every year traveling to add their expertise to patient care in 12 Montana communities, as well as towns in rural Wyoming and North Dakota. Billings’ St. Vincent Healthcare provides similar services to other communities.

With or without outside help and state-of-the-art technology, the result of wide open spaces and sparse population is self-reliance, and that, says Anderson, can have its ups and downs. The reward: “I think it’s about believing in it and doing something you believe in doing.”

He goes on to say, “I would recommend rural Montana, because there are all sorts of opportunities here for self-actualization.”

In fact, his recipe for anyone itching to escape a nerve-wracking big-city existence: “If you want to try a small town, being a doctor would do it. To the kind of guy who wants a full experience and a good family life, it’s a great experience.”

And, no matter what, people in most of Montana’s low, low population areas are determined to keep their hospitals. They’ve proved their determination by raising surprising sums of money for building or rebuilding. In other cases, wealthy citizens have financed health care, either in buildings, endowments, or trust funds. As Mitchell in Harlowton puts it, “The hospital can’t survive without the community, and the community can’t survive without the hospital.”

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Eileen Lockwood is a free-lance writer based in St. Joseph, Missouri.
She regularly contributes community profiles to UO.