Live & Practice: The Great Outdoors 2018

In small towns and metropolitan cities across the country, the great outdoors meets locals just footsteps from where they live and work.

For physicians looking west, there’s Billings, Montana, where seeking outdoor adventure is a lifestyle, and Salt Lake City, Utah, a new hotbed of arts and culture that sits beneath the Wasatch mountain range.

Looking east, physicians will find rural sophistication mixed with a New England ski town vibe in Lebanon, New Hampshire. And for those who want to escape the snow for the sun and surf, Fort Lauderdale, Florida, beckons.

Billings, Montana

In Billings, there is an undeniable sense of adventure, and that’s a big part of why people move there.

Many of the physicians who work in Billings aren’t native to the area, but they chose Billings for the chance to interact with diverse patient populations or raise their kids in a place that offers affordability and endless outdoor recreation options. It doesn’t hurt that the weather cooperates: Billings has close to 300 days of sunshine a year.

The city of Billings calls itself “Montana’s Trailhead,” a nod to the outdoor opportunities for locals and visitors alike.

As the largest metropolitan area within a 500-mile radius (Calgary, Alberta, and Denver, Colorado, are among your next closest options), Billings boasts a strong sense of community, progressive regional commerce and unlimited access to the outdoors.

John Pender, M.D., a bariatric surgeon and chief of surgery at Billings Clinic, recalls that one day a flier for the Montana hospital came across his desk. At the time, he was on the academic faculty at East Carolina University, acting as a fellowship director for surgical fellows. “I thought, ‘Montana, that sounds interesting,’” recalls Pender. “And here we are.”

One of Pender’s primary motivations for moving to Billings was the opportunity to diversify his areas of practice, rather than narrowing his focus. “Being in a university, they really want you to subspecialize,” he says. “I got pigeonholed to do one or two operations. Coming up to Billings, Montana, has allowed me to be a general surgeon.”

Pender says that Billings Clinic epitomizes the idea of “big city medicine in a small town.” The hospital serves patients from Montana, Wyoming, North and South Dakota, and treats approximately 750,000 people each year. “When you’re eight hours from the next competitor, you really get to practice medicine,” says Pender.

Winter weather is a factor in treatment, too. Given that some patients live several hours from the hospital, both physicians and hospital administrators have to devise innovative solutions for patients who have chronic health challenges and who don’t live close enough to return regularly for follow-up appointments.

“It creates opportunities for people to think outside the box,” says Pender. “We have a great outreach program through which the clinic provides a car or even a plane to get us out to these small communities to reach patients.”

The clinic is physician-led. “The governance policy states that the CEO will always be a physician,” says Rochelle Woods, physician recruiter at Billings Clinic. “Physician leaders are at every level, from the board to department chairs.”

More than 450 physicians and advanced practitioners cover more than 50 specialties in the 304-bed hospital, which sees 50,000 visits per year to its Level II Emergency and Trauma Center.

As the largest health center in the state and the region’s tertiary referral center, the clinic has 13 regional partnerships in Montana and Wyoming. It was ranked as the best regional hospital in 2017-2018 by U.S. News & World Report, and is currently recruiting for almost every specialty, from cardiology to pediatric gastroenterology.

The hospital’s record isn’t the only point of acclaim. In 2016, Billings was named the “Best Town for Outdoor Activities” by Outside. With close proximity to fly fishing streams, the Rocky Mountains, the Yellowstone River, the sandstone bluffs known as the Rimrocks, and a 40-mile trail network that loops throughout the city, residents never tire of the outdoor offerings.

For physicians and their families, “It’s an easy city to acclimate into,” says Woods. “People come for the outdoor activities and the accessibility, so the majority of people are not from Billings. Unlike the Southeast or the Midwest, where most people move because they have family, people move to Billings for the outdoor activities and to raise kids where they can easily be outside.”

The welcoming and friendly nature of the people who call Billings home also makes the city ideal for newcomers, according to John Brewer, CEO of the Billings Chamber of Commerce.

“Despite the connectivity and big-city amenities, Billings maintains a small-town feel with people who seek authentic connections and take the time to look you in the eye and make you feel welcome,” he says. “Ask people what they love about Billings and you will receive responses that in some way relate to the goodness of the people in the community.”

Though the great outdoors is one of the area’s main attractions, it easily coexists with a vibrant arts and culture scene. Popular annual events include the Magic City Blues festival, Symphony in the Park and the Big Sky State Games, an Olympic-style competition held each July. There are farmers markets, car shows, street dances and evening festivals during the summer, which residents can enjoy in between rappelling the Rimrocks, strolling along the Yellowstone River, or skiing nearby mountains, just to name a few options.

