August 11, 2021 421 PM
ALPINE – The Texas Academy of Family Physicians has named Dr. Adrian Billings the 2021 Texas Family Physician of the Year. Billings serves patients every week in Alpine, Presidio and Marfa, but as his career has advanced, he’s also taken on the mantle of sharing the hardships families in West Texas face when accessing care. In doing so, he has spoken for his patients on statewide, national and international stages, advocating for better healthcare access in rural communities.
When Dr. Billings arrived in Alpine in July of 2007, he was a fresh-faced doctor coming off of an obstetrics fellowship. On a National Health Service Corps scholarship, he could get student loan relief after four years of service in an inner city or rural underserved area.
Hailing from Del Rio, the doctor was drawn to Alpine for its similar border culture and small community, but what sealed the deal was his previous visits to the Big Bend area, studying for three separate months during residency and rotations under Dr. James Luecke.
Most service corps workers arrive at their service area and affiliate with a federally qualified health center (FQHC), but when Billings arrived in West Texas, there were none to be found. He started a private practice instead, and within four years, his loans were forgiven and he could be on his way to a big city.
Instead, he merged with Marfa’s brand new FQHC, now Preventative Care Health Services, and began expanding out from Alpine, into Marfa and Presidio.
Billings and his wife, Susan, took the leap and grafted themselves into the Alpine community. A faculty advisor during Billings’ residency had previously practiced in Alpine, and offered him “the best advice,” Billings recalls. “He said, ‘Go to Alpine and take care of Alpine, and Alpine will take care of you and your family,’ and that’s truly been the sense.” He moved to the area with his wife and two young sons, and had a third boy soon after.
On top of his regular work, he joined the Alpine school board. He became the go-to doctor at Sul Ross and Alpine High football games and keeps his number in the phone book so anyone who needs him can reach him – day or night, weekday or weekend. “It’s been a wonderful place to raise kids, and I feel like I have communities that have supported our family,” he says.
He took on numerous leadership roles and board positions and developed connections outside of the area to keep track of what was happening in the broader medical community. During his time in the area, medical resources have vastly improved by many measures.
When Dr. Billings was first considering a job with the local hospital in Alpine, he agreed to take the role only if they brought full-time ER doctors to the emergency room and added epidural analgesia and electronic fetal monitoring devices – big steps that immediately improved care for locals. Today, over $2.9 million in federal support is brought to the area yearly by PCHS, which has expanded to provide medical, dental, behavioral health and pharmacy services.
But by other measures, Billings is wary of the future of rural healthcare. “In 2014 with the passage of the ACA, there were a lot more patients with healthcare insurance. It seems like we’re sliding back with more and more people who don’t have insurance and need to access our sliding fee scale, and the rising cost of medicine is astronomical, including insulin. People are even having a hard time affording their generic medicine,” he describes.
More glaringly, the labor and delivery wing at Big Bend Regional Medical Center has closed its doors on weekends since early July, citing a nursing shortage. “The attrition of the workforce out here – it seems it’s harder to recruit and maintain healthcare officials out here,” Billings says.
COVID has played a big role in exacerbating the healthcare worker shortages in the Big Bend area. Hospitals nationwide are facing workforce shortages as employees burn out and leave the profession, and at the peak of the pandemic, Billings says the area lost hospital nurses who were able to receive pay increases and signing bonuses in bigger city hospitals. On top of nurses departing, at least four doctors and a physician’s assistant have left the area in the past year alone.
The healthcare industry is at a crossroads, and the Big Bend is no exception. “Medicine is becoming more urbanized, specialized and centralized, and my biggest fear – if we don’t make changes in the pipeline and workforce and enable people – is that all healthcare in these rural areas will be done through telehealth. Telehealth works for some things but you can’t deliver a baby through telehealth,” Billings says. “We have to be able to enable and maintain some basic semblance of healthcare service in these areas if we can’t do everything. There has to be investment by state and national governments.”
Recruiting new doctors to the area can be challenging even under normal conditions, and has been a perennial issue in the Big Bend, which cannot compete with the amenities a big city has to offer young med students, like a Walmart or a commercial airport, he says. But Billings points out that his own recruitment began when Dr. Luecke welcomed him as a student. “It demonstrates the importance of hosting medical students and residents in these medically underserved areas, because some of them are going to come back.”
He’s taken the responsibility of recruiting seriously: he’s the director of the Texas Family Medicine Preceptorship Program, and at a hands-on level, he’s hosted over 300 medical school students and 50 residents. Among those were doctors Katie and John Ray, who eventually returned to the area and are now Billings’ partners at PCHS.
“I really enjoy teaching and service, and I really feel this calling now to try and work on workforce development for rural communities,” he says. He’s also trying to get more rural youth accepted into healthcare training programs with the hopes they will eventually return to their hometowns to practice medicine.
Billings believes that if there’s one reason he received the Texas Family Physician of the Year award, “It’s because of my practicing medicine outside the exam room,” he says. When he isn’t practicing medicine, teaching students or volunteering on the school board, on a bi-national health council and as Presidio EMS medical director, he’s using those experiences to testify on the hardships and rewards of practicing medicine in a remote, underserved area.
“I teach med students that I have a M.D. behind my name, a white coat, and I’m a Caucasian middle-aged male and have a certain privilege that many of my patients don’t,” he says. He directs those advantages toward helping others, opening up doors to tell his patients’ stories to a broader audience.
Billings has told the stories of Alpine, Presidio and Marfa residents as far as Geneva, Switzerland, where he testified before United Nations officials about the need to train rural doctors in certain life-saving surgeries. Closer to home, he recently shared about the nursing workforce shortage at the Capitol in Austin and spoke to the White House’s COVID-19 coordinator about vaccination successes and challenges in highly-vaccinated Presidio County.
Billings says awards like Texas Family Physician of the Year “are really nice to have, and have been mostly generated by a trainee or medical student. It’s much better than any paycheck I’ve gotten, when someone thinks I’m doing something worthy enough of an award.”
Most rewarding of all, the doctor says, are the relationships he’s built while working these past 14 years in Alpine. Whether it’s the rural charms of running into patients out in the community and making house calls, or the connections outside of the Big Bend when trying to improve access to care statewide and nationwide, it’s the relationships that leave him feeling like his work is important and validated. “I think if you have a calling,” he says, “you just want to help and try to improve things. It’s so worth it.”