Is That Deductible? Standing in the Gap: Family Docs in Maternity Deserts

For over 30 years, I’ve worked in maternity care, helping families welcome their newest members into the world. I’ve witnessed the beautiful moments of new life and the intense responsibility that comes with being a family physician in rural America. As someone who's spent decades in this space, I've seen firsthand the quiet yet profound crisis happening in rural areas where maternity care has become a rarity—turning many regions into "maternity deserts."

This fall, I decided to turn my focus to an especially hard-hit area: John Day, Oregon. The town is one of many across the country where access to maternal healthcare is teetering on the edge of extinction, leaving families in desperate need of reliable care during one of life’s most critical moments—childbirth. My socially driven mission during this "Act 2" of my career is to join fellow family doctors to stand in the gap, providing essential maternity services in these areas. For those wondering, “Is that deductible?”—yes, the expenses associated with this work can be, but more importantly, it speaks to the power of aligning your professional work with a socially conscious mission.

Why I Went to John Day, Oregon

John Day is a small, isolated community in Eastern Oregon, home to a critical access hospital that provides essential services to the people living in this remote area. However, the hospital has faced a devastating provider shortage over the past year, losing six healthcare providers leaving only two family doctors to carry the weight of nearly every medical need. These two physicians have been juggling everything—maternity care, C-sections, newborn care, inpatient hospital care, ER coverage, and more.

In rural areas like John Day, family doctors are the backbone of the healthcare system, often stepping into roles traditionally filled by specialists. Their comprehensive training allows them to cover a wide range of medical services, from emergency care to delivering babies. Still, the burden they carry is enormous, and the risks associated with being the sole providers for critical medical services can be overwhelming. Without family doctors, communities like John Day would be left without a lifeline, with the nearest referral center being three hours away.

Standing in the Gap: The Role of Family Doctors

I’ve always had deep admiration for family doctors who serve in rural settings. These physicians often operate without the luxury of having specialists down the hall or quick access to high-tech medical centers. Instead, they are the specialists, the surgeons, the maternity care providers, and the emergency doctors all rolled into one. In John Day, the lone general surgeon on the staff is often the only surgical specialist available for miles, and beyond that, the next step up in care is hours away.

This reality places an immense burden on the shoulders of family doctors who are, by necessity, multi-talented, highly trained, and incredibly adaptable. They provide critical care in communities that would otherwise be neglected. While it’s inspiring to witness what family doctors are capable of, it’s also heartbreaking to see the strain that this work places on them, especially when support is so limited. Yet, despite the challenges, they continue to serve their communities with grace, skill, and a sense of duty that is unparalleled in the medical profession.

Maternity Deserts: A Growing Crisis

Across the U.S., rural hospitals are closing their maternity wards, leaving vast "maternity deserts" where families are forced to drive hours for basic obstetric care. In some cases, women are delivering babies on the sides of highways or in makeshift areas because they cannot make it to a hospital in time. According to a recent CNN story, US faces maternity care crisis, with 1 in 3 counties lacking obstetric doctors to provide care the crisis is worsening, as many rural healthcare providers struggle to maintain maternity services due to a shortage of doctors, nurses, and financial resources. This is especially alarming in states like my home state of Indiana, where many rural hospitals have shut down their maternity wards in the last decade. For me it was a little over a year ago that my hometown rural hospital discontinued maternity care forcing patients to travel 45 minutes for maternity and newborn care.

As I have seen this issue snowballing over the country, I knew I had to act. So, I took a locum tenens position in John Day, not just to help fill the gap but also to stand with the doctors who are doing everything they can to keep their community safe.

The Costs and Practicalities of My Locums Mission

Taking on locum tenens work in a remote area like John Day isn’t just about showing up. There are significant logistical and financial considerations to make it happen—considerations that every physician working through a professional corporation (PC) should be mindful of when assessing their tax deductions.

Here’s a breakdown of the costs associated with this locums role:

• Medical Licensing and Credentialing: The medical licensing process took nearly three months, requiring paperwork, exams, and an investment of time to ensure everything was in order. Credentialing also involved background checks and insurance verifications to ensure I met the necessary qualifications.

• Malpractice Insurance: Covered by the locum company, malpractice insurance is essential in this line of work. It provides peace of mind and legal protection as I take on high-risk duties like obstetrics and C-sections.

• Travel Expenses: My flights to and from Oregon, along with a rental car, were all arranged and covered by the locum company, ensuring I had reliable transportation during my assignment.

• Lodging: Staying in a small town like John Day, I chose Airbnb for my accommodation, which was also covered. This provided a comfortable, local experience while I focused on the work at hand.

• Food: While food wasn’t covered by the locum company, I chose to do a per diem expense through my PC, which allowed me to source my own meals and benefit from the tax-free arbitrage. This strategy gave me a small financial benefit while keeping costs reasonable.

These expenses, all covered through my PC, are essential for anyone considering locum tenens work to understand. They are not just part of the job; they’re part of maintaining the professional autonomy that allows me to engage in meaningful work while still running a profitable micro-corporation. In essence I am able to still practice my passion of family medicine maternity care, but essentially doing it as a practice without walls.

The Importance of Standing Together

In John Day, I wasn’t alone. I joined arms with two other family doctors, each of us doing our best to fill the void left by those who had departed. Together, we provided essential maternity care to a community that desperately needed it. It was a powerful reminder of the importance of solidarity in medicine, especially in rural areas where healthcare access is so limited.

My admiration for family doctors everywhere has only deepened through this experience. These physicians are the unsung heroes of rural healthcare, doing whatever is necessary to take care of their communities, often at great personal and professional cost. Their dedication to providing comprehensive care, even when resources are scarce, is nothing short of remarkable.

A Call to Action for Physicians

If you're a physician feeling the weight of burnout in your current role, or if you’re looking for ways to give back while maintaining control of your professional life, consider the possibilities of locum tenens work or even starting your own micro-corporation. With the right support, you can create a practice that aligns with your values and gives you the flexibility to serve where you’re needed most.

I have a great $1000 opportunity for both of us if you are interested in exploring locum work with Weatherby Health, the largest locum provider in the country, and one that I personally use. If you follow this link, we’ll both be paid $1000!

For just $99, you can become a member of SimpliMD, gaining access to over $2,500 worth of business products designed to help physicians thrive in the marketplace. Additionally, my course, “Creating a Practice Without Walls,” provides practical guidance on how to set up a micro-corporation that gives you agency in your professional life while enabling you to serve in meaningful ways.