“Billings has balance,” says Brewer. “It’s large enough to experience the community at your own pace, but small enough to still run into friends at the grocery store. In Billings, despite the national economic challenges, business is strong, residents are enjoying life, and the scenery is as wonderful as the quality of life.”

That quality of life, says Pender, has made a huge difference for his family. “All year round, we do stuff as a family—hiking, camping, floating on the Yellowstone River. It really has brought us closer as a family.”

Salt Lake City, Utah

Salt Lake City, Utah, is celebrating an era of new vibrancy. The redevelopment that heralded the 2002 Winter Olympics has helped reshape Utah’s capital into a hot spot for arts, culture and community—not to mention outdoor adventure, as the city is nestled in a valley beneath the towering Wasatch Range.

In addition to the excellent quality of life, physicians in Salt Lake City enjoy a patient-centered approach that prioritizes the well-being of the community.

Tim Johnson, M.D., spent his undergrad and med school years at the University of Utah. Then it was on to Rochester, New York, where he completed his residency at the University of Rochester before doing a chief year in 2006. But though he only has great things to say about his experience as a physician in Rochester, he still missed Utah, and decided to move back and start working for Intermountain Medical Group in 2006.

Johnson practiced general internal medicine at the hospital for five years before being named regional medical director of Intermountain Medical Group. In 2015, he became an administrative medical director, and in 2017 was promoted to senior medical director. Even in his leadership role, he still sees patients on Thursday mornings.

“Intermountain is very patient-centered,” he says. “From a clinical perspective, as I practice medicine, I get to think about what is best for the patient. It doesn’t mean I don’t think about the financial aspects, but it’s not the first thing I think about.”

“Safest care, patient quality of care, patient access to health care…those are first,” he adds. “I love that we have a sense of duty not just to our patients, but also to our communities.”

In addition to the 504 beds at Intermountain Medical Center, which has a da Vinci robot, expanding telemedicine service and a cancer research center, the health system has another 21 hospitals across Utah, plus one in Idaho. According to Intermountain Healthcare physician recruiter Deanna Grange, about 39,000 employees and 1,500 physicians work for Intermountain’s wide network of hospitals and clinics.

“We’re a not-for-profit, integrated health system,” Grange says. “Even though the future is constantly changing, we’re in good shape because we’re a united front.”

Intermountain Healthcare currently has about 100 openings for physicians in specialties including neurology, psychiatry, gastroenterology and OB-GYN.

“If someone is serious about their profession yet requires almost-immediate access to year-round recreation and a very high quality of life, they’d be hard pressed to find a more ideal location,” says Shawn Stinson, director of communications of Visit Salt Lake.

According to Stinson, those who are unfamiliar with Salt Lake City, or who have not visited in the past 10 or 15 years, will likely be pleasantly surprised by what they find in the Salt Lake City of today.

“Trust me when I say, those of us who have lived here for some time know, understand and appreciate the perceptions that Utah’s capital city is saddled with, but those days are fading rapidly,” he says.

For instance, while many first-time visitors might associate conservatism with the city, Salt Lake City has an incredibly strong LGBTQ community, and in 2016 elected Jackie Biskupski, an openly gay woman, as mayor.

Sitting in the shadow of the Wasatch Range, Utah’s capital attracts professional skiers, climbers and cyclists as well as weekend warriors who take advantage of the rock climbing, biking, hiking, snowshoeing, camping and fishing options, not to mention Nordic skiing or snowboarding at the 10 world-class ski resorts within an hour of downtown.

Unbeatable access to the outdoors makes for an incredible lineup of annual events, which include Oktoberfest at Snowbird and Tour of Utah, a week-long professional cycling race. Summer outdoor concerts and year-round festivals also highlight the arts and culture scene, which Stinson says is “on par with some of the nation’s finest.”

“There’s so much to do; I don’t have to travel virtually anywhere,” says Johnson. “I’m looking out the window now at the beautiful mountains. In 10 minutes, I could be hiking up the trails or snowshoeing. Ski resorts are 12 miles away from my house. A lot of people that are interested in Utah are interested in outdoor sports, and there is the opportunity to be very active here.”

When Johnson reflects on his decision to move home to Utah, he’s certain it was the right move.

“My values align with Intermountain’s and what I’m trying to accomplish, and I feel completely engaged in helping Intermountain achieve amazing things for our communities and our patients,” he says.

