2011 Family Physician of the Year Finds Unique Niche Among Rural Underserved

FP Battles Substance Abuse Epidemic, Embraces Innovation

September 29, 2010 05:35 pm Barbara Bein

Fresh out of the U.S. Army a decade ago, S. Hughes Melton, M.D., knew exactly what he wanted to do and where he wanted to do it: He wanted to be a family physician with a practice among the rural underserved.

"Having grown up in the suburbs, I knew I didn't want to live there. I wanted to serve the underserved, but I didn't want to live in a city, so I chose Southwest Virginia," he told AAFP News Now in a recent interview.

S. Hughes Melton, M.D., is named the Virginia AFP's 2009 Family Physician of the Year.

Melton settled in Russell County, Va., a coal mining and agricultural community located in a wedge of Appalachia between West Virginia, Kentucky, Tennessee and North Carolina. There, the former Washington, D.C., suburbanite launched a practice that today provides the full spectrum of family medicine care to the area's rural underserved and specializes in helping patients with substance abuse problems.

In recognition of his work, Melton was honored Sept. 29 as the AAFP's 2011 Family Physician of the Year during the opening ceremony of the Academy's annual Scientific Assembly in Denver. It's an award given to an outstanding American family physician who provides compassionate and comprehensive patient care and serves as a community role model -- professionally and personally -- to other physicians, residents, medical students and health professionals.

Modest Beginnings: Two FPs and a Trailer

Melton's journey began modestly. In July 2000, he partnered with another family physician, Brian Easton, M.D., and the two opened a clinic, later to be known as C-Health -- for "Complete Health" -- in a rented trailer in Lebanon, Va., with no staff and no patients.

The rolling mountains of Virginia's Appalachian region form the backdrop for Melton's Russell County practice.

"We had both been given the same vision for a cutting-edge family medicine clinic that would make life better for the citizens of Russell County," which was a federally designated health professional shortage area, Melton said. "We believed then that the advantages of starting out as a team outweighed the disadvantages of starting out with two physicians and no income. We were right."

Today, C-Health has grown to serve more than 18,000 area residents. The clinic, which moved from the trailer into an 8,500-square-foot, state-of-the-art health care facility in 2006, offers a full range of family medicine services -- from pediatrics to geriatrics and everything in between -- as well as nursing home care and inpatient care at the Russell County Medical Center. Two satellite clinics in nearby Honaker and St. Paul, Va., allow the physicians to be closer to their patients in outlying areas of the county. The physicians also make house calls.

Melton counsels a young female patient. Depending on what they're being treated for, patients may be seen individually, as well as in a group setting.

Dedication to Service, Innovation and Community

From the beginning, Melton showed a commitment to service. C-Health helps its low-income patients obtain free medications through pharmaceutical company-sponsored patient assistance programs. In addition, the clinic puts 2 percent of its monthly collections into a "practice tithe fund" which helps pay for patients' medications, shelter, heating and other bills.

At the same time, C-Health incorporates many features of the patient-centered medical home, or PCMH, using physician-led interdisciplinary teams and collaborating with pharmacists and mental health counselors. Open-access scheduling allows patients to book "same-day" appointments, and C-Health's electronic health records system -- in place since the clinic first opened -- soon will include a patient portal.

"The next 10 years will see the development of many new and better ways to deliver primary care. It is my goal for C-Health to be a leader during this time of innovation," Melton said, adding that the practice plans to apply for PCMH recognition from the National Committee for Quality Assurance after revised PCMH standards are published in January 2011.

Another innovative approach to delivering care that C-Health has adopted -- shared medical appointments, also known as group visits -- has proved especially helpful in caring for a particular subset of patients, according to Melton. When he first arrived in Russell County 10 years ago, the region was in the midst of a substance abuse epidemic. Prescription narcotics, such as oxycontin, were local abusers' drugs of choice. To address this epidemic, Melton became an expert in chronic pain and substance abuse treatment.

Many of his patients began using the drugs as painkillers and later became addicted, Melton explained. Others, including pregnant women, were drawn into substance abuse by acquaintances or even so-called friends.

Today, Melton and his team of nurses and substance abuse counselors treat more than 80 patients through shared medical appointments and drug-replacement therapy with buprenorphine, which is marketed as Suboxone.

"You replace a drug of abuse -- oxycontin, for example -- with a drug of therapy so the patient can take part in counseling and recovery groups," Melton said.

Melton also takes an active role in bringing along future FPs and other health care professionals: Each year, he and other C-Health staff precept 40 medical, nursing and pharmacy students who rotate through the clinic.

2011 FPOY Finalists

Lisa Dodson, M.D., of Portland, Ore.
Michael Madden, M.D., of Alexandria, La.
Adrian Ramos, M.D., of Modesto, Calif.
Charles Rhodes, M.D., of Concord, N.C.

In addition, Melton is highly involved in bettering his community. Among many such activities, he serves on the board of the Medical Society of Virginia Foundation, completed its year-long Claude Moore Physician Leadership Institute and became a state legislative advocate. He also serves as chairman of the board of Friends of Russell County Wellness and Fitness Inc., a nonprofit organization that seeks to bring wellness programs to Russell County.