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Pennsylvania Refuge

“We used to talk about being in the middle of nowhere. Now it’s the middle of everywhere.” That’s how Joseph Bisordi, MD, describes the demographics in southern and central Pennsylvania. In fact, he says the whole state is unique, at least in one way: “It has the most people living in places with less than 2,500 population, the U.S. government definition of a rural town.”

Scores of towns in this area fit the description and are often named for their founders, such as Wernersville (pop. 1,934) and Campbelltown (pop. 1,609). Comedians like to joke about going through Intercourse (pop. 1,200) to get to Paradise (pop. 1,043).

There are “big sisters,” too. Harrisburg, Reading, and York add a metropolitan flavor to this region that’s been described as an area of fertile fields, rolling hills, and sparkling streams. The Appalachian Mountains rise along the western part of the region.

In Danville, population 4,897, Bisordi, a nephrologist and the chief medical officer at Geisinger Health Center, believes he’s found the perfect setting for his practice and his life.

Bisordi well remembers his first encounter with Geisinger, a huge complex complete with 394-bed hospital, extensive residency program, and state-of-the-art research facilities. “A friend from Georgetown was coming here for an orthopaedics residency. He said, ‘It’s one of the places you ought to think about, a different model, a full-time clinical faculty dedicated to patient treatment.’ I really was surprised at the opportunity to learn directly from specialists. And the interview wasn’t a

perfunctory session with one physician, but a whole day with five or six. It was clear to me that I wanted to be in this kind of high-clinical setting.”

Thirty-two years later, he’s still convinced it’s the right place for him. “I wanted to be, in New York vernacular (he’s a native), a maven, an expert, and to be in a place that had a critical mass of specialists who could provide care for my patients.”

Often likened to the Mayo and Leahy Clinics, Geisinger reached its current zenith gradually, but it all started with a gift from one woman. Abigail Geisinger, the 88-year-old widow of iron magnate George F. Geisinger. The hospital opened in 1915 with one operating room, seven nurses, and 70 beds. Geisinger Health System now encompasses three hospitals, 38 community practice sites, and some 12,000 employees. Physician recruiter Elaine Tomaschik jokes, “Geisinger employs more people than there are living here (in Danville).”

John Bulger, DO, a Geisinger hospitalist, makes a distinction, though: “We’re rural, but we’re not frontier.”

Not your rural stereotype

The sophisticated rural environment suits these physicians. Bisordi says, “I spent the first 20 years here raising a family. I coached my son’s soccer team for 13. I could go to a game and be back at the hospital in five minutes if I was needed. I love the commute!” Not only that, “In New York (my son) would have had to be a top college prospect to make a high school basketball team. Here he could participate without that kind of competition keeping him off of a team.”

Bulger grew up in rural Martinsburg, PA, but got his fill of dense population while studying at the Philadelphia College of Osteopathic Medicine and completing a residency in that city. “In Philadelphia,” he grimaces, “every time I get on the Schuylkill Expressway I thank my lucky stars that I’m here. And, by the way, I can see the stars here at night.”

Harrisburg is 50 miles to the southwest, but for Bulger and his colleagues, culture, entertainment, and sports are a mere 20 minutes away at Bucknell University. It’s one of three colleges in about a 30-mile radius that provide diversion for residents. There are also interesting things to see and do in some of the nearby villages.

In contrast to more southern Appalachia, with its isolated mountain towns and challenging practices, the Pennsylvania network of small municipalities and productive farms is considered more of a refuge than a hardship posting by these physicians.

“Rural is a bit of a misnomer,” says Kimberly Skelding, MD, an interventional cardiologist now going into her third year with Geisinger. “It makes me think of country doctors and primary care,” she says. In contrast, practitioners in these 41 counties “just have to make one phone call, the helicopter is there and tertiary, if not quaternary, care is provided in Danville.

“Within 40 minutes patients can be treated (at Geisinger).”

The overriding lure of Geisinger for Skelding is its blend of research and patient care. “I have been working with the National Institutes of Health (NIH) since 2001 on a genomic project. Geisinger was supportive and gave me time to go to Bethesda to continue my research. The unique health records here gave me an opportunity to perform research that cannot be done elsewhere. I could bring new device research to my practice and I could be involved in program development. As a young faculty member, you often don’t have the opportunity to do any or all of these things.”

Skelding also reports that this is the only Pennsylvania site now offering a gene therapy protocol, AWARE, for women with angina but without options for revascularization, thus attracting people from all over the state and parts of Ohio for treatment. “The resources available here, the altruistic patients who enroll in these trials, and the support for researchers (are invaluable).”

Community access

Physicians and patients in other small communities have their own facilities close by. On November 18th, McConnellsburg’s 1,106 residents are opening the brand new Fulton County Medical Center on 22 acres of farmland donated by local businessman D.A. Washabaugh. The independent Critical Access Hospital, south of Danville, obtained almost 40 percent of its funding donated by the 14,000 citizens of the county to replace a 1950 facility.

A combination nursing home, acute care hospital, and full service 24-hour emergency room, it is in a truly bucolic setting, says A. Misty Hershey, the marketing and business development director. “You can look out of the ER window and see corn growing, cows grazing, and fields of grass.” Not far away, mountains fill out the scene. Although only 10 physicians are in attendance, the hospital now has four new, up-to-date diagnostic machines and an on-site helipad. “Before,” Hershey says, “the helicopter had to land on a parking lot in another area, with patients transported by ambulance from FCMC to the nearest trauma or heart center.”

The smaller hospitals do compete with larger institutions in the cities for physicians and other providers. For recruiter Marie Royce at Summit Health in Chambersburg, with 248 beds, the good news is, “Sometimes young residents want to go to bigger cities, but, after practicing there for a while, they realize they want a quieter place to raise children.”

There is some competition for patients as well. Summit Health, according to its Web site, “reaches across greater Franklin County to provide health-care services where once there were none.” Chambersburg’s distance from Harrisburg and Danville, 50 and 100 miles respectively, gives credence to the claim. But, besides being a “high-quality community hospital, it’s a regional center for selected medical specialties.”

Royce adds, “We’re 65 miles from the famed Hershey Medical Center, but everyone seems to think he has to go there, or to Johns Hopkins, for advanced treatments we have here.” That includes stenting and angioplasty, as well as 3-D imaging and precise targeting of tumors with the TomoTherapy Hi-Art system and intensity modulated radiation therapy (IMRT) which allows specialists to attack breast tumors with radioactive seeds from a balloon catheter.”

Urban support

Raymond F. Kostin, MD, the chairman of the Department of Surgery at PinnacleHealth System in Harrisburg, sees the other side of the coin. Since Pennsylvania’s certificate of need requirement expired in 1996, he says, “every small hospital started putting in sophisticated machinery. For whatever reason, in this state people don’t want to go to other places for medical care.” But, adds Kostin, a thoracic surgeon, “they don’t understand that diagnosis is becoming more and more complicated. It’s also a matter of finding technologists who know how to interpret the machine results.” While this is a problem for hospital administrators, it’s encouraging to job seekers in the field.

Larger hospitals in the cities provide the services that the smaller hospitals do not. Facilities such as PinnacleHealth System, the Milton S. Hershey Medical Center and Children’s Hospital just east of Harrisburg, York Hospital, and Reading Hospital and Medical Center and St. Joseph Medical Center in Reading support the southern part of the state. And there seems to be need enough for all.

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