Helping the Healers
Since its founding more than 40 years ago, The West Virginia School of Osteopathic Medicine has been training doctors for service in rural communities.
Zane Dennison was the kid who was always going to do something special with his life. Clean-cut, respectful, and respectable, he got good grades during his time at Braxton County High and was especially talented at math and science. When he thought of his future, “it was either going to be engineering or medicine,” he says. He eventually started leaning toward the latter and, after graduation, he headed to Fairmont State to study biology and chemistry.
He volunteered with the local emergency medical service, eventually earning his emergency medical technician certification. He thought about studying to become a paramedic, but realized he wouldn’t be satisfied just leaving patients at the hospital doors. Dennison decided to become a doctor.
It’s the kind of beginning that could lead anywhere—a big city medical school or even a West Coast tech startup. But like so many West Virginians, Dennison could not shake the pull of home. He wanted to find a way to stay among the people and places he loves while also making a difference.
Then, one day on campus, he met a recruiter from the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg who convinced Dennison to drive down and tour the campus. He did, and was immediately sold. “I just knew that’s where I wanted to go. I didn’t apply anywhere else,” he says.
When it came time for Dennison to meet with an admissions panel at WVSOM, he laid out his plans for the future in bold terms. “I was born here and I’m going to die here,” he says. “I want to do backwoods medicine, see patients in the clinic and in the ER, and, at church on Sunday, do a follow-up.”
That was exactly what the administrators wanted to hear because, as much as Dennison hoped to attend WVSOM, he was exactly the kind of student the school was looking for.
Is There a DO-ctor in the House?
Primary care doctors are not easy to come by in many West Virginia communities. Thirty-eight of the state’s 55 counties are designated “health professional shortage areas” by the federal government. That means, in those areas, there are more than 3,500 people for every single primary care physician. “The need is huge,” says Dr. Jim Nemitz, WVSOM’s vice president for administration and external relations.
Demand for primary care doctors is increasing with time, too, as more residents get health insurance through the Affordable Care Act and baby boomers age into senior citizens. This latter factor presents a double-whammy—not only are patients getting older and needing more care, but the state’s supply of doctors is aging into retirement. So while the number of primary care physicians in West Virginia rose 30 percent from 2008 to 2015—with more than 430 doctors setting up shop around the state—that trend must increase to meet the demands of the future.
This is not news to the folks at WVSOM. “The founders of the school recognized we had this problem in the early 1970s,” Nemitz says. That’s why four primary care doctors—Carlton Apgar, O.J. Bailes, Donald Newell, and Frank Wallington—purchased the campus of the former Greenbrier Military School in 1972 to open an osteopathic medical school. “Since its inception, it’s been part of the mission to train docs for service in rural communities,” says Patti Crawford, the school’s director for outreach.
The school has produced more than 3,000 graduates since 1978. Of those, 758 are practicing in West Virginia—nearly 600 in primary care practices, and nearly 400 in rural communities. WVSOM ranks fifth in the nation for the percentage of graduates who enter primary care specialties, according to U.S. News & World Report, and first in the nation for graduating physicians who practice in rural areas, according to the journal Academic Medicine. “What we’re doing here, we’re doing right,” Nemitz says.
The school’s success in training rural physicians begins with recruiting the right kinds of students. The school has developed a series of pipeline programs, like anatomy lab tours and pharmacology camps for high school students. There’s a “green coat” program for undergraduate college students interested in medical school, where participants work 10 to 20 hours per week at a rural hospital, shadowing physicians and other health care professionals. “This is an opportunity to make this connection,” says Janet Hinton, coordinator for WVSOM’s Rural Health Initiative. “And they get a taste of what it’s like.”
When students apply to WVSOM, the school’s admissions process favors applicants who express an interest in primary care, and especially those who are interested in working in rural communities. And once they begin attending classes, the school does everything possible to encourage students to pursue primary care specialties. “They’re surrounded by primary care role models. I think that has an influence,” Nemitz says.
Although every third- and fourth-year student at WVSOM is required to devote three months to rotations at rural hospitals and clinics as part of the school’s “statewide campus” system, students who are especially interested in rural medicine can apply to be part of the school’s Rural Health Initiative at the end of their first year.
The program accepts 12 to 18 students each year who each receive physician mentors, scholarships, and financial support for travel expenses and housing during their rotations. RHI students help with community outreach activities in their second year and then, in their third year, have the opportunity to participate in multiple field experiences where they receive specialized training in industries like timber, agriculture, oil, gas, and wilderness medicine. During a course on coal mining, for instance, students attend safety training and then go underground into a mine, where they learn about the jobs in a mine to better understand ailments working conditions might cause.
