NCH graduates three residents
By AMBER LESTER, Staff Writer July 08, 2004
A study once found that southwest Virginia could never support any type of residency program in hospitals. But with a true pioneer spirit and hard work, Norton Community Hospital has defied the naysayers.
On June 26, the hospital held a graduation ceremony at Lonesome Pine Country Club for three internal medicine residents. When he was told of the study years ago, Dr. Maurice Nida refused to believe the results. Not only was establishing a residency program possible, but it was needed.
"There was a need to train hometown kids to become hometown doctors," Nida said in a recent interview. "It used to be that foreign doctors would come in, fulfill their obligations, get their green cards and leave the area."
In 1996, the Pikeville College School of Osteopathic Medicine was established in Pikeville, Ky. Nida heard about the school from a pharmaceutical representative. A few days later, Nida called John Strosnider, the medical school dean, to offer to help educate students in any way he could.
Not long after that conversation, Strosnider traveled to a hospital in Ashland, Ky. to discuss the possibility of setting up a residency program. In his speech at the graduation ceremony last month, Strosnider conveyed the cold attitude of the Ashland staff.
"They thought we were foolish to have a D.O. school in the foothills of Kentucky," he said, referring to a doctor of osteopathy program. Osteopaths focus on treating the whole person, rather than one particular illness. Most become primary care physicians.
When Strosnider paid a visit to Norton Community Hospital, however, he was pleased to find a much more receptive atmosphere.
"Norton was warm, gracious and curious," he said.
The school made an agreement to send students to Norton for a new internal medicine residency program.
SETTING IT UP
Before the hospital could accept students, it had to make the transition from a community hospital to a teaching center. Nurses had to be taught how to deal with the interns, and learn how much authority the new students would have. The hospital had to obtain Drug Enforcement Administration registration numbers, which allow interns to write prescriptions. It also had to build a library of reference tools. Finally, the hospital had to get certified by the American Osteopathic Association.
"We're independent," boasts Nida. "We can issue certificates as an individual education body."
In 2001, Norton Community Hospital was ready to accept its first resident students.
In the program, students enter their residency as interns, having completed medical school. They spend the first year rotating through the sub-specialties, such as pediatrics and gynecology. New interns also spend every fifth or sixth night at the hospital. They continue through their second and third years before graduating as fully capable attending physicians. This month, a new group of 12 residents and interns started the program.
"Each year, the growth and maturity increases," said Nida. "We hope by the third year that they're ready to go out into the community as physicians."
MEET THE DOCTORS
The recent graduates all entered the program with a specific interest in helping the people of the mountains. All three, Craig Graul, David Sheppard and Jody Bentley, come from small towns themselves. When choosing their specialty, each was drawn to osteopathy because of its slightly different philosophy toward treating patients.
The osteopathic field believes in treating the "whole" patient, rather than just one illness. Osteopaths also receive extensive training in manipulative treatment, the musculoskeletal system and preventive treatment. Most are trained to be primary care physicians. For these doctors, one of the biggest appeals of internal medicine was the emphasis on getting to know the patient.
"It isn't just running tests, but actually getting to know a patient," Graul said. "You have to dig a little deeper."
Osteopathic doctors often practice primary care in rural areas. It was the need for hometown doctors that pushed Jody Bentley into osteopathy.
"The people of southeastern Kentucky need to be able to relate commonality and speak the same dialect," Bentley said. "I know what they know and they know what I know."
The three doctors all grew up in rural Appalachia. Graul hails from Versailles, Ky. while Bentley is a native of Hazard, Ky. Both men attended University of Kentucky and then the Pikeville College School of Osteopathy. Sheppard grew up in Foster, W.Va, a town that he describes as "a very small town, smaller than Norton." He attended the West Virginia School of Osteopathic Medicine before moving to Norton to begin the residency program.
All three new doctors remember the first year as chaotic. Though they were embraced by the staff and patients, the program was certainly in the trial-and-error stage.
"Initially when there were just three of us, it seemed like nothing worked," said Graul. "Getting attendings to do lectures was a challenge, but that's smoothed out tremendously."
"We were the guinea pigs," agrees Sheppard. "We took call every third night."
With no one to hold their hands, the doctors were aware from the beginning of their responsibility.
"From the first night, I was completely by myself except a phone connection to attending doctors," Graul recollects. "Sometimes I would get so far into it, I was too proud to call. But it gave us an edge because nobody was in front of us - we were doing it."
EXPERIENCE GIVES AN EDGE
Being the first students in a small program was anything but a hindrance. The doctors unanimously agree that joining the residency program at Norton gave them an edge over their classmates at larger hospitals.
"We had more hands-on training as far as performing procedures," said Sheppard. "We saw a variety of diseases that my friends at bigger places didn't see. Here, you're not just a person in a line watching a procedure."
Bentley agrees, stressing the diversity of pathology available at more rural hospitals.
"Anybody who thinks you won't see diverse pathology is wrong," he said. "One hundred percent of the people who told me I wouldn't see it either haven't been here, have never practiced rurally, or are not involved in academics."
Nida, too, has felt the advantage of having interns in the office.
"My patients have come to enjoy being part of the educational process," he said. "When patients trust attending physicians, they are more receptive to students."
Nida's main goal for the residency program was to train the doctors here and hope they would choose to stay. When Graul interviewed with Nida he told him, "If I come here, I'll stay." True to his word, Graul has agreed to practice at Dickenson County Hospital.
"He'll do Dickenson proud," said Nida.
Sheppard will remain with Nida at Norton Community Hospital. Bentley will graduate in December, but will continue to work with Norton Community Hospital following his completion.
As they begin their medical careers, the doctors will remember all the advice and important lessons they learned from their experiences with Nida.
"He taught me to always listen to my patients," said Graul. "If you really listen to what they are saying, you won't miss things you shouldn't miss." "He told us, 'If you think of it, do it,'" adds Bentley. "Dr. Nida raised us from the ground up," said Sheppard. "He's been a mentor."
Nida found that teaching was the best form of education he could get.
"You are never too old to learn. As educators, they've made us better doctors."
