Dr. Granville Vance gets ready to ride one of his horses at his home on the outskirts of Dillion.

It’s renown for the string of billboards that litter Interstate 95 and the giant sombrero that welcomes travelers to South of the Border. Yet underneath all the glitz of its sprawling tourist attraction, Dillon, South Carolina, is basically a small town, one that opened its arms to Dr. Granville Vance when he arrived in 1990. “A new physician coming into a small town does not go unnoticed by the community; you are widely welcomed,” said the family medicine physician. A graduate of the Family Medicine Residency at Palmetto Health Richland, Dr. Vance chose to join a rural practice in Dillon, near the North Carolina/South Carolina border, when he finished his medical training.

Thirty-five family medicine physicians that completed their residency at Palmetto Health Richland now practice in rural areas throughout South Carolina. It’s a career choice with unique challenges and rewards, explained Dr. Jamee Lucas, an associate professor in the USC School of Medicine’s Department of Family and Preventive Medicine and the program director for the Family Medicine Residency. “There is no referral right next door,” Dr. Lucas said, noting that while physicians are in short supply in South Carolina’s rural areas, specialists are an even scarcer commodity. “Family medicine physicians in rural areas have to decide if a referral is worth a 60 or 90-minute trip for the patient,” she said. This places a more extensive burden of care on the physicians who serve the residents of these communities. “Out of necessity we have to incorporate a lot of skills into our practice that would be under the umbrella of specialists in another setting,” Dr. Vance said.

Dr. Jody Ellison takes time to discuss health concerns with patient Delorise Porter of Eastover.

When particular medical problems require outside expertise, Dr. Jody Ellison doesn’t have to schedule her patients for an inconvenient out-of-town appointment. Several specialists come to the Richland Community Health Care Association in Eastover on a monthly basis. Located halfway between Columbia and Sumter, the practice is in an area where there are few amenities. “I wondered about going to a community where I didn’t have access to other types of care when necessary,” said the 2000 graduate of the Family Medicine Residency. “Yet it’s worked itself out,” she said, adding, “I don’t hesitate to pick up the phone and call someone if we don’t have the help we need here.”

Because Columbia’s hospitals and Sumter’s Tuomey Healthcare System are a cumbersome 30 to 45-minute commute from Eastover, Dr. Ellison and her partner rely on hospitalists to provide inpatient care for their patients. Conversely, Dr. Vance and the five other physicians at Dillon Family Medicine, are located close to McLeod Medical Center of Dillon, where they regularly admit patients. “For the hospital to survive we have to support it,” he said of the 92-bed facility. “With the hospital providing medical continuity and a major employer for the area, we view hospital care as a service to the local community and patients,” he said.

Transportation to office visits tends to be a problem when lower income and elderly patients are spread out through sparsely populated terrain. “There are little dirt roads after little dirt roads,” Dr. Ellison said in describing Eastover. Her practice responds by sending a van down county roads to pick up patients. Dillon Family Medicine found another way to address the dilemma. “More than 50 percent of our patients are walks-ins based on acute illness or when transportation became available,” said Dr. Vance. “If it’s your only opportunity to get in for the next two weeks, then it’s okay with us,” he said.

Both physicians agree that small town medicine provides a greater degree of familiarity with patients. “It’s more personable than in a larger city,” Dr. Ellison says of the practice in Eastover, where she commutes 40 minutes from Columbia. “We treat a lot of family members and generations of family members. Because everyone knows each other, word of mouth helps get in patients who really need to be seen,” she said. Since Dr. Vance lives in the community where he works, he shares another level of interaction with his patients. “Your personal encounters outside the office are largely your patient population – they serve you at restaurants, care for your car, and are the electrician and plumber you call for your home,” he said. “Most of my children’s friends are also patients of the practice,” he added.

Such a degree of familiarity can also have its disadvantages. “Another challenge is that you have very little privacy,” Dr. Lucas said. Before Dr. Vance moved his family to a home on the outskirts of Dillon, it wasn’t uncommon for people to drop by the house for a quick piece of medical advice. Though the move eliminated the “front door consults,” he and his wife both continue to field ongoing requests in public places. “It’s a practice in graciousness,” he said of how they respond. Sometimes it’s easy to field a simple question. In other cases he draws the line, particularly when his wife is asked to act as an intermediary. “When someone asks my wife to give me a message, she tells them nicely that I have asked her not to relay messages, but I would be glad to assist them through the regular office channels,” he said.

Despite the inherent limitations, Dr. Vance and Dr. Ellison are both more than content with the choice they made to work in rural medicine. In fact, Dr. Vance was so committed to the practice in Dillon that he recruited three other family medicine physicians, two of them classmates from the Family Medicine Residency at Palmetto Health Richland. “In general, physicians change practices three times in a career, most within the first two years. We have noticed that our graduates in the rural areas tend not to move,” said Dr. Lucas. While federal programs to help repay medical school loans may factor into a physician initially selecting a rural location, Dr. Lucas doesn’t see this as the tie that binds. “They may get there thinking this isn’t where they will spend their whole lives. Yet they become a part of people’s families and such crucial members of the community that nobody will let them leave,” she said.


Reprinted from Connections newsletter, May 2005

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