Lebanon, New Hampshire

Sitting at the crossroads of New England is Lebanon, New Hampshire, a small town in a picturesque region that is home to top health care and educational institutions.

With four distinct and beautiful seasons—and outdoor recreation options to match—the area offers sophisticated rural living and is a decidedly great place to work, play and raise a family.

Many major and minor highways lead to and from Lebanon, but the spirit of the outdoors permeates everything in this iconic small town in New Hampshire’s Upper Valley.

Dartmouth College and Dartmouth-Hitchcock Medical Center serve as focal points for Lebanon area business and culture, employing thousands of people between them, and are both sources of pride for a town that recently celebrated the 250th anniversary of its founding.

For Gillian Sowden, M.D., a Dartmouth-Hitchcock Medical Center physician, the fact that she became a psychiatrist working in New England is in some ways a surprise. Sowden grew up in Scotland, and wanted to be a vet for most of her young adult life.

“In Scotland, you have to decide what you want to study right out of high school,” she says. “At 16, I could have gone to college. I was a huge science nerd. I studied biology and wanted to figure out a way to have a career that combined my love of learning and science with helping others.”

Instead, she left home to attend ski school in Norway. But even though she made the British biathlon team for Nordic skiing and shooting, she realized it was not going to be a career.

Because she didn’t want to stop skiing, she applied to medical schools in the U.S. that had ski programs and earned her undergraduate degree at Williams College. She met her now-husband at Williams, and decided to stay in the U.S. to attend medical school at Harvard.

“I went to med school thinking, I’ll do anything but psychiatry,” she says. “But in my first psychiatry rotation, I was struck by the relationship between patients and the physician.”

While Sowden completed her residency in Boston, she and her husband often talked about where they wanted to settle with their twin boys. “We were looking for a cute New England town that had an academic center because that felt like home.” They found Dartmouth-Hitchcock, and as Sowden says, “It’s been perfect.”

“This place is so unique,” she says. “It’s this small New England ski town with a massive medical hub. At the same time, you have all the amenities of a city here because of Dartmouth College. You have Division I athletics, a million festivals, events and theater.”

Professionally, Sowden has found Dartmouth-Hitchcock to be a perfect fit. “My colleagues are incredibly smart and capable physicians, but they are also very grounded and down-to-earth, kind people. It’s fun to be able to collaborate in such an intellectually stimulating yet warm environment,” she says. “I also work with medical students, and it’s important to me to combine that. It’s open and engaging, rather than that pressure cooker feeling.”

“It’s very collegial, very respectful,” agrees Kyle R. Hayman, manager of talent acquisition for clinical operations at Dartmouth-Hitchcock. “People work well together. We are trying to achieve the healthiest population possible and essentially transform health care not only in our region, but ultimately setting the standard for our nation.”

The 396-bed academic medical center is the hub of the Dartmouth-Hitchcock system, which includes four affiliate hospitals and 14 ambulatory clinics spread between New Hampshire and Vermont. With a network of 1,135 physicians and 10,000 employees, the hospital network serves around 1.9 million patients across the upper northeast.

In 2016, Dartmouth-Hitchcock Medical Center was named one of “100 Great Hospitals in America” by Becker’s Hospital Review. Innovative facilities include the Williamson Translational Research Building, which accelerates lab research into patient care, and the Center for Surgical Innovation, a state-of-the-art facility dedicated to improving surgical procedures.

“We have an MRI and CG machine that is able to move in and out of our operating room,” says Hayman. “For surgeries that are really delicate, that can make the difference between restoring someone’s ability or causing permanent disability. It’s curing cancer versus missing a bit of a tumor. It’s priceless to the individual patient.”

Right now, Dartmouth-Hitchcock has recruiting needs in virtually every area, according to Hayman, citing primary care, psychiatry, dermatology and neurology as acute needs. As for what would entice someone to live and work in the Upper Valley, there is no shortage of reasons.

“If you like to downhill ski, cross-country ski, hike or camp, this is the place. We have lakes and rivers if you like to boat or kayak or row,” says Hayman. “I also hone in on our location; we’re just a couple hours from a handful of larger cities. It’s nice to be in a small, safe community with fantastic public schools and activities for children, and also be able to drive an hour or two and experience a big city for a night or the weekend.”

The Lebanon area may also be attractive for physicians whose partners may be looking for employment, as the city is a hub for business. Though the resident population is 13,500, the daytime population, due to commuters and shoppers, is over 50,000. According to Rob Taylor, executive director of the Lebanon Area Chamber of Commerce, many of the region’s flourishing companies can “trace their lineage back to the college or the hospital.”

