OAKLAND - On four hours of sleep after a late-night emergency C-section, after resuscitating the newborn who wasn't breathing, Dr. Ken Buczynski is back on the maternity ward at 7:30 a.m. with another woman about to deliver.
Before the end of the day comes 14 hours later, he'll leave and return several times, to administer the epidural himself and later to bring dark-haired Miley Welch into the world. He will visit a hospitalized elderly man who is having part of his foot amputated. And he'll see more than two dozen other patients in his office, from a 6-month-old with a bump on his eyeball to a 62-year-old struggling to control her diabetes.
Such is the hamster-wheel life of the country doctor in Garrett County, Maryland's largest county by area but smallest by population. Here, in the wooded mountains at the tip of the state's panhandle, where the physician shortage is felt every day, there are no obstetricians and very few specialists. Instead, there are a handful of doctors such as Buczynski who consider treating the rural poor a calling - otherwise, they might not be able to put up with the extreme hours, isolation and loss of anonymity that come with the job.
Unrecognizable to many on the East Coast, the cradle-to-grave care that Buczynski, 35, and his colleagues deliver is slowly disappearing as a way of practicing medicine. Still, he says, it has its benefits.
"Our patients' care is not being fractured by seeing an endocrinologist for their diabetes and thyroid and the cardiologist for their high cholesterol, their gynecologist for their Pap smear," says Buczynski.
"When you start seeing all those doctors, oftentimes the left hand doesn't know what the right hand is doing. In our community, that patient with those problems is likely coming to their primary care doctor 90-plus percent of the time ... and if specialty care is required, we help patients get that. I think that's a good model."
Good or no, it's the only model they've got.
Buczynski was in his family medicine residency in rural Kansas five years ago when he saw an advertisement seeking a "Christian doctor" for an established practice in a rural community first designated with a physician shortage by the federal government three decades ago. The description of Oakland struck him as just the kind of place he was looking for - and a place that clearly needed someone like him.
But Buczynski, unusually sure of himself for a man of just 30, had dreamed of running his own practice. So he cold-called Don Battista, the longtime CEO of Garrett County Memorial Hospital, the 56-bed facility that is the only one out here at the state's western extreme. Battista is used to getting such calls, but they're typically from doctors who come to nearby Deep Creek Lake on vacation and fantasize about a permanent move to a slower pace. That's when Battista has to break the news: This job is no lazy day on the water.
As the two spoke, Battista could see that Buczynski was serious, and soon they struck a deal. The hospital would make Buczynski a small loan to set up office space and eventually pay off his $140,000 in student debt. The local economic development agency would lend more for electronic medical records. When he arrived five years ago in October, there were six patients scheduled that first day.
Today, Buczynski, a former outside linebacker who looks as if he could still fit into his University of Virginia uniform, has built a practice of 10,000 patients - men, women and children drawn to his gentle demeanor and practical manner. His Wellspring Family Medicine employs 23 people, including a partner and three physician's assistants, at the main location in Oakland and a satellite office 20 miles up the road in Accident. He is hoping to recruit a third doctor this summer.
It's a calling
"I always felt called to this kind of practice," says Buczynski, who attends the Faith Evangelical Free Church with his pregnant wife and their three young children. "And you really need that calling because to go to a recruiting fair and say, 'Come to rural America where everyone will know your car, your business, your house, what kind of chicken you buy at Wal-Mart, and you'll take call 168 hours at a time and there's no mall for an hour and a half. ...'
"When you start talking about those things, it's a real detractor to a lot of physicians."
There are four family doctors in Garrett County who deliver babies, and two must be on call at all times. Buczynski and his partner, Dr. Richard Porter, alternate weeks on call. Before Porter arrived in September 2006, only two doctors in the county delivered babies. It was the medical equivalent of house arrest: Neither could travel more than 20 minutes from the hospital at any time. Battista calls it "an unusually generous commitment to make to a community."
That went on for more than six months.