Surgeon’s Perseverance Significantly Affects Rural Patient Care

“We set up our own rural health clinic—literally in two double-wide trailers behind the hospital.”

—Patrick L. Molt, MD, FACS

Patrick Molt, MD, FACS, was one of the first babies born at the small-town Fairfield Memorial Hospital in its 72-year history. Today, Dr. Molt serves at the hospital’s chief of surgery and president of the hospital’s governing board.

A recently opened surgical pavilion at the hospital—the largest expansion in the Fairfield, IL, facility’s history—features the Patrick Molt Surgical Services Department.

This is the story not only of improved healthcare in rural America, but also the pinnacle of a doctor-gone-home story that showcases how leadership qualities of surgeons can and do make remarkable impacts.

“Here’s a guy who is in big-city practice, doing big-time oncologic surgery, and he just decides to come home,” said Tyler G. Hughes, MD, FACS, Secretary of the American College of Surgeons. “To develop a surgical center like he has, with all new bricks and mortar, is an inspiration. This will be a legacy to what one person who dedicates themselves to a community can accomplish.”

This is a legacy of not only bricks and mortar but also of the impact just one surgeon leader can make on his or her community—today and generations beyond.

How It Started…

Dr. Molt was born in 1952, just over a year after the hospital opened in Fairfield, the county seat of Wayne County, population 20,000. He was born into a 100-year grain and livestock farming family and had to run the farm with his brother at age 15 after their father died. Dr. Molt’s father dreamed of becoming a physician, but serving in World War II ruined that dream, one that Dr. Molt took up.

After graduating summa cum laude as an undergraduate at Washington University in St. Louis, MO, he was big-city bound, earning his medical degree at Mount Sinai School of Medicine in New York, NY.

Dr. Molt’s postgraduate training also took place in New York, his internship and residency in general surgery at Mt. Sinai and his fellowship in surgical oncology at Memorial Sloan Kettering Cancer Center. He went on to work as assistant chief of surgical oncology and chief of surgical oncology at Westchester Medical Center and St. Agnes Hospital, both in White Plains, NY, just north of New York City.

All the while he was teaching surgery at Mount Sinai, Cornell University, New York Medical College, and Rush Medical College.

With that impressive training, education, and positions of leadership, Dr. Molt was an unqualified success. But “the business of surgery,” including managed care, profitability, and related concerns, was taking its toll.

“I was an early adopter of burnout,” he said.

Because professional success does not necessarily equate to personal satisfaction or happiness, Dr. Molt was getting restless in the late 1990s. His future constantly tumbled in his mind.

“I wondered if I was meant to continue to do surgery or something else entirely,” he said. “What I saw was that moving back to a rural area would solve a lot of the issues that I had, because everyone in those days was saying, ‘I need to cut my overhead and increase my volume.’ [Returning to a rural setting] for a surgery practice was one way to cut your overhead and increase your volume.”

As it sometimes does, fate intervened. Dr. Molt received a call from his brother, back home in Fairfield.

“He said, ‘You know, the hospital back here just lost their surgeon.’ And I responded ‘Really? Gee, well maybe I should come back and talk to people about that.’ So I came back home and talked to the hospital board and they were enthusiastic to have me, and I was enthusiastic to find a new situation.

“So, I came home.”

How It Went…

Dr. Molt returned to his hometown and a struggling hospital. With little reinvestment in the hospital in roughly the last 20 years, Dr. Molt’s challenge was significant.

“At that time, 1974 was the last time there had been any expansion, and they realized they needed to modernize the operating rooms (ORs). They needed to modernize the emergency room (ER). At the time, the ER was about 150 square feet—enough space for two stretchers and a small desk. And that was about it,” he said.

The struggling hospital soon enlisted new leadership, and Dr. Molt, the chief of surgery, focused on his patients. In current models of surgical training and practice, surgeons learn many procedures and usually decide in which surgical discipline they will specialize. Dr. Molt enjoyed no such luxury upon returning home.

“Anyone who needed just about any surgery, I was their guy. I was busy just going to work, seeing my patients and performing the procedures that they needed. There was little room for anything else.”

Meanwhile new hospital leadership, including chief operating officer Katherine Bunting-Williams, PhD, RN, MSN, was planning an expansion project that included renovation of the inpatient care areas and construction of two new ORs and a five-bed ER.

Dr. Molt’s leadership was almost immediately a critical element of the hospital’s growth. He was named chief of staff in 2003, has served on the hospital’s board of directors since 2008, and became its president in 2015.

One of the first steps to growth was establishing a rural health clinic.

“We do things country-style here,” Dr. Molt said. “We set up our own rural health clinic—literally in two double-wide trailers behind the hospital. We have subsequently established three other clinics: two in our county and one in the next county over, which does not have a hospital.”

Through these expansions into the community, Fairfield Memorial derives most of its income—85%—from outpatient services.