The most important thing WVSOM does to prepare students for work in the state’s less traveled areas, however, is to train them in the philosophy of osteopathic medicine. The practice originated in Kirksville, Missouri, in the 1870s with Dr. Andrew Taylor Still. He had grown frustrated by medical practices of the day—like bloodletting and dosing patients with mercury—which he rightly recognized were doing more harm than good. Still pioneered a new approach to doctoring that focused on preventive medicine and the body’s ability to heal itself.
Today, DOs, as doctors of osteopathy are called, make up roughly 20 percent of primary care doctors in the United States. In West Virginia, 63 percent of primary care doctors are DOs. They receive largely the same training and licensure as allopathic doctors, or MDs, but DOs also receive training in “osteopathic manipulative treatment,” where doctors diagnosis and treat ailments through gentle pressure, stretching, resistance, and other physical contact.
And unlike allopathic medicine, osteopathic medicine also considers their patients’ emotional and spiritual wellbeing in addition to their physical conditions. “You’re not just treating a symptom. You’re not just treating an ailment. You’re treating the whole person,” says Crawford, the WVSOM outreach director.
It turns out this all-encompassing approach to medicine is uniquely suited for rural medicine because, doctors are often more than just health care providers in their chosen communities. They’re also role models, mentors, and coaches, and their practices are not limited to the walls of the exam room.
The Doctor Will See You Now
If you’re waiting to see Dr. Robert Snuffer, you’re probably going to be waiting a while. Snuffer is always busy, and he’s always behind. It’s not that he’s inconsiderate or inefficient, though—Snuffer just has lots of patients, and is known to take his time with each one. “It makes for some long visits. But a lot of times, that makes a big difference to people,” he says. His patients seldom complain about the wait because they know, when their time eventually comes, Snuffer will take just as long as he needs with them, too.
He devotes each Friday to house calls for patients who are too sick or are otherwise unable to get to his clinic, Weston Family Medical Care. And he continues doctoring outside office hours. “My kids hate to go to Walmart with me,” he says. “(Patients) call me, they come to my house. I’ve got guys that bring their bear dogs by sometimes, if it’s a Sunday afternoon and there’s no vet open. That’s what happens in a small town. It’s part of being in the community.”
Snuffer came to medicine as a second career, after serving in the Army and then becoming a physical therapist. He worked his way into a job as director of physical therapy at Stonewall Jackson Memorial Hospital in Weston. But he became frustrated by what he saw as indifference in some doctors at the hospital. Snuffer decided he could do better. He applied to WVSOM because of the school’s focus on rural medicine, and because he was intrigued by osteopathy’s emphasis on treating the whole person. “I have a lot of people who come to see me because I recognize their divorce is what’s causing their back pain. You can’t have good physical health if you don’t have good mental and spiritual health.”
Now, in addition to treating his patients, Snuffer is committed to passing on the skills he’s learned to a new generation of WVSOM students. He says he wants students to realize medicine is more than just book learning—to be a successful physician, a doctor must possess both technical expertise and interpersonal skills. “I tell my students, very few jobs allow you to go home and say ‘Somebody’s better off because I went to work today.’”
Weston Family Medical Care is a regular stop for students doing their rural rotations, and Snuffer takes great pride in making sure they get their hands dirty. “Students are enamored with the thought of being a doctor. So what I do is, I put them in there and say ‘OK, Doctor. This one’s yours.’ It’s scary,” he says. He’s been known to have them examine patients, formulate diagnoses, and make plans for treatment. Snuffer holds their hands through the process—the students aren’t really doctors yet, after all. But he believes it’s important for students to get hands-on experience before they get those coveted initials in front of their names. “You can’t learn to be a doctor if you don’t do doctor stuff,” he says.
Snuffer says his interest in teaching comes from his time at WVSOM and the mentors he had there. “They taught me how to take care of people instead of just doing medicine.” Now, he wants to provide that same guidance to young doctors-in-training.
Zane Dennison, who’s now in his third year at the medical school and a member of the RHI program, spent eight weeks at Snuffer’s clinic in summer 2016. “He’s what I want to be,” he says.
Dennison still remembers a woman who came into the office one day during his rotation. “She’s been through the wringer with her back problems and some knee things. We just did some manipulation on her that we’d learned from school, and her pain was gone,” he says.
“It hits you—this is why I’m doing this. You get to see positive change in somebody’s life, right now.”
Next year, Dennison will go to “audition rotations” to determine where he’ll spend his residency after med school. He’s considering United Hospital Center in Bridgeport, where Snuffer did residency.
Dennison says he’s not sure what he’ll do after completing his residency training. He still holds to the plan he spelled out for WVSOM’s admissions panel. “The dream would be to come back home to Braxton County. I would love to see a hospital put a small clinic here in the county,” he says. “It’s a lot of work. I’m just a student, but even now it’s a lot of work. It’s a lot of sacrifice. But that’s your reward. People depend on you.” www.wvsom.edu/