Community is our Backbone

In a time when a small town is shattered by violence toward its most precious asset, and babies nationwide are under threat of formula shortages, it is impossible to underestimate the power of community.

The tragedy in Texas belongs to other voices to tell. We salute them and send solidarity as their stories unfold and their arms go around one another.

Community is how rural people survive challenge. Being part of a community is not a “soft skill.” Like the mountains that surround our towns here in Southwest Virginia, community gives us backbone. And hope. And solutions.

In the baby formula shortage, people in my rural town are texting one another: this brand is at this store. I just found X at Y.

They can’t buy them for each other, because WIC vouchers don’t transfer, plus most stores have limits. So they do the best they can with the location and time alerts. With the high price of gas, a couple of neighborhoods have, when the “it’s at this place” message comes, will share gas prices in a single van ride to the store some 40 minutes away.

This is a place to be proud of, these strong, kind towns and hamlets that make up Southwest Virginia. We’re all in this thing called life together. Community is our watchword, and our go-to. We don’t take it lightly. If you are lucky enough to be studying here, don’t miss the opportunity to understand this life force in action. It will change your life.

Wendy Welch, PhD
GMEC Director

Call for Submissions

The Local Voices blog is a new initiative that encourages self-awareness and self-efficacy.

It provides personal perspectives from our medical community that reflect life, beauty, and lessons learned in SWVA and rural localities.

We are actively seeking residents, physicians, medical students, or anyone in the healthcare community to share their stories and experiences from living and working in Southwest Virginia.

If you are interested in contributing to the Local Voices blog or have questions about content and submissions, please email

We also ask you to please share the graphic below on your social media or with anyone who might be interested in submitting a blog entry.

Rural Access to Anesthesia Care Scholarship

The American Society of Anesthesiologists sponsors a scholarship for medical student and resident members introducing future physicians to rural anesthesia.

Applicants must either be a third or fourth year medical student in an approved U.S. program or residency program, and be a member of the ASA.

Application Steps

Fill out the scholarship application and submit along with a 250 word essay explaining why you are interested in the Rural Anesthesia Scholarship Program to the ASA Medical Student Component, at

Applications may be submitted four times each year based on this schedule: 

  • By January 1 for a March 1 or later start of rotation
  • By April 1 for a June 1 or later start of rotation
  • By July 1 for a September 1 or later start of rotation
  • By October 1 for a December 1 or later start of rotation

The application will be forwarded to the ASA Committee on Rural Access to Anesthesia Care for review and a final decision. The committee will notify the applicant of its decision by 30 days before the rotation starts.

Rural Access Scholarship website

Uneven Distribution of Emergency Physician Residency Programs Can Impact Workforce Challenges, New Analysis Finds

A new analysis of the emergency physician resident workforce in Annals of Emergency Medicine finds that while the number of residency programs is increasing, new residency programs are disproportionately located in urban areas in states with existing programs, rather than rural communities with limited access to emergency care.

“Predictions of an oversupply of emergency physicians in the next decade may not apply to every part of the country,” said Christopher L. Bennett, MD, MA, assistant professor of emergency medicine at Stanford University School of Medicine and lead study author. “Regional differences over time need to be considered in any discussions of workforce challenges—these findings underscore the likelihood that rural emergency physician shortages will persist.”

The number of emergency medicine residencies expanded from 160 to 265 between 2013 and 2020, according to Accreditation Council for Graduate Medical Education (ACGME) data analyzed. The study also notes that of 6,993 emergency medicine residents in the 2020 American Medical Association data set, 98% were in urban areas.

Read full article here

The Drive to Succeed

Before I joined the Lonesome Pine Family Medicine Residency Program in Norton, I took a long career break. I thought my biggest challenge would be getting back into medicine with younger, “fresh out of med school” residents. It turns out, that was not it at all.

I live in Kingsport, TN. Most of my rotations are in Big Stone Gap or Norton, VA. 50-mile door-to-door distance, it takes nearly an hour drive through mountain roads. I was excited about restarting my medical training, so the distance or drive was not going to dampen my spirit. Over the next 3 years, I tried different things to utilize those two hours a day. I tried it as my “thinking time”, to mull over various matters of life, friends, colleagues or patients, so by the time I am home, I am not carrying them in my head anymore. I also tried it as my talk show catch up time. I would pull them up in my phone and listen through the car audio. But near exam time, I started listening to the AAFP Board Preparation audios in the car. They were very useful, and they were presented by some great physician educators. Some of the presenters were faculty who make the board and in-training exam questions. I made it my routine to listen to them during all my drives to and from residency rotations. As I advanced in my residency, I started to feel intimidated by them. If they talked about something I was not familiar with, I would feel shame. They spoke about various medical topics as if they were common knowledge, yet I did not know anything about them!

