Examining the Doctor: John Matthew and the rural health center movement

Vermont Business Magazine, Dec 01, 2006 by Marcel, Joyce

There are two kinds of doctors," Dr John D Matthew told me as we sat down for an interview. "Some are interested in living well and earning. And some are interested in serving well and learning."

Then he smiled and said, "But even my children, when they were young, asked me why wouldn't I be a real doctor and get them a swimming pool."

When it comes to serving and learning, Matthew, the founder, CEO and medical director of The Health Center in Plainfield is a leader of the pack. At a time when many medical practices are so full that they can't take on new patients, while few medical students are interested in becoming primary care physicians, Matthew can barely contain his enthusiasm for rural primary care medicine.

"I went to meeting of the American Association of Medical Colleges a few years ago," he said. "Every specialty and subspecialty was jockeying for position. I said, 'You need a different kind of person to come to medical school. You need people who understand that this is a service profession. This is a calling."'

The American health care system is in crisis. Millions are uninsured and have little or no access to health care.

People are living longer and dealing with complex and more chronic diseases. Medical students come out of training so overloaded with debt that many of the brightest no longer consider a career in medicine. Because of managed care, primary care doctors' fees are capped. Physicians deal constantly with insurance company bureaucracies, an insensitive Congress, intricate webs of Medicare rules and regulations, predatory pharmaceutical companies, high malpractice rates, frivolous lawsuits and a host of other problems.

The simple and vital bond between a patient who needs care and a caring doctor who wants to provide it has never been more threatened. And forget about house calls.

And then there are doctors like Matthew and places like The Health Center.

The Health Center is located in a nondescript, mostly twostory building that sits in a field behind the Plainfield Post Office. A horse farm across the road, owned and run by Matthew's son, scents the air with manure and hay.

On the day I met with Matthew, 61, a soft-spoken, smallboned man with a high forehead, long hair and a welltrimmed beard tinged with white, he was about to take off for his first real vacation in two and a half years.

Born and raised in Charleston, SC, Matthew still has a Southern accent to go with a heaping helping of Southern charm. Wearing a suit, a t-shirt, and high brown boots, he led me on a tour of the crowded health center before we settled down to talk.

Matthew started THC back in 1973 as an adjunct to Goddard College. It was designed to serve a population spread over the towns of Cabot, Calais, East Montpelier, Marshfield, Plainfield and Woodbury, with Goddard's student population making up a seventh town.

The center has since grown into a crammed-to-the-gills facility open 60 hours a week and booked for every minute of that time. With a rapidly growing caseload that tops out at 7,800 patients and all their files, a laboratory, three doctors, four physicians' assistants, dentists, secretaries, physical therapists and mental health therapists - 34 full-time and 19 part-time staff members - jammed into 9,600- square -feet of space, it's a busy place,

"In the course of one day, we have a staggering number of people through here," Matthew said.

It's no wonder the center has recently embarked upon a $2.1 million capital fund drive to double its space.

Unlike most medical practices, THC accepts new patients all the time. It provides health care for everyone on a sliding payment scale; Matthew estimates it has provided over $1 million in reducedprice medical, dental and mental health services over the years. The staff practices a team approach to medicine, where patients' illnesses are discussed in meetings and the whole staff is "the doctor" for each patient.

"In a lot of practices, it's your patients, my patients and 'How are you?'" Matthew said. "We really team up. We put our heads together. We share rounds in hospitals. The patients are all ours. Even if someone sees me 90 percent of the time, we consider them 'our' patients but they're seeing one doctor for chemistry or continuity. Any we have very, very good physician assistants. We start every day with open PA slots, so if someone is sick, we can see them that day. And we're open three evenings and Saturdays. Medicaid recently came from a - meeting with us and said 'You guys stand out for low ER use.'"

Over 45 percent of THC medical patients are on Medicaid or Medicare, and it is one of only two dental facilities in the state accepting new Medicaid dental patients. It is the only primary care facility in its area. Even with the inefficiencies of overcrowding, THC has managed to reduce its patients' hospitalday stays, lowered the use of specialists, and lowered health care costs overall. It even provides that all-elusive medical Holy Grail, house calls.

Medicine is not without its risks, and one of Matthew's worst experiences came in 2000, when one of his PAs injected a woman with a drug to combat nausea from migraines. An artery in her arm was severely damaged and caused gangrene. Eventually, her hand and forearm had to be amputated. She sued THC and settled out of court. Then she sued the drug company, Wyeth, and recently won a $6.8 million settlement. Matthew testified for her and against the drug company in that suit, but he is haunted by the experience.