Lebanon is also home to miles of scenic trails, as well as the “Northern Rail Trail,” which is built on the former railroad bed between Lebanon and Concord, New Hampshire. “We have many recreational opportunities, from boating and cycling in warm months to skiing and skating in the cold months,” says Taylor.

“The nature of this area was the biggest attraction,” Sowden adds. “Everything we read said this was one of the greatest places to raise kids. It really rang true. My kids have the life I wish I had. Don’t get me wrong, my childhood was good, but theirs is just awesome. This winter, they are skiing every weekend. They’re little ski stars already at age 5.”

Fort Lauderdale, Florida

In Fort Lauderdale, residents enjoy miles of sand and ocean and great weather year-round.

Gaining a reputation as a “mini Miami” because of its sophisticated, welcoming culture, this city of 2 million knows how to enjoy life and all the area has to offer. Physicians will discover diverse patient populations here, not just the significant Medicare demographic.

Adam Lessne, M.D., has been a physician at Gastro Health in Fort Lauderdale for a year and a half—a position he’s been working toward since high school.

Lessne attended Nova High School, a magnet school in Florida. Already with a strong sense of his career ambitions, he applied for and was accepted into a seven-year medical program at Boston University.

After graduating from Boston University, he landed at Mount Sinai Medical Center, where he completed his residency, then completed a fellowship at Albert Einstein College of Medicine. While he says he enjoyed his time in Boston and New York, he wanted to live and work in a place that was closer to his family and friends.

When Lessne interviewed with Gastro Health, he says that “meeting the partners sealed the deal.” In his discussions with the practice’s physicians, he learned that they do community work in area hospitals, where they take care of patients whether they have insurance or not.

Patients who are treated at Gastro Health are essentially visiting a patient-centered medical home for their digestive system. If a patient needs a procedure or a surgery, they can often be seen the next day. There is a pharmacy service, a radiological service and fusion center on site, so if a patient has an acute problem, it can be treated then and there.

Gastro Health has more than two dozen locations in South Florida, employing close to 100 gastroenterologists. According to physician recruitment manager Alexis Feldman, “there is no shortage of need for physicians in the Fort Lauderdale area.”

Gastro Health is recruiting gastroenterologists in Palm Beach County, the Naples/Fort Myers area and Broward County.

Gastro Health, Feldman says, “is an excellent option for gastroenterologists who are interested in private practice with the support of a large, financially stable organization.” Despite the organization’s corporate structure, she adds, each care center “maintains an individual culture and family that makes each office feel like home.”

Many physicians in the region encounter this welcoming atmosphere not only in the office, but also saturated in the culture and communities of Florida, particularly in the lively and sophisticated downtown areas.

Says Feldman: “In my opinion, the best part of southeast Florida is the diversity. Fort Lauderdale and Miami draw people from all over the world, which has created a community where all are welcome.”

“Greater Fort Lauderdale is a very welcoming and diverse destination,” agrees Jessica Savage, vice president of public relations for the Greater Fort Lauderdale Convention & Visitors Bureau.

“We embrace residents and visitors of every culture, origin and sexual identity. Our area is also very cosmopolitan. We have an extraordinary culinary scene, an eclectic mix of foods, and top chefs putting creative twists on their dishes.”

Locals and visitors can relax along the New River during Sunday’s outdoor jazz brunches, taking in the beautiful weather and water views, or stroll down Las Olas Boulevard and experience shopping, galleries, restaurants and nightlife. Popular annual events include the Las Olas Art Fair, the Tortuga Music Festival, the Fort Lauderdale International Boat Show, and the Fort Lauderdale International Film Festival—among many, many others.

There is also the outdoors, which is focused on the water culture of the region. As Feldman says, “If you love the beach, Fort Lauderdale offers miles and miles of sand and ocean. I moved down here from Chicago three years ago and can attest to the true bliss that such easy access to the beach and consistent sunshine brings.”

In addition to swimming and sunning, residents can find adventure on biking trails and nature walks—or, like Lessne, by taking to the canals with his paddleboard or exploring the rivers on his inflatable kayak.

“Being outside is the best part of South Florida,” he says. “Here, even in the winter, you can be outside….I make fun of my friends in the northeast when it’s Christmas Day and I’m walking around in shorts and sandals.”

For now, Lessne is happy to have come full-circle, making his way back to his original goal of being a gastroenterologist in a place where he is close to family and can regularly enjoy time with his nephews, siblings and parents.

“I feel very lucky that I found the right group, the right partners and a place that allows me to focus on professional development,” he says. “I’m thrilled to be in the perfect place.”