For patients and trainees alike, rural dermatology clinic has their back
Published on Monday, August 22, 2022
By: Gary Pettus, gpettus@umc.edu
The pig’s feet cost Erin Sears $5.10. A bargain, considering what they can teach her.
She found them in a market in Louisville, a small town in north Mississippi, and trotted them back to the Main Street clinic, where fellow medical student, Rachel Wilkinson, poised with needle and sutures, got ready to dip her own toe in the water.
At Wilkinson’s side was Dr. Adam Byrd, demonstrating the way to stitch up incisions he had made on appendages traditionally eaten. “When I was a medical student,” Byrd told her, “I used to sew on my couch. It’s not like it was a $20,000 couch.”
For the past five years in Louisville, Byrd, assistant professor of dermatology at the University of Mississippi Medical Center, has mostly sewn up humans instead, there in the satellite clinic that continues to put its best foot forward on the terrain of rural health care. He’s the only dermatologist in town.
His clinic is a welcome presence for patients and a windfall for medical students like Wilkinson and Sears, and for dermatology residents eager for a taste of rural medicine, in a place where country music plays in the background and a breakroom sign urges you to “Say Grace.”
“The rural practice is for someone who is a little more confident of the education they received,” said Byrd, a 2011 graduate of the UMMC School of Medicine. “I would put a UMMC student up against an Emory student or a Vanderbilt student any day of the week.”
Since its birth, the clinic has not stood still. It has, in fact, moved to a new location in town, to a larger facility that would not exist, Byrd said, minus a partnership with Winston Medical Center, which built the Main Street building and leases it to the clinic. The staff, numbering seven, has more than doubled in size.
Its reputation hasn’t stood pat either, traveling far beyond Winston County, presenting as a singular model for others to follow, especially for this reason: UMMC Dermatology-Louisville is the centerpiece of a rural-specific dermatology residency program created by UMMC.
Among the 142 accredited U.S. dermatology programs, it is the only one of its kind.
“When leaders in dermatology around the U.S. think about Mississippi, they think about Dr. Byrd’s unique rural academic office 90 miles from Jackson serving the previously unmet dermatological needs of thousands of Mississippians and training medical students and residents to understand the joys of practice outside cities,” said Dr. Robert Brodell, who was chair of dermatology when he and Byrd opened the clinic under the auspices of the Department of Dermatology, now chaired in the interim by Dr. Jeremy Jackson.
“In addition, they think about our rural dermatology track which is delivering more dermatologists to serve rural Mississippi and rural America,” said Brodell, now professor and chair of pathology.
Since 2019, 68 dermatology residents and students from 15 states and Canada have trained in Louisville.
Of the three or four residents the dermatology faculty accept for the program each year, one is a rural-track resident who will do a three-month rotation in a town of about 6,000, somewhat smaller than Covington, Louisiana, where resident Dr. Josh Ortego grew up, mostly.
“A dermatologist is the only kind of doctor I ever saw myself becoming,” Ortego said. “Before medical school, that’s the only doctor I really had any exposure to.”
Ortego is a current rural dermatology-track resident, as are Dr. Ben Rushing and Dr. Hannah Badon, who designed the T-shirts worn by clinic care coordinator Julie Hunter, RN, and other staffers. “We’ve got your back … front, face, nails, hair,” the T-shirts say.
Asked to describe the appeal of the rural-track program, Ortego cited the clinic’s sky-high numbers and the area’s low-key lifestyle.
“Dr. Byrd schedules 40 to 50 patients a day,” Ortego said. “Our other clinics might schedule 20 to 30. He schedules two to three surgeries every morning. Whereas, in our residency surgery clinic in Jackson, they’ll schedule about five surgeries every Thursday afternoon. And the residents aren’t in that clinic all the time.
“Because of my training in Louisville, during my first year I’ve already met all of my residency’s surgical requirements.”
Byrd hopes the lure of a rural practice numbers will help draw more physicians to places like Louisville, where they’re most needed – “someone who will put some skin in the game,” he said.
A study published in 2018 found that, over an 18-year period, the gap between the distribution of dermatologists in metropolitan areas compared to rural communities continued to swell, “with many counties lacking a dermatologist.”
“Our preference (for trainees),” Byrd said, “is someone from a rural area who thinks they will want to practice in a rural area, preferably in their hometown.
“Rural dermatology is not a separate specialty, but it is a different approach. It’s one-stop. I will see a newborn with a large birthmark, a nursing home resident on oxygen, a college student with acne, someone with lupus. I consider myself a family dermatologist.”
Byrd’s own family has been here for years. He was born in the town where he once mowed his neighbors’ lawns and where his grandmother taught school. A field surgeon in the Mississippi Army National Guard and an Operation Iraqi Freedom veteran, Byrd is an outdoors lover who understands his patients’ attachment to small towns and staying put.
“People don’t like to drive to the big city,” he said. “We’ve had patients who needed Mohs surgery and who told me, ‘Dr. Byrd, you either cut this out, do it here, or I will leave it alone.’
“A rural dermatologist has to say, ‘I will do the best I can right here.’ It’s gratifying to have patients who trust you that way.”
That’s about 6,000 trusting souls – the number Byrd saw last year. Of course, many, like Patricia Holton, are townspeople. “Without this wonderful clinic, I would have to drive about 60 miles to Columbus,” Holton said.
But they come from other small towns, too, such as Mize and Macon. Because of the clinic’s insurance acceptance rate, some travel from larger cities. Bob McKee, 88, rode in from Starkville, chauffeured by his daughter, Jan, on the 60-mile round trip to Louisville; there, fourth-year UMMC resident Dr. Sarah McClees treated his skin condition with surgery.
“There’s a lot of surgery here,” said McClees, a Birmingham native, explaining why she’s taking an elective in Louisville. “And they see a little of everything.”
McClees and other trainees receive a housing stipend and stay at a local hotel, the Mason Boutique, which also puts up medical students like Sears and Wilkinson when they’re not shadowing Byrd or practicing suturing on Sears’ purchases. (Pig’s feet are used in academic medical centers, too.)
A native of Monticello – population 1,400 or so – Sears chose to do a two-week elective in Louisville, where “a typical patient reminds me of what a typical patient would be in Monticello,” she said.
Although Wilkinson’s Pascagoula hometown is almost four times bigger than Louisville, she’s considering practicing rural dermatology. On her second day at the clinic, her suturing improved quickly with Byrd’s guidance.
“That’s looking good,” Byrd said. “You owe Erin for those pig’s feet, by the way. $5.10.”
