Edwards is a solo practitioner at Garza County Health Clinic, in Post, and the only physician serving the county (population: 4,872). Raised in Belton, he holds degrees from Baylor University and the University of Texas Medical School at Houston. He completed his residency at Waco’s McLennan County Medical Education and Research Foundation before moving to West Texas in 2005.
When I decided to be a doctor, I knew I wanted to do small-town medicine. During my residency, my wife and I traveled to probably thirty different small towns in Texas, and every town we looked at had at least one doctor—except for Post.
Both my granddads were small-town country doctors. They could do anything and everything, from delivering babies and amputating extremities to setting broken bones and treating heart attacks. That’s what I grew up knowing a doctor was—someone who could treat everything. During college, it was always in the back of my mind that it might be something I would do. I changed my major five times trying to figure out if there was anything else that tickled my fancy, but I just kept coming back to medicine. It’s kind of a cliché answer, but I wanted to help people.
My day starts with a pile of charts and paperwork. There is a tremendous amount of paperwork—all sorts of forms that the insurance companies and pharmacies and Medicare and Medicaid and workmen’s comp need filled out. I try to whip through it all in thirty minutes, then I start seeing patients. My day is pretty much booked from the get-go, seeing people with chronic diseases like diabetes and hypertension, but we try to leave some slots open to treat acute illness and injury. On a typical day we’ll have an oil-field injury come in or a cowboy who’s been bucked off his horse and broken a rib. We also do a lot of newborn care. On Wednesdays I run over to the nursing home and see folks there. Really, it’s just a big variety, and that’s why I like it so much. You never know what the next patient can be. I’ll break for lunch if I can, but sometimes we’re too busy to even do that. I wind things down around five-thirty and then head home to try and have some family time.
I used to see thirty to forty patients on my own, but last fall we hired a physician’s assistant, and she’s helped cut my workload down. Combined, we’ll see forty to fifty patients. When you see, individually, more than thirty a day, it’s just too much, and you really aren’t giving good care. So getting help was a blessing; I can serve the community and not burn out. Of all the primary care practices in the nation, we are currently in the ninetieth percentile in number of patients seen and procedures performed. That kind of volume is not good, really, because you don’t get to spend enough time with each patient. But the need is there. At one point I thought about closing my practice to new patients and saying we have enough, but you just hate to turn away sick folks.
We take all comers. Our state, and the country, is dangerously short on primary care physicians, so we see anybody and everybody we can. We don’t care if you have insurance or no insurance. At a suburban practice, 90 percent of patients will have good insurance, which means you can limit your practice to 10 percent Medicare or no Medicare. But in a rural environment, a large part of your town is the Medicare population. About 30 percent of my practice is Medicare, and 23 percent is Medicaid, which means the government makes up 50 percent of my practice. It’s a good mix, but that paperwork is a headache. And the reimbursement rates almost aren’t worth the hassle: Medicare only pays 60 cents for every dollar I charge; Medicaid is even worse.
To me, the underlying cause for the shortfall of primary care physicians is those poor reimbursement rates. Go to a med school and ask the juniors and seniors there, “Why aren’t you going into family practice?” And if they’re being honest with you, a big part of it is going to be money. When students are trying to pick their specialty and they’re looking at a $300,000-plus starting salary for anesthesiology versus $140,000 for family practice, it’s a no-brainer. That makes it sound like doctors are greedy, but when you’re coming out of school with $140,000 in debt and you want to buy a house, you want to buy a new vehicle, and you want to start a family, a higher salary looks a lot better. These days everybody is talking about universal health care and government versus privatization. But it doesn’t matter if everybody in the world has insurance; if there aren’t enough physicians to handle the load, then none of it will work.
Recently, in one week, I got two recruitment phone calls and four recruitment postcards from different rural towns in Texas. On average I receive two or three letters a week, but it has really ramped up in the past year. I’ve been contacted by people in Clifton, Glen Rose, Haskell. And it’s not because it’s me. I’m sure they’re calling every doctor they can. I talked to a couple of them, and they’re desperate for docs. For example, I’ve got a buddy in Sweetwater who I trained with, and a while back he called and asked if I could take a week off and let my assistant run my practice so I could cover his for a few days. He just wanted a break to go on vacation, but he couldn’t get anyone to cover him.
When I finished my medical training, there was talk that I’d continue the practice for one of my granddads, in Belton. But I felt drawn to somewhere with a bigger need. Now I’m starting my third year, and we’re definitely growing. You don’t realize this until you graduate from med school, do your residency, and start practicing, but as a primary care physician, you aren’t just dealing with someone’s high blood pressure and diabetes; you are dealing with a person. When you ask, “Why didn’t you take your meds?” they might say, “Oh, I don’t have any money because my daughter just wrecked her car and I had to pay for that.” Or “My daughter just got a divorce and I’m going through a lot of stress.” I’ve been amazed during my three years in practice how much of a visit can be devoted to stress issues, work issues, relationship issues, just life issues. To be effective, you need to listen. You have to take time.
That’s what primary care is all about: your relationship with the patient. It’s time-consuming and stressful, but it’s what makes it fun. You put your heart and soul into it.
