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Progress 2013: Bringing health care closer to home

Dr. Nance Lovelace looks over a set of X-rays inside her office at New Market Family Health Center. Rich Cooley/Daily (Buy photo)

Valley Health, a major employer in the Northern Shenandoah Valley, is working toward bringing health care closer to home. Rich Cooley/Daily (Buy photo)

Valley Health focuses on what residents in smaller communities need

By Kim Walter

Valley Health has quite a presence in the surrounding counties, and it doesn't look like that will be changing any time soon.

The organization serves our community through hospitals, primary care locations, specialty practices and more. It's one thing to keep the average position filled, especially in larger facilities like Winchester Medical Center. It's another thing, though, to find out what is still lacking in the smaller communities.

In 2012, 33 physicians were recruited for Valley Health and independent practices. Some were new to the area, while others brought an everyday service to a community that didn't have it before.

Either way, the organization is making progress to get local patients exactly what they need a little closer to home.

Nancy Hiett, Valley Health's physician recruiter for the past 12 years, said the organization looks at a variety of factors when determining what health care providers are needed in the community.

"Here, and across the country, hospitals have seen a need in primary care," she said. "But there are other broad needs that we are constantly looking at - cardiology, general surgery, vascular surgery."

While a majority of physicians practice in the Winchester area due to the large market, a number of medical staff have been brought in to physically go to the smaller communities like New Market and Front Royal, she said.

"People are traveling less, I think," she added.

A challenge in physician recruitment that Hiett has noticed over the years isn't necessarily identifying the need, but more identifying a practice opportunity that makes sense for the doctor and the community.

"It's an entire move for a physician, and oftentimes their family," she said. "We also have to think about retaining the doctors once they're here, which is why it's important to make sure there is a need for their services."

One way to address as many needs as possible in some smaller communities is a multi-specialty clinic approach, which has worked for some years in Luray, according to Jeff Feit, vice president of physician support services. He had worked exclusively with Page Memorial Hospital for 11 years, and just last year entered the new position.

Feit said years ago, a few doctors were working in one building, but there was extra space to rent out. More independent doctors were brought into the space through once-a-week or once-a-month visits to extend their practices and increase their volume of patients.

"We needed to bring these services to the area, and it really worked well for the residents," Feit said. "It made it easier for them in terms of certain tests and follow-up appointments because they didn't have to travel nearly as far."

He mentioned the approach works well for the physicians, as they are all located so closely together, which facilitates improved communication.

There are also ongoing cardiology outreach efforts in Woodstock and dermatology outreach services in Front Royal. A newly recruited OB/GYN also works with patients in both Woodstock and Front Royal.

"In the long run, we'd love for this care to be permanent in each area, but we want to make sure we're doing what we do well," Feit said. "We're all here to help people get better. That doesn't change."

While Valley Health has a community of general surgeons who have provided surgical care for a number of cancers for many years, one recent addition handles a specialty that has not been available to patients before.

Dr. Patrick Wagner came to Winchester Medical Center last August to establish a surgical oncology practice. He mainly focuses on anatomically complex areas, like the esophagus, stomach, liver, pancreas and rectum, or advanced cancers.

Wagner said a fraction of these patients will still prefer to go to hospitals at University of Virginia Medical Center in Charlottesville or Johns Hopkins, but "most would rather receive the care closer to home."

"When a patient is going through a cancer operation, they're in the hospital for a number of days, and that can result in a lot of trips back and forth for family members. It can be a hurdle," he said.

Before joining Valley Health, Wagner tried to predict the number of patients and cases he might work on in his first three years. He figured the number of cases would grow over the years, and would be relatively low in the first six months to a year as he established his practice.

However, Wagner has seen roughly 125 patients since August and worked on 95 cases - the number he thought he'd be dealing with in his third year.

"The population here is growing and aging, so the need for cancer services will increase everywhere," he said.

Another thing that makes Wagner unique was his decision to practice in a non-university setting. He said about 50 surgeons a year graduate from the program he did, and the majority will go on to a research or academic hospital, which is why so many people wind up traveling to receive certain services.

"I think there are a lot of folks out there who don't realize our capabilities here," Wagner said. "Maybe people are just used to thinking of the hospital in a certain way, but we've done so many upgrades. There has been a good oncologist, radiation oncologist, for a long time. What I do is really just a piece that completes the cancer team here."

Dr. Nance Lovelace also joined the Valley Health team as a family practitioner in August through the New Market Family Health Center. Lovelace, an osteopath, looks "at the person as a whole, not just the disease." Her special interests are geriatrics and diabetes.
The location of her office saves many community members from having to travel an additional 18 miles to Shenandoah Memorial Hospital.

"When my patients find out that I'm a permanent doctor, they say 'Oh, thank God,'" Lovelace said.

Lovelace also does her best to see as many patients as possible each day, especially those who are already sick and whose only other option might be the emergency room. The health center also has a close working relationship with Mt. Jackson Family Health, which helps in the overall goal of making it easier for patients to be treated.

"We're especially looking to work with patients who maybe don't have insurance," she said. "No one should stay away just because they don't think they can afford it."

In Front Royal, Skyline Orthopedics and Sports Medicine added a new physician and surgeon a little more than a year ago after the practice changed hands in 2011.

Dr. Charles Abrahamsen transitioned from running his own private practice to becoming a Valley Health employee, and the move hasn't come without changes.

"It was huge," he said. "Before, I had to run a business, but now all I have to do is be a doctor."

Abrahamsen said he feels in the next three to five years that running a solo practice will be next to impossible due to changes coming with the Affordable Care Act.

With a special interest in sports medicine, and as a lifelong athlete himself, Abrahamsen enjoys treating other athletes, and "getting them back on the field as quickly as possible."
Patients at the practice range from a 7-year-old with a broken finger to an elderly resident with a hip fracture, and many ailments in between. Abrahamsen has learned, though, that 65 percent of the local residents who could come to the practice go outside the county to Winchester for treatment.

When Abrahamsen first started in Warren County, though, the practice was pretty busy, seeing about 30 patients a day.

The practice also works with local schools, meeting with coaches and student athletes to keep them up to date with health care options and how to avoid injury.

"I've just got more time to give to my patients," he said. "In medicine, progress is happening, and Valley Health is no exception. It's a great opportunity for doctors to become an employee and let go of the administrative part. And the changes in care are excellent ... good things are going on right here in the valley."

Contact staff writer Kim Walter at 540-465-5137 ext. 191, or kwalter@nvdaily.com

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