Meeting a Need

May 8, 2014

For about as long as Dan Avery, MD, has been practicing medicine, he has had ties to Winfield, Ala.

His relationship with the small rural town in Marion County started during his residency, when he practiced in the Carraway Northwest Medical Center Emergency Department. He worked part time in obstetrics and gynecology, until after his fellowship training, when he moved to Winfield to work full time. 

After several years of private practice, the Winfield hospital stopped its OB/GYN services and the obstetrics malpractice insurance carrier went bankrupt, so Avery moved back to his hometown of Tuscaloosa, where he is now professor and chair of the College of Community Health Sciences’s Department ofObstetrics and Gynecology. He also serves as a professor and the division chief of pathology in the Department of Surgery.

Still, once a week, he drives a winding two-lane highway for about 60 miles until it brings him into a downtown made up oa few blocks of antiques stores, an old-fashioned theatre, and the like. A left-hand turn takes him to Women’s Clinic of Winfield: a small building adjacent to Northwest Medical Center. Avery practices here with William Lenahan, MD, with whom he has worked offand on throughout his career. Why he’s kept his ties to Winfield is simple, Avery says: The provision oOB/GYN and prenatal care to rural areas is critical.

“It’s the greatest need in the state,” Avery says. “And the essence othat need is in rural Alabama.”

According to the Alabama Department of Public Health, the lack of OB/GYN services in rural counties makes it challenging for rural residents to receive adequate prenatal care. In Alabama, 25.9 percent of the live births in 2012 occurred with less than adequate prenatal care, according to the ADPH and the Adequacy of Prenatal Care Utilization (Kotelchuck) Index. The lack of adequate prenatal care can lead to problems and complications, according to the U.S. Department of Health and Human Services’ Office ofWomen’s Health. Babies of mothers who do not receive prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care, the department says. Avery sees about 25 patients a day when he is in Winfield; he has about 4,000  patients there total. And in Marion County, only 17.7 percent of births occurred with less than adequate prenatal care—the lowest percentage reported in its region, according to the index.

In a recent report with College associate professor John McDonald, MD, Avery concluded that only 10 percent of trained family physicians offer obstetrics care. He also noted that fewer medical students are choosing OB/GYN as a specialty, and even fewer are settling in rural, underserved areas to practice. While he says smaller communities often cannot support specialty practices like OB/GYN, more family physicians should offer obstetrics to help alleviate the issue.   

The role a family physician plays in a community is a big one, he says. For him, visits to Winfield are like going back home. “When I come here, I’m seeing folks I’ve taken care of for a long time,” Avery says. “Some of my patients I delivered, and now they are having children.” That lifelong relationship with his patients is what he loves about his practice. “That’s what we are trying to teach our residents—it’s the long-term commitment to a place that counts.”