Bill Klaproth (Host): This is Outer Banks Health. I'm Bill Klaproth. With me is Dr. Robert Wetzel of Outer Banks Health Family Medicine - Manteo and Dr. Jeffrey Ray of Outer Banks Health Family Medicine - Kitty Hawk, as we talk about Outer Banks' goals of new programs, education, and attracting more medical students and residents. Dr. Ray and Dr. Wetzel, welcome.

Jeffrey Ray, MD: Bill, thanks for having us.

Robert S. Wetzel, MD, FACP: Hey, Bill. Great to be here.

Host: Absolutely. Gentlemen, thank you so much for your time. Very much looking forward to this discussion today. Dr. Ray, let me start with you. So, you've been with Outer Banks Health for more than 10 years. Why do you think now is the right time for OBH to bring in medical students and residents?

Jeffrey Ray, MD: Well, I think, right now, we have reached a point in our organizational history where we have the capacity both in terms of numbers of primary care physicians and practice space to be able to accommodate students. Prior to this, during the pandemic era, we lost quite a few of our physicians and really just wasn't a great time to have students or learners in our space. So, now's the perfect time. The organization that we're now part of is an academic organization.

Host: I love hearing that. I know the pandemic kind of cleared things out. I'm glad to see us building back. I think this is really great. So, thank you for that, Dr. Ray. And Dr. Wetzel, you joined OBH this August with a strong interest in teaching. What drew you to this organization and being part of its educational mission?

Robert S. Wetzel, MD, FACP: Absolutely. So in my former career, I was very much involved in academic medicine. I was facilitating a program where we taught first and second years how to become doctors and take histories. And I also had the opportunity to precept third year students in the outpatient setting. So, it was an excellent opportunity for me to kind of come down to the outer banks and bring the skills that I had in New Jersey down to the rural area. I grew up going to the beach down here, and I love the area. And as I got to know the healthcare needs, it was just an excellent opportunity to grow my practice and also help teach the future generation of physicians.

Host: Well, we're glad you're here. So, that's really good to hear. And Dr. Ray, how does teaching and mentoring connect with OBH's mission and your personal passion for advancing healthcare in the community?

Jeffrey Ray, MD: Well, we have just recently started reaching out to ECU Health in terms of trying to connect with medical students. And As Dr. Wetzel has already done the PA program at ECU. But prior to that, we've actually been precepting nurse practitioner students. And in Kitty Hawk, over the past four years, we've actually precepted a total of seven nurse practitioner students.

What we've been able to do with those students is to roll them back into the practices within our community. So, all of the students that we have taught, with the exception of, I think, the one that we're currently precepting, all of them have gone to work somewhere, either with ECU Health in the Outer Banks Hospital or one of our private community practices. So, teaching is a great conduit to actually bringing people into our community and potentially adding providers and additional capacity within our space.

Host: And we appreciate your passion for this, and what you said at the end there is absolutely true. And Dr. Wetzel, I understand you're now working alongside Dr. Baker at the newly expanded Manteo Family Medicine Clinic. How does that space and team set the stage for training future providers?

Robert S. Wetzel, MD, FACP: Absolutely. Yeah. So, that office originally was a family practice from a very longstanding physician in the Manteo community. And he kindly gave the space over to the Outer Banks's Health. And they were able to expand that space. And for myself alone, we have all nine exam rooms with an acute care visit, three of which I'm only using right now. And then, we have the three expansion rooms for medical students to be involved.

And in my former career, I could tell you, space is always a limiting factor. It is not going to be a limiting factor here. We can have as many rooms as we need for the students. My office is set up as a collaborative work area. We have a station set up for the students as well as like future advanced practice providers, so I cannot speak more. This area is set up and meant for teaching.

Host: Yeah. You mentioned space earlier, so glad that that space is being put to good use. And, Dr. Ray, you've hosted medical students before and are about to welcome your first resident. What have you learned from these experiences?

