Growing up in the Southwest Texas border town of Del Rio, Adrian Billings, MD, dreamed of becoming a working cowboy. Instead, he found a career as a different kind of frontiersman: a family physician in the underserved rural Big Bend region.
Although medicine wasn’t his initial choice, Dr. Billings’ passion for his work is palpable and extends far beyond the exam room, especially when he’s training future rural physicians.
“Medicine should be about service and a sense of calling,” he said, adding he was drawn to practice in a rural border region because it’s where he feels he can make the greatest impact.
“It’s so important for medical students to hear, ‘I love my job,’” Dr. Billings said. “I would become a family physician all over again, and I would choose the same path to become a rural physician.”
Staying close to home
Dr. Billings might have missed his calling to medicine had he not worked as a local anesthesiology technician while home from his first year of college. After getting the chance to scrub in on surgeries and assist with deliveries, he resolved to go to medical school.
He wasn’t accepted to medical school right out of college and instead earned a doctorate in experimental pathology at The University of Texas Medical Branch (UTMB) in Galveston. He then went on to work at the Centers for Disease Control and Prevention in Atlanta as a postdoctoral fellow.
He was ultimately accepted to UTMB and received a National Health Service Corps (NHSC) scholarship, which covered his medical school costs in exchange for a four-year primary care commitment in a medically underserved area. That NHSC commitment brought Dr. Billings back to West Texas after graduation. Although he had hoped to return to Del Rio, where his family’s roots date back to the 1880s, it didn’t qualify as a medically underserved region at the time, so he chose nearby Alpine.
After practicing solo in Alpine for four years, Dr. Billings merged his private practice with a federally qualified health center in Marfa to form Preventative Care Health Services (PCHS), which has since expanded to Alpine and Presidio.
In addition to serving as chief medical officer of PCHS, he is an associate professor of family and community medicine at Texas Tech University Health Sciences Center (TTUSHC) School of Medicine-Permian Basin, co-president of the Presidio-Ojinaga Binational Health Council, and team physician for the local high school and university football teams.
Dr. Billings relishes these roles, listing his home number in the local phonebook and dispensing reassurance to patients who come up to him in the grocery store.
“Rural physicians, they’re big fishes in small ponds,” he said. “You’re somewhat of a local celebrity because people so much depend upon you.”
Training camps
Alpine’s biggest challenge is a shrinking workforce, what Dr. Billings calls “brain drain.” Between February and August, five of the region’s 10 physicians left for jobs as far away as New Zealand. Big Bend Regional Medical Center, an already small community hospital in Alpine with only 25 beds, halved its labor and delivery hours in early July due to a nursing shortage.
Dr. Billings attributes this exodus to the ongoing COVID-19 pandemic, which has taken an emotional toll on many health care professionals. PCHS, for example, no longer has enough staff to keep its three locations open five days a week, so they are now closed intermittently, meaning patients must either delay care or drive further to access it.
“It’s like having a small football team,” he said. “We don’t have anyone on the bench to pull in when someone is sick, leaves, or is on vacation.”
Deepening that bench is a perpetual project for Dr. Billings. Since he began practicing in Alpine 14 years ago, he has hosted more than 300 medical students and around 50 residents for rotations. Six former trainees have returned as family physicians for at least some period of time in the Big Bend.
“Hosting trainees has been a great pipeline for recruitment, not to mention allowing my patients to have better care,” he said.
Dr. Billings also helped establish a two-year rural training track for family medicine residents at TTUHSC School of Medicine-Permian Basin, with PCHS hosting its first resident two years ago. The goal is to train residents in a rural, underserved environment so they feel equipped to practice in one.
“Rural medicine can sometimes be practicing in the dark,” he said, explaining that physicians in Alpine can’t order same-day test results, MRIs, or in-person consults with specialists. “To ask someone trained at Massachusetts General Hospital or the Mayo Clinic to … come to a frontier, medically under-resourced area like ours, it would just be a completely different environment for a physician trained in a well-resourced quaternary care center.”
In addition to his work as a recruiter, Dr. Billings is a seasoned advocate, testifying before the Texas Legislature, U.S. Congress, and World Health Assembly in support of resources for underserved areas, from the Texas border region to developing countries.
Dr. Billings knows firsthand how health care is binational – and why advocacy must cross borders, especially during a pandemic. It’s easier for some of his patients to see a physician, pharmacist, or grocer on the other side of the Texas-Mexico border than to drive to his office in Alpine. As co-president of his regional binational health council, he is a vocal supporter of supplying COVID-19 vaccines to Mexico, to keep both communities safe.
“Commerce and infections cross the border easily,” he said.
Dr. Billings’ commitment to what he describes as “practicing medicine outside of the exam room,” coupled with his sterling reputation as a family physician, has earned him accolades. The Texas Academy of Family Physicians recently named him family physician of the year.
It has also guided his career, as he’s grown from a community physician to an advocate for rural health care at the state, national, and international levels.
“If my calling 14 years ago when I moved out here, or 20-plus years ago when I had a calling to go to medical school, was to become a rural physician … my calling now is, ‘How can I enable more of a robust rural health care workforce?’” he said.