Daniel Dahle, M.D., the Bieber, California, doctor who was named the 2019 Country Doctor of the Year, admittedly fits the bill.
“I grew up a country person, I live with country people and I am a country doctor,” Dahle, a family practitioner, said in an interview with FierceHealthcare, from the Big Valley Health Center where he has been seeing patients for more than 30 years.
The 70-year-old Dahle said he had never heard of the Country Doctor of the Year award until his daughter Danielle Dahle, M.D., a psychiatrist in Boston, decided to nominate her father and called him to tell him he was one of three finalists.
The award is given by Staff Care, a physician staffing company, which has recognized exemplary physicians practicing in communities of 30,000 people or fewer since 1992. The award recognizes the spirit, skill and dedication of America’s rural medical practitioners.
“I’m very honored by it and I was surprised,” said Dahle, who provides care for residents of a rural area of northern California that is larger than five states.
Those who know him say Dahle more than deserves the award.
"Dr. Dahle is more than an outstanding primary care physician. He is one of the pillars on which his community stands. The people, the health system and the economy of his region simply could not do without him," Jeff Decker, president of Staff Care, said in an announcement (PDF).
“We are ecstatic for Dr. Dahle. I can’t think of a more deserving physician to receive this award,” said Dave Jones, CEO for Mountain Valleys Health Centers, which includes the Big Valley clinic, in an announcement telling patients about Dahle’s award.
The rural life
Working in a community 45 miles from the nearest traffic light, Dahle said he wouldn’t have it any other way. For one thing, he doesn’t wear a white coat and patients are more than likely to see him wearing a plaid shirt and jeans.
“I wore a tie on the first day and I’ve never worn one since. That’s more than 33 years ago,” he said.
Dahle said he grew up on a potato farm about 75 miles northwest of Bieber, near the Oregon border.
“I like the rural life. I always have,” he said.
In fact, Decker and Staff Care’s Phil Miller visited Dahle for an interview and tour of his clinic before making the award.
“The award has been around for 20 years or so and it’s gone to people in a lot of different states. They told me this was the most rural area they had ever been to. It’s pretty isolated up here in northeastern California. It’s logging, it’s ranching and we’re pretty rural,” he said.
Dahle left the area in 1969 to join the military and was a medical corpsman in Vietnam before earning a Ph.D. in radiation biology and a medical degree from the University of Rochester in New York. In 1985, he returned to his home area and began practicing in Bieber, a town of 300 people, where he has been practicing at the Mountain Valley Health Center ever since.
The sole primary care physician in Bieber, he works at the center, which is a Federally Qualified Health Center that sees all patients, regardless of ability to pay. He draws patients from an area that extends over 7,500 square miles, larger than Rhode Island, Delaware, Connecticut, Hawaii and New Jersey put together.
Doing it all
As a primary care physician, Dahle does it all. In addition to seeing patients at the health center, he is almost single-handedly keeping his local hospital, Mayers Memorial Hospital in the town of Fall River Mills, open.
He admits more than half of its inpatients, drives the 25 miles one way almost every day to do hospital rounds, covers the emergency department and manages care for long-term patients at its nursing home. The hospital CEO says he accounts for 50-60% of the revenue at the hospital.
“As a rural hospital goes, so goes the community,” Decker said. “Few people want to stay in or move to a place where there are no healthcare facilities. By supporting the local hospital, Dr. Dahle has done more than keep patients alive—he has kept the community alive.”
A major provider of healthcare in the community, Dahle said he is hanging on waiting for a replacement to take over. He’d like to retire in a couple of years and hopes that a husband and wife team who are now completing their residencies will take over for him.
The wife is an obstetrician who grew up in Bieber and attended the local high school, and the husband is a family practitioner. Dahle has precepted both in his office.
“It’s very important to have local people coming back here,” he said. “It’s very tough to recruit rural family practitioners or rural doctors in general.”
The hospital stopped doing obstetrics three years ago and Dahle said he hopes to get that reopened so it can recruit the new obstetrician. Dahle has made educating future healthcare providers part of his mission and each year provides training to medical residents from the University of California, Davis as well as students from the physician assistant program at the University of Iowa.
A huge change in practice
Though he has seen rural practice evolve during his tenure, Dr. Dahle believes the essence remains the same.
“Much has changed in 30 years,” he said. “But patients still respond to someone who really knows them and to someone who really cares.”
Medicine has changed tremendously in a third of a century, he said. “And I don’t think all of the changes are for the better. We’ve become more digitalized, more politicized.”
When he began practicing, he could focus on his patients.
“We had a bookkeeper, a receptionist, a nurse and myself,” he said. Now a practice has to have many people taking care of administrative tasks in order to get reimbursement from the government and private insurers.
“It’s not like it used to be,” he said. Back in the old days, he could pick up the phone and call a specialist to see a patient who needed further care.
“They’d say, ‘oh yes, send ‘em right down’,” he recalled. Now doctors must go through insurance companies, with pre-approvals for everything, he said. “It’s a lot more of a pain in the butt nowadays.”
And the computer has not made life easier. When the practice went electronic about 15 years ago, Dahle threatened to retire. Instead, the practice assigned him a medical assistant who does all his computer work.
Dahle sees patients and dictates his notes, which are transcribed into the electronic medical record and are also copied into paper charts. “I still use paper charts,” he said.
One thing hasn’t changed: The time he spends with patients.
“I make a lot of time [for my patients],” he said. “I used to see 20 patients in a day and no problem I could get out by five o’clock. Now it’s way harder.” His days are longer, and like many doctors, he takes paperwork home with him.
But one thing remains the same. “I still love the people.”
Dahle says his daughter decided it was appropriate to nominate him for the award. He was chosen from more than 60 nominees from across the country.
“She knew I had practiced in rural America, delivered more than 1,000 babies and done surgeries and this and that,” he said.
Virtually all of the town’s residents (including the actor Clint Eastwood, who has a ranch in the area) have been positively impacted by Dahle in one way or another.
He says he would not have done things differently.
“I don’t think so. I’m extremely happy with my job. I’m glad I chose the place I did. In retrospect, I wouldn’t have done anything different,” he says.
And being in a rural area gave him opportunities he might otherwise not have had. For 25 years, he coached track and field at the local high school until he retired two years ago, although he’s still on board as an assistant. And he lives on his family’s 4,000-acre farm.
“I’m five miles away from the road and I’m happy as can be,” he said.
He is also proud of his children. Along with his daughter, he has a son David who is a special agent for the FBI and another son, Dennis, who is a financial advisor.
And he made clear to the Staff Care officials that he can’t take all the credit.
“When they were here, I told them I worked hard and all that, but a lot of the credit needs to go to the other people I work with at the clinic. We have a great staff up here. We’ve grown over the years from one clinic to seven clinics. I feel really honored to work with all the people I work with,” he said.
The community plans to honor Dahle in a ceremony in the Big Valley High School gym on April 12. As part of being named the 2019 Country Doctor of the Year, Dahle was to be given two weeks of time off, as Staff Care offered to provide a temporary physician to fill in for him at no charge, a service valued at approximately $10,000.
But instead of vacation, Dahle said he’d rather take the money—though not for himself. He plans to give away the $10,000 award to a patient who is struggling in her battle with cancer.
“I don’t need the money. I’d rather see it go to someone who needs it,” he said.