Lucia Williams, MD, has seen Texas medicine from both the big-city perspective and the small-town one. To help rural physicians like herself, the Jacksonville obstetrician-gynecologist says, big systems and small practices need to forge greater ties.
Drawing on Texas Medical Association President Douglas Curran, MD’s urging physicians to build stronger relationships in general, Dr. Williams says promoting collegiality between small-town doctors and their big-city counterparts can aid rural practices.
“That’s something that the power of the TMA could do that would make a real difference,” said Dr. Williams, a member of TMA’s Committee on Rural Health. “I also think [it would help] for academic institutions to realize that when I pick up the phone and call you to transfer a patient, I’ve thought of all the other options. I’m calling you because you’re my best option. And sometimes, I don’t feel like they appreciate that, and [feel] more like I’m dumping something on them.”
A La Grange native, Dr. Williams is now employed at UT Health Jacksonville in East Texas. She began her career in Houston in 1988 in practice with another physician, then was later on her own. After the labor and delivery unit closed at Houston’s now-defunct Spring Branch Medical Center, she returned to her small-town roots, moving herself and her three children to Groesbeck and working at the labor and delivery unit in nearby Mexia. After that unit also closed, she moved to Jacksonville, where she had a solo practice until 2013.
At that point, she became one of the many small-practice casualties of the conversion to electronic health records.
“I just couldn’t afford to do that as a single parent with two kids in college,” she said. “So I closed my practice and became employed.”
Since then, she’s adjusted to the life of an employed physician. She no longer tackles the day-to-day worries of running a practice, such as making sure there’s enough money in the bank to make payroll, or managing wait times in the waiting room.
But as a rural physician, she notes, “many times, you’re pretty much on your own.
“It’s not like you’re in a big hospital where you can call 15 consultants to help you decide on what’s wrong with this patient or how best to treat this, because those specialists just aren’t there. You’re much more on your own in terms of patient management, patient decision-making, and trying to figure out what’s going on.”
Improved ties between metro physicians and rural doctors would help not only Dr. Williams, but also her patients. She says when she calls a maternal fetal medicine specialist in the closest big city, Dallas, for help on a patient, the specialist frequently just tells her, “Well, send her to me.” Sometimes, patients won’t even want to go there, she says, because they can’t or don’t want to make the 90-minute drive.
“If there’s specialized help they can get, they just don’t want to do that,” she said. “They’ll just tell you, ‘Just do the best you can; I don’t want to go to Dallas.’ And you have to be able to live with that, even though you know they might get optimal care if they would just go to Dallas. Because there are things we just can’t do here.”
Organized medicine also can help out rural physicians, she says, by working for better payment rates. She’d also like to see TMA develop a consulting group of physicians, perhaps using telemedicine, for their colleagues to call for advice on treatment and liability issues.
“The work that rural physicians do is very important,” she said. “Most of the medical centers from the med schools know that if all the little rural hospitals and practices in Texas closed and everybody descended on the med schools, that they clearly could not handle the volume. So I think we perform an important service.”