Life became increasingly challenging between the pandemic turning normalcy upside down and trying to balance my residency and personal life. I began to get nervous about my ability to pass the exam. With a lot of encouragement and help from my wonderful colleagues and faculty in my program, I continued with my “prep”. I took my board exam in April and was expecting the results in 6 weeks. Imagine my surprise when I got a preliminary result of pass, one week after the exam!

I got the results during the day, and on my drive back I turned on the AAFP Board Prep audios. This time it felt different. I was not intimidated. Instead, it felt as though I was having a casual, knowledgeable conversation with colleague.

And now, I am ready to travel far as a doctor, in every sense of those words.

Manju Pushkas, DO

Changing the World

“…when the visit is over, I have solved one real problem.  Just one, maybe a relatively small one.  But that grateful patient, on that day, leaves armed with concrete information that will improve their health.  I didn’t rewrite history, but I put a ripple in the water. “

I had the audacity in my youth, to believe I could reform the US healthcare system.  I would personally crusade for–and open access to–high quality primary care for every American.  The federally qualified community health center, a model for comprehensive primary care, already existed; it just needed expanded access for all.  The necessary shifts in policy, payments and infrastructure were simple and obvious.  It was unfathomable that any American could not or would not agree on such a basic human need that benefitted individuals and communities both now and generations in the future.

I thought, as a physician, that I would prevail as the voice of authority and reason with policy makers, payers and administrators. Working in the trenches as a rural family doc in Appalachia would lend me experience and credibility.

I could not have been more wrong.

I am now a “mid-career” physician: tired, cranky and always behind on paperwork. I’ve seen so much that–while I haven’t seen it all–rarely does anything still have power to raise my eyebrow. 

From interest and necessity, I have worked hard to understand: clinical medicine, healthcare policy and healthcare administration, the intricacies of Medicaid and Medicare, how drugs are priced, the Affordable Care Act, and risk management, among other topics.

What I have learned after countless phone calls, letters, faxes and meetings, is that our healthcare system is a gigantic balled up wad of Christmas lights no one has the inclination or motivation to detangle.  It is impossible to penetrate, cannot be understood. It is illogical, redundant. Attempts to decipher it lead to a dead end and often a big shock.

I’m a slow learner, so it took time to accept that I failed to reform healthcare because it cannot be done. The realization put me in a brief slump, feeling as if I’d wasted my life hiding in the mountains instead of campaigning for justice for all.  What if I’d tried harder?

I could have chosen differently, spent my career crafting policies impacting entire populations.  But, at the end, did my work matter would still have been the haunting question.  I’m not convinced that my non-career as a policy maker would have gotten me much more than migraines and a retirement pot luck.

Instead, I’m a middle-aged country doc. No one outside my community knows my name.  My patients call me Ma’am, Hon and even Sweetie. I call insurers, pharmacies and specialists in front of my patients so they know I am their advocate. I have no special authority or power, repeating my identifiers and waiting on hold just like everyone else.

But when the visit is over, I have solved one real problem.  Just one, maybe a relatively small one.  But that grateful patient, on that day, leaves armed with concrete information that will improve their health.  I didn’t rewrite history, but I put a ripple in the water.  I find deep satisfaction in knowing that I made a difference for that patient on that day. 

And it is enough. 

Melissa L. Zook, MD, FAAFP, FASAM, HIV-S
Family Practice Physician 
London Women’s Care – London, KY

Dr. Zook will be speaking at the
2022 Head for the Hills Conference
on November 4-5th in Abingdon, VA

Click here for more details on this year’s conference!

Strengthening the Rural Health Workforce to Improve Health Outcomes in Rural Communities – COGME 24th Report

Link to Full Report

Recognizing the care inequities and the changing needs of rural America, the Council on Graduate Medical Education (COGME) provides this report and recommendations to strengthen rural health workforce training and improve access to health care through evidence-based, patient- and community-centered health workforce investments spanning education, training, and practice.

To address the crisis in access to care for rural populations and develop a health professional education system that increases rural health workforce capacity, COGME developed a series of three issue briefs on the rural health workforce, each with its own set of recommendations.

