And then there was one doctor in Rappahannock County

Dr. McCue closing medical practice: How his departure affects community health

Dr. John McCue tells the story of a visit from a patient he had come to know well. They chatted about serious science – physics and chemistry, as he remembers it – until finally McCue asked why he had come in for an appointment.

“I forget,” the man responded. Upon checking with the nurse, McCue was told the patient had complained of “severe abdominal pain.”

“That kind of thing happened all the time,” McCue recalled. “You get talking about this and that and they’d lose track of why they were there.” 

That phase of McCue’s life will close at the end of the month when he retires as a primary care physician, a role he’s filled in Rappahannock since 1998 when he joined the staff of the Rappahannock Medical Center, following the retirement of Dr. Werner Krebser. In 2001, he set up his own practice, Mountainside Medicine, outside the Town of Washington.

Now 68, he said he will continue to do hospice work and would like to help at the Free Clinic in Warrenton. Also, he and his wife Susan Hotelling, a social worker who serves as practice manager, want to have more time to visit their young grandson in Tampa and their soon-to-be granddaughter in Denver.

But, he said, he’ll miss his patients “terribly” and has found it difficult to say goodbye. “They’re more like family than patients,” he said. “I think some of them know me better than I know myself.”

McCue set up practice in Rappahannock to get away from the stress of being an emergency room doctor in Fairfax and Fauquier County hospitals. It wasn’t long before he discovered what it meant to be a country doctor. Patients would give him apple or lemon meringue pies, sometimes steaks. While on a house call, he learned that what he thought was a broken bridge was actually a cattle guard. Through it all, he developed a deep respect for those working the land here.

“Some of the most brilliant people I’ve met are farmers,” he said. “They have to know how to take care of everything.”

At its peak in 2016, McCue said the practice was seeing as many as 35 patients a day. As he aged, so have his patients, and their health needs have become chronic. “We’ve been dealing with more severe conditions,” he said. “Diabetes, poorly controlled obesity, high blood pressure, renal failure, arthritis. Dementia is a big one, too. 

“Their problems have become more complex, with a lot more medications,” he added. “A lot of thought and hard work goes into it because you need to be very careful with patients as they age.”

‘Up for the challenge’

With McCue’s retirement, the county will be down to one family medicine practice – Miller Family Health and Wellness, run by Dr. Brooke Miller and his wife, Ann, a nurse practitioner. They took over the Valley Health Page Memorial Hospital’s practice outside the Town of Washington two years ago.

When asked about the prospect of becoming the only family medicine practice in the county, Miller replied,”We’re up for the challenge. Ann and I don’t have plans to retire any time soon.” He pointed out that their son, Henry, is doing his medical residency and plans to join the family business in two years.

Miller said he has seen an “explosion” of chronic illnesses, not only only in older county residents, but also younger ones. In particular, his practice is seeing more patients with anxiety and depression.

“Those are two of the biggest things we deal with,” he said. “A lot of young people out there are nervous and anxious. The lockdown with COVID-19 was very detrimental to the mental health of people.”

With chronic physical conditions, Miller said the practice’s focus has been on “reversing” those ailments, when possible, by getting patients to reduce their dependence on medications.

“We want to help them improve their wellness and not just treat the symptoms of disease,” he said. “A lot of our patients come in and remark that they’re tired of going to see a doctor who has his head buried in a computer and then rushes in and gives them a prescription.”

Filling gaps

While a shortage of medical care options is now common in many rural communities, it’s that much more problematic for a remote county with an aging population, such as Rappahannock.

Last year, county native Dr. Andrew Kohler and his wife, Krista, who’s also a physician, began offering another alternative. They launched a nonprofit service called Atlantic Telehealth, which allows people to have online doctor appointments, as well as receive referrals for specialists.

The Kohlers recently moved to Connecticut where Andrew was hired by the Internal Medicine Department at Yale New Haven Hospital to expand remote care monitoring. Krista is on maternity leave, but Andrew continues to provide virtual medical care through Atlantic Telehealth. He said online appointments are available Monday through Sunday every other week.

“It’s like being able to call your longtime country doc and run something by him,” he said.

At the same time, the need for a coordinated, more robust health care network in Rappahannock is now a focus of Rapp at Home, which supports and provides services for older county residents.

“This has bubbled up to being our top priority,” said Joyce Wenger, the nonprofit’s president.

To that end, Rapp at Home is spearheading an effort to create what it’s calling the Rappahannock Rural Health Network (RRHN), an initiative launched in collaboration with a variety of health care services or organizations in the region. They range from Valley Health Systems, the University of Virginia Health System and the Fauquier Free Clinic to Mountainside Physical Therapy, Aging Together and Encompass Community Supports. Wenger said Rappahannock County Emergency Medical Services and the county’s public school district are also involved.

The goal is to first develop a strategy for how those different partners can work together to fill health care gaps here, whether it’s in ensuring that medical and mental health care are more accessible or finding ways to better educate county residents about following healthier lifestyles.

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To cover the cost of hiring a full-time administrator, the network has applied for a grant from the Health Resources and Services Administration, a subagency of the Department of Health and Human Services. Ultimately, RRHN intends to address health care needs in Rappahannock, Culpeper and Warren counties.

Its grant proposal includes statistics reflecting where Rappahannock stands on key barometers of the community’s health. According to data from the Virginia Department of Health, Rappahannock ranks higher than the state average when it comes to the percentage of its population which is pre-diabetic or obese or not physically active. It also has a higher percentage of smokers.

“There are a lot of possibilities for how all these health organizations can work together,” said Wenger. “We’re going to keep pushing to keep this going.” 

Randy Rieland is a reporter for Foothills Forum, a nonprofit organization that supports local news in Rappahannock County.

Foothills Forum is an independent, community-supported nonprofit tackling the need for in-depth research and reporting on Rappahannock County issues.

The group has an agreement with Rappahannock Media, owner of the Rappahannock News, to present this series and other award-winning reporting projects. More at foothillsforum.org.