Jeffrey Ray, MD: What I can tell you is that having students definitely keeps you on top of your game. You really have to stay abreast of all of the current topics, or they're going to definitely question what you're doing with patients. So, it's always a good way of making sure that you're staying on top of your game. And actually, we have already engaged with the medical resident that you're referring to. And so, that has been quite the experience. We're still kind of learning our way through that, because this is the first time that we've had a resident come out and do any kind of clinical rotations with us.

And I've been sharing that person with Dr. Wetzel and Dr. Baker. So in the days that I'm in clinic, he's with me. And then, they are sharing him in their clinic on the days that I'm not clinically active. So, it's an interesting process. I did meet him back in February. And part of the reason for this elective rotation for him was almost a try before you buy kind of scenario.

So, we're hoping that, again, as I mentioned before, we're hoping that this may be a conduit to getting someone to join us. I think we have some space in the future, we'll have a need for an additional physician within the primary care arena. So, he may be a solution for that. But future state, we anticipate hosting more medical residents as time goes on. And I'm hoping that he'll carry the torch back to the program in Greenville and encourage some of his fellow residents to seek a similar elective rotation here.

Host: Yeah. That's an important conduit back for sure. And we're certainly hoping this works out, and it seems like it is, and it's going to be a great pipeline for future residents and a big benefit for our community. Dr. Wetzel, in your view, I'd like to get your thoughts on this. What are the biggest benefits for a physician when working with students or residents in practice?

Robert S. Wetzel, MD, FACP: Absolutely. The passion the students and residents bring, you can't match it. These students are very engaged. And as a physician, time passes and sometimes you can fall into the regimen of seeing patients after patients. And having the students there just brings back that desire to care for patients. And then, when you have a challenging case and they have the opportunity to have that aha moment where they're making a diagnosis and you work through that, it's one of the most rewarding experiences.

This past week, I was actually completing some letters of recommendations for students I had at my former job. And I got to see them through all three years. And just seeing what they're going to be going into. And specialty-wise, you can't beat it. And it's a real benefit for the patients, just because of the quality of care and the engagement that the students and also the physicians bring when they teach.

Host: Certainly a benefit for the patients, but I'm wondering, Dr. Ray, how do they feel? Have you noticed anything on how they feel about having learners involved in their care here at OBH?

Jeffrey Ray, MD: I think the patients really appreciate that. It's a rarity to have a patient decline to have a student involved in their care. And as I tell all of my patients, I thank them for helping to teach the practice of medicine to someone, because that's really where that comes from. When you learn to practice medicine, really, it's hearing stories and being able to connect those to what you've learned from textbooks. And so, to be able to come and practice that and for patients to be involved in that process, I think, is something very special.

And I would like to echo what Rob said. I think that they bring an energy to the practice that you really don't have when they're not there. And I think that that energy is felt not only by us as practitioners, but our staff and the patients themselves.

Host: Yeah, that's great to hear. And I know both of you were in that same stage of your career some time. And I know the people that brought you up and mentored you appreciated your energy when you first got to practice. So, you're paying it back, and we really appreciate that. Dr. Wetzel, you've already connected with PA and medical student programs. I'm curious, what excites you most about bringing more learners into the Outer Banks?

Robert S. Wetzel, MD, FACP: Absolutely. As I've come to know this area, I've understood that there's a great opportunity to improve care and just provide care for patients that had not received care. There was a gap where patients needed care for a few years, just with transitions. And having learners here to understand the needs of this population and grow with it, and then hopefully want to stay here and provide and recognize all the amazing things that the Outer Banks offer, it's an amazing opportunity to be able to work with these mid-level practitioners as well as medical students.

Host: And then, looking ahead, Dr. Ray, I know that potentially this could be really good news envisioning a rural family medicine residency. Can you talk about that a little bit and how a Family Medicine Residency Program could shape the future of healthcare in the Outer Banks?