From these briefs, COGME calls on Congress and the Department of Health & Human Services to prioritize the following six (6) recommendations:

  • Federal funding for a comprehensive assessment of rural health needs to identify gaps in essential care.
  • Federal training investments should follow the National Academy of Medicine recommendation to link GME funding to population health needs.
  • Direct the HHS Secretary to develop a set of measures that ensure value and return on public investment in GME financing with a focus on rural areas
  • HHS should invest in sustainable solutions that focus on building a stable healthcare workforce in rural communities
  • Centers for Medicare and Medicaid Services work with the Health Resources and Services Administration and other agencies within the Department of Health and Human Services to identify and eliminate regulatory and financial barriers and create incentives to health professional education, training expansion and innovation that promote rural population health
  • CMS should support and test sustainable alternative payment models (APMs) that enhance the delivery of team-based interprofessional education and practice

View Full Report Here.

Field of Dreams: Rural Medicine

With myths of outdated equipment, poor quality of training, and little variety in clinical cases, Rural Medicine often comes in last place on the list of dream jobs.  Of course, this couldn’t be further from the truth.  As a former Internal Medicine resident in small town, rural America, I found that Rural Medicine provided an idyllic scenario with a high autonomy of patient care, a wide variety of patient cases, and endless opportunities for procedures and “hands-on” training. 

Not appreciating what I had experienced during my training, I chose to practice in an urban area with lots of amenities and larger hospitals.  I’ll summarize my experience with the cliche “the grass wasn’t greener”, and you can guess what happened – physician burn out.  Having now transitioned to Academic Medicine, I am often reminded of my rural experiences as I hear medical students gush about their experiences in rural hospitals – being a vital part of the healthcare team, immersed in direct patient care, first in line for procedures, and in close relationships with their patients and colleagues. 

A 2019 study from the University of South Dakota Sanford School of Medicine reported that physician burnout rates were lower in rural areas (25%) in comparison to urban areas (51%) with the following contributing factors: having more autonomy in your job, having closer relationships with patients, and having a greater variety of duties at work.  Of course, this study had reported exactly what I had found to be true.  My please to you – when it comes to choosing your career, please don’t make my same mistake. Instead, rewrite your list of choices with Rural Medicine at the top – your Field of Dreams.   

Cassi Jones, DO, FACOI
Director of Clinical Affairs
Assistant Professor of Internal Medicine
DeBusk College of Osteopathic Medicine

Student teamwork shines in emergency situations

Virginia Tech Carilion School of Medicine student Michael Spinosa points out details on a chest X-ray for a patient during the Interprofessional Education Simulation Day at the at the Carilion Clinic Center for Simulation, Research and Patient Safety on April 22, 2022. Photos by Clayton Metz for Virginia Tech.

In an emergency situation, teams of providers from healthcare, human services and education professions must quickly merge their skills and collaborate to help a patient in need. During the Interprofessional Education Simulation Day, students from the Virginia Tech Carilion School of Medicine (VTCSOM) experienced the fast-paced nature of a healthcare emergency first-hand and worked alongside students from other institutions to solve complex problems.

VTCSOM partnered with Carilion Clinic, Radford University Carilion and the Radford University Waldron College of Health and Human Services to host the event on Friday at the Carilion Clinic Center for Simulation, Research and Patient Safety in Roanoke. Around 118 students participated, with groups of 4-6 representing future medical doctors, physician assistants, registered nurses, social workers and respiratory therapists.

“The VTCSOM and RUC students already work closely in our HSSIP domain curriculum; this experience provides them a chance to put the principles they learn in class into action,” said Sarah Parker, the chair of Health Systems and Implementation Science at VTCSOM. “The value of different perspectives is put on display during a multidisciplinary simulation like this. I hope they take this experience as a foundation for building excellent interprofessional teams.”

Continue Reading

Lessons Learned

by Dina Weinstein – Richmond Magazine

“I have been in practice for a long time, and I am always humbled when I learn new information from colleagues. I have also learned that we don’t always have the answers and it’s OK to tell your patients that.” —Dr. Stephanie Lacey

The COVID-19 pandemic has lingered over the medical community for more than two years, bringing an array of challenges, hardships and grief. So, when Richmond magazine asked our Top Docs 2022 survey participants to reflect on life lessons learned over the course of their work, many shared how they were affected by the horrors wrought by the novel coronavirus, professionally and in their personal lives.

Some reflected on patients who left lasting impressions, others recounted recent horror scenes of lives taken too soon and threats to their own health and well-being. The force of medical teams was a theme in many of the responses. The mindset that it is a sacred honor to serve and heal came through strongly in many stories, as well as the crucial role compassion and listening play in treating patients.  

Read Full Article Here

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