How It’s Going…

As the health of the community and its hospital has improved over the last 2-plus decades, Dr. Molt’s impact has been obvious. But growth happens on a continuum, and the best performing hospitals target incremental growth.

When the leadership of Fairfield Memorial Hospital gathered a couple of years ago to discuss strategic planning, the key to the facility’s growth quickly became obvious—through surgery.

“We looked at our mission, we looked at access to care, we looked at what we are doing well and that could be sustainable,” said Dr. Bunting-Williams. “We needed something that would give us a good return for the efforts that we are doing to care for our patients.”

The hospital increased access to healthcare by opening a 7-day-a-week urgent care center to serve Fairfield and Wayne County. With an increasing population and after 2 years of the pandemic, the next step would be the largest expansion in hospital history—72,000 square feet of new and renovated space to expand the ORs and a variety of other services.

The recently completed building includes:

• Nine slots in the ER, more than double the current capacity
• Three urgent care exam rooms
• Two new ORs
• Space for orthopaedics, urology, general surgery, and pain management, including 28 exam rooms
• A third-floor, 31-bed intermediate and long-term care wing

At a cost of approximately $20 million, the hospital remains focused on the expansion of healthcare services that are not available in Wayne County and the surrounding towns.

For example, with the expansion from two to four ORs, the hospital has welcomed Dr. Kory Blank, an orthopaedic surgeon who, like Dr. Molt, has returned home. Also, Lauren Williams, MD, another local resident who is finishing her postgraduate work at Rush Medical Center in Chicago, soon will join the team. The hospital recently hired a full-time urologist.

The Impact of a Surgeon’s Leadership

The state of rural surgery is well-known. Dr. Hughes’s work on the Advisory Council for Rural Surgery revealed to him that about one in 10 early career surgeons chooses to practice in a rural setting. At the same time, rural populations are seeing an influx of older and retiring residents who are leaving urban settings. Providing quality healthcare in small communities can be a significant challenge.

Much like those residents, surgeons often make the same move. Tired of competing with hundreds of other physicians for patients and procedures, weary of continuing to fight insurance companies, eager to practice medicine more simply, many mid-career surgeons choose to return to the roots of medicine.

“Being a rural surgeon reminds you of why you went into medicine in the first place,” said Dr. Hughes. “If you’re in a city you might develop a nice relationship with a patient for 5 or 6 weeks, and then they are gone. The chance of seeing a patient you’ve performed surgery on is one in a million. In a small community, you can hardly throw a rock without hitting a patient of yours. You can’t get to the checkout in Walmart without a former patient saying, ‘Hey, doc, what do you think of this?’”

Rural physicians tell countless stories of patients bringing fresh fruit from the garden or, like one of Dr. Hughes’s patients, freshly baked Christmas cookies every year. The highly personal aspect of practicing medicine in rural communities can feel like a 180-degree switch from an urban setting.

But often, the job goes beyond the physician-patient relationship. A rural doctor who is a leader, as Dr. Molt has been in Fairfield, establishes important relationships with other physicians to help their development, to say nothing of the growth of a hospital, clinic, or health system.

“Dr. Molt has the ability to help us grow through leadership of the other medical staff,” said Dr. Bunting-Williams. “Dr. Molt often has sit-downs with other doctors, asking them how he can help grow their practice and about whether their work-life balance is where it should be. Because he is in these positions of leadership, our medical staff is growing rapidly. His leadership with the medical staff is a proven entity here, and we’re very proud to have him.”

The soft-spoken and humble Dr. Molt describes this leadership as “kind of fatherly talks” with other medical professionals. As he notes, if you have 50 surgeons on staff and one leaves or underperforms, there are 49 others to collectively help the team. But if you have a limited staff, you must shepherd each of them individually.

“When you have a small staff, as we do—we have a single orthopaedic surgeon, we have a single urologist, we have a small number of primary care physicians—we really have a big investment in our staff. And it’s important to us that we see to it that they continue to be healthy and happy in their practices so they can keep our community as happy and healthy as possible,” said Dr. Molt.

“I’ve come home to take care of my people”

Just after Dr. Bunting-Williams heaped praise on Dr. Molt for working most every weekend to check that patients were receiving proper care and treatment and answering all their questions, Dr. Molt quickly swatted away those accolades. He made sure to mention that providing quality care sometimes means moving patients along to minimize wait times for others in line.

“Please don’t make me out to be warm and fuzzy; if you want warm and fuzzy, get a kitten,” he said.

But earlier in the interview, Dr. Molt gave an assessment of his own success. Perhaps warm and fuzzy would be a bit dramatic to describe his answer, but reflective and slightly emotional would accurately describe his answer.

“The thing that has enabled me to succeed as well as I have is that I really, actually care for the patients. When I came back, one of the things that I said to one of my acquaintances was, you know, I’ve come home to take care of my people,” he said, voice breaking slightly and pausing. “And I think people know that. I really, really care about their welfare.”

Thomas J. McFeeley is a freelance writer.