Jeffrey Ray, MD: Sure. Well, this is definitely a future state project. I'm a graduate of ECU Medical School back before it was called the Brody School of Medicine. And I actually participated in their first rural family medicine residency program. So, that was in the mid-1990s. That program was retired for a few years and then, eventually, resurfaced.

Currently, there's three locations that the, family medicine residency program has with their rural residency. But we've talked with them. And basically, we're just told, "Come up with a proposal because that aligns with the mission of the medical school, which is to provide primary care practitioners for North Carolina and specifically for Eastern North Carolina." So, anything that we do in terms of developing a residency program, having students can rotate through, that just furthers the mission of the Brody School of Medicine. So, looking forward to doing that.

We purposely placed Dr. Wetzel with Dr. Baker, and knowing that that Manteo Family Medicine space was large enough to potentially accommodate something like that, you've got two people there that are passionate about teaching. Rob has the academic background to bring that component to something like this. So, it really gives us a special opportunity, potentially to be able to pull something like this off. So, that's kind of what we're looking forward to, a future state that could provide maybe two residents. Even if they didn't stay, that would provide two additional physicians to see patients within the primary care space ongoing, as long as that program were to continue. So, we'll work toward that. That's our ultimate future goal, if we can pull that one off. But with Dr. Wetzel and Dr. Baker, I'm sure that we've got a better shot at that than we've ever had.

Host: Definitely positive things moving forward, and so great to hear you say that, Dr. Ray. Dr. Wetzel, a couple thoughts from you. If you imagine OBH five or ten years from now, how do you see the teaching culture helping OBH grow and stand out as a destination for both care and education?

Robert S. Wetzel, MD, FACP: Absolutely. With the groundwork laid now where we had our first resident out, I kind of had this aha moment where I was thinking about things that I could further my career. I am internal medicine by training and I have a lot of hospital-based experience. And I had this master plan and master thought that, at a point when we could start incorporating the inpatient rotations and kind of have that collaboration between the family medicine and hospital medicine and internal medicine side, I think that's where I'm really going to have a strong opportunity to bridge that gap. And I think we won't only be doing outpatient, but I think there'll be a time where we having inpatient rotations as well. And I think that's my master plan and my vision for five to ten years from now.

Host: Well, it's a very exciting vision and plan. So great to talk with both of you today on the growth of OBH. Before we wrap up, I'd love to get some final thoughts from each of you on this. Dr. Ray, if we could start with you. Any additional thoughts?

Jeffrey Ray, MD: Well, I just am excited for what the future holds in terms of where we're going with the educational piece of this. Again, this aligns with our organizational mission and goals in terms of the academic presence. And even if we can't recruit somebody out of the program to our area, if they land somewhere in Eastern North Carolina, then we'll count that as a success. There's a desperate need across our region to have enhanced healthcare. And this is one way that we can perhaps contribute to the larger cause in terms of our region in Eastern North Carolina.

Host: That's a great way to look at it. And thank you for that, Dr. Ray. Appreciate it. Dr. Wetzel, final thoughts from you.

Robert S. Wetzel, MD, FACP: Absolutely. I'm just so excited to be here. I've never felt more supported by an administration and an academic institution like ECU and Outer Banks supporting me. I'm only like a month or two in right now, so I know the future is going to hold great things and I'm hoping that medical students and residents see that same passion and want to stay in our area, because of it's a great place to be and work.

Host: Absolutely. Great stuff. Dr. Ray and Dr. Wetzel, thank you so much for your time today. I appreciate it.

Jeffrey Ray, MD: Thank you.

Robert S. Wetzel, MD, FACP: Absolutely.

Host: And once again, that is Dr. Jeffrey Ray and Dr. Robert Wetzel. For more information, please visit outerbankshealth.org. And if you found this podcast helpful, please share it on your social channels. And please visit outerbankshealth.org/podcasts for our growing podcast library. I'm Bill Klaproth. This is Outer Banks Health, the official podcast of Outer Banks Health. Thanks for listening.