Bryson City: just what the doctor ordered

fr swainmedAs Dr. Randall Castor stared down the final weeks of his residency, it was clear those long, grueling years of medical training were about to pay off.


The world was at his fingertips. Pick a city, any city, and a job would be waiting. America’s doctor shortage was particularly acute for general practitioners like Castor — a jack-of-all-trades physician in high demand on the front lines of medicine everywhere.

Calls from recruiters came fast and furious, dozens a day, too many for Castor to even field. 

“You have headhunters calling you constantly. I ignored most of them, but I happened to answer this one,” Castor said.

The pitch to come practice in a small town in the mountains of North Carolina was intriguing. 

“We wanted somewhere with some mountains, a small town feel and not a lot of traffic,” Castor said.

Castor and his wife set out on a road trip from Ohio to see if Bryson City fit the bill. It did, and he soon settled into a trio of roles as a emergency room doctor, family practitioner and hospitalist at Swain Medical Center.

SEE ALSO: A moving target: Small-towns’ eternal chase for doctors

But after three years, Castor was restless and ready for something new — not a new town, but a new venture all his own.

Six weeks ago, Castor opened the doors of a start-up, stand-alone urgent care center and family practice on the outskirts of downtown Bryson City. Success was instantaneous.

“It has blown me away the positive response we have gotten from the community,” Castor said.

A new practice can typically expect a dozen patients a day in their first six months. 

“Last Monday, I saw 40,” Castor said.

Castor employs two physician’s assistants and a total staff of 20. The quick success is due in part to the marked shortage of family doctors in Swain County and unmet demand for basic medical care locally. (see related article)

“We wanted to provide services that weren’t here. Castor saw the need. I saw the need. We all saw the need,” said Harvey Crape, a longtime physician’s assistant at Swain Medical Center who came out of retirement to go back to work for Castor.

Still, Castor went to three banks before he found one willing to loan to him. Not only were there start-up costs of a building, expensive medical equipment and computer systems, but also the lag in medical billing would pose a cash flow hurdle the first few months — until insurance claims and reimbursements began rolling in on a steady basis.

It seemed risky to lenders, but not to Castor.

“I knew what a success it would be. I knew from living here that people couldn’t get appointments for three months to see a doctor, so I knew the need was here,” Castor said.

Still, Castor admits he’s going against the national trend in healthcare, one of consolidation among hospitals and doctors’ practices into megalithic networks.

“It is very difficult to start up your own private practice in this medical environment,” Castor admitted. 

But he also believes people want quick and convenient medical care — the founding principle behind the hybrid style of medicine Smoky Mountain Urgent Care and Family Medicine offers.

“We do traditional family medicine in an urgent care setting seven days a week,” Castor said, citing instant on-site labs and x-rays. “It is a good way to do medicine. If I am sick, I want to know right away what is wrong with me.”

This rural corner of Western North Carolina seemed like the perfect proving ground for the theory.

“This was our field of dreams. We knew if we built this people, would come,” Crape said

For now, Castor is still working shifts in the emergency room at Swain Medical Center to avoid drawing a full salary from the practice for himself. On top of that, Castor has two kids under the age of three.

It’s been a monumental undertaking — but worth it, he said.

As an autonomous practice, he is free from the bureaucracy and corporate mentality of larger health care systems.

“It is frustrating to be stuffed in a box and told ‘This is the way you are going to practice medicine no matter what,’” Castor said. “It isn’t a computer punch list where you shoot down the line.”


For want of a nail

Steve Heatherly, the CEO of Swain Medical Center, doesn’t see Castor’s new practice as a competitor.

 “Frankly, we viewed it as a positive for Dr. Castor to try something he wants to do here in this community rather than go somewhere else and do it,” Heatherly said. “Swain County needs physicians.”

Heatherly said he hopes Caster is successful.

“We intend to maintain a highly collaborative relationship with him,” Heatherly said.

Family doctors are a critical link between patients and hospitals. They are the air-traffic controller of health care, a patient’s first-stop for whatever ails them.

Family doctors pass patients up the chain to specialists, refer them to surgeons, order tests and evaluations, or admit them to a hospital if need be.

With a shortage of family doctors in Swain, however, patients were going as far afield as Asheville.

“People couldn’t get health care here,” Crape said. “They were going all over.”

Wherever they went for that initial visit is where they would be funneled into the system, the revenue from those patients lost to the local community for good.

Thus Castor’s venture is being embraced rather than resented if it can keep the trajectory of patient care closer to home.

“We view that as an access point in the community,” Heatherly said.

Nonetheless, few doctors are in the business of starting their own practices these days. 

“What Dr. Castor is doing is somewhat against the grain of what is happening nationally. I respect his desire to want to do something entrepreneurially,” Heatherly said.

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