SOLO PRACTITIONER.

AuthorMartin, Edward
PositionPhysician Joe Liverman

In a remote rural county, Joe Liverman practices the kind of medicine that health-care economics turned into a lost art.

Sloshing in from Pamlico Sound, Far Creek forms a harbor for the Sea Duck, Laura Dana and a score of other fishing boats and trawlers docked in Engelhard. Men in rubber boots sit in the doorways of crab and oyster houses, smoking cigarettes. In a pine grove across a wooden bridge over a canal alongside Lazy Lane squats a gray building with no sign. People who live here know where the clinic is. Not enough strangers come to bother.

On this Wednesday morning, Miss Bessie, 81, comes in from New Holland, 20 miles west, for a monthly checkup and trip to Farrow's Red & White for groceries. Kathy Anderson, who runs the lab, struggles to find a vein in the old woman's small arm. Finally, blood fills the vial. "Look at it go," Miss Bessie says, giggling.

Sometimes in the summer when farmers and fishermen smash their fingers or get chewed up in machinery, 30 patients a day come to the clinic. But today is slow. A 70ish woman with a walker nods off in the waiting room as a Wings rerun drones on the TV. In an office down the hall, Henry Joe Liverman burrows into an oversized armchair, a stethoscope draped over his neck. There's more to medicine, he explains, than what he learned in med school. "When some little fellow comes in here trying to hold the tears back, I let Billy Bass sing him a song." He picks up a plastic-mounted rubber fish. It flaps and croaks, "Don't worry, be happy ..."

Here in Hyde County, Joe Liverman has no practice-management consultant to tell him that the $28 he charges for an office visit is too little. No managed-care plan demands that he quit entertaining kids with Big Mouth Billy Bass so he can increase his patient volume. Here, Liverman, a short man with thin silver hair, practices in the twilight of what he calls the golden age of medicine. He is 76 and expects to quit by 80 -- "if my health holds out that long." Of the 15,470 physicians licensed to practice in the state, he is the last -- or certainly one of the last -- of the country doctors.

The North Carolina Medical Society Foundation in Raleigh, which recruits doctors, and the Cecil G. Sheps Center for Health Service Research in Chapel Hill, which tracks them, say he's the only one in the state still serving an entire county by himself. A plastic surgeon who lives in Scranton, 40 miles away on the other side of Lake Mattamuskeet, no longer practices. Liverman's county is one of the state's most remote, 1,364 square miles -- about the size of Mecklenburg and Wake combined -- of black dirt, swamp, water and wilderness barely above sea level, with no incorporated town and fewer than 6,000 souls. R.S. Spencer Jr., whose family has run Engelhard hardware and furniture stores since 1900, sizes up his community. "We're fishing, farming and old families. There's just not a lot of anything else."

Liverman has treated three generations of patients, often from the same families. At the old, two-story Hotel Engelhard, owner George Terrell shapes hamburger patties in the kitchen. His left arm is heavily scarred. Terrell had ripped it open after recoiling from an electrical shock while repairing an air conditioner. "He stitched me back together," says Terrell, who drifted into and out of shock while Liverman fought to staunch the bleeding. "Sooner or later, he works on everybody."

But not for much longer. Experts point to scores of reasons why solo doctors like Liverman are disappearing. Young city-born physicians don't like the personal and professional isolation, low pay and long hours. Country doctors can't afford $3,500 a week to hire locum tenens -- fill-in -- doctors to permit them to take vacations or time off to continue education. Their patients die, not neatly and efficiently in dim hospital rooms tended by anonymous nurses, but looking at them with frightened eyes.

Liverman's voice grows soft. He thinks back to the day a fisherman he'd known for years came in and sat in the old hard-back chair next to his desk. My chest hurts, the man had begun explaining, but doc, please don't send me off to no strange hospital. Liverman had opened the man's shirt and lifted his stethoscope. "Just as I touched his chest, his heart stopped." He swallows and there's a pause. "You rarely save the ones like that." A decade later, Liverman would diagnose one of North Carolina's first AIDS cases, the son of old family friends. City doctors don't treat their family. County doctors don't have a choice. A bronze plaque in the Liverman Clinic waiting room reads, "Dedicated to the Glory of God and in Loving Memory of Florence C. Liverman, 1897-1966." It was Saturday, the hospital in Belhaven hopelessly far away. He put his mother to bed. She squeezed his hand, whispered to him and died.

Still...

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