Sunday, February 14, 2010

Dr. Steven Smith moved to the Florida Keys 31 years ago with a goal of finding a better work-life balance and more time for diving and fishing.

Things didn't go exactly as planned.

These days, he's lucky to fish three times a year. Smith instead spends most of his waking hours treating patients in Marathon, where he has worked as a family doctor and general surgeon for the last three decades.

His dedication to his patients recently earned him the 2009 Country Doctor of the Year award.

The award is presented to a physician who best exemplifies the spirit, skill and dedication of America's rural medical practitioners, according to Phil Miller, vice president of communications with Staff Care, the physician staffing firm that awards the honor. It was created in 1992 to honor the effect country doctors have on small towns and inspire younger doctors to go into medicine in more rural areas, he said.

Smith's schedule is "punishing" by even doctors' standards, Miller said.

Smith, 61, has rounds at Fishermen's Hospital in Marathon beginning at 6 a.m., seven days a week. He's at the office by 8 a.m. and often sees patients until 9 or 10 p.m., averaging anywhere from 25 to 50 patients a day. He frequently sees patients on Saturdays when their ailments can't wait or if they were bumped earlier in the week for another emergency.

Every other Tuesday he drives to the Upper Keys to perform surgeries at Mariners Hospital all morning, then it's back to his office in Marathon to see patients the rest of the afternoon and evening. He also performs surgeries in Marathon.

"Dr. Smith was unique in being two doctors in one -- both a surgeon and diagnostician," Miller said. "That's very unusual. We were impressed he was able to do that."

Smith estimates that he logs six weeks of the year in his car driving between the two hospitals, making rounds and personally visiting patients.

"His work ethic is so admirable," said Beverly Ferris, a nurse who works in Smith's office. "He's generous with his time, he's compassionate and he's there for his patients. He doesn't mind being called in his off hours -- as little as they are."

Ferris said Smith doesn't like to rush people and will stay and talk with patients as long as they need, sometimes answering the same questions over and over. She is regularly tasked with trying to keep him on schedule.

And when Smith's employees are leaving the office to head home at 10 p.m. each night, he's often on his way back to the hospital to check on patients again. He's also on call at the emergency room in Marathon, and may get three or four calls in the middle of the night in addition to any emergency calls to his answering service from his regular patients.

It's a mystery to all who know him how he is able to maintain such a hectic schedule day after day, year after year.

"I guess the satisfaction that you're helping people," Smith explained. "It's just something I've always been able to do ... since medical school."

Smith recalled working 110 to 120 hours a week during his residency at Tulane University in New Orleans. He and his wife, Barbara, a nurse who works alongside him in his practice, moved to the Florida Keys in hopes that he would relax his schedule and have time to enjoy all the water activities he loved. But his work ethic followed him here.

Smith has yet to use the new boat docked in the canal behind his home. After taking a moment to calculate, he admits he hasn't been fishing in 10 months.

Smith said his only regret about working so much was not spending more time with his two children when they were younger.

"Neither of them wanted to be physicians because of how many hours I worked," he said.

Smith himself was inspired to become a doctor after watching his father, an obstetrician.

"For many years his office was actually attached to the house," Smith said, joking that his first toy was a speculum. "He delivered 350 babies a year."

Smith had planned to follow his father into obstetrics and gynecology until he was lured by general surgery in medical school.

Smith's dedication to medicine is not lost on his patients. In his office, a stack of cards and letters sits atop the desk -- notes of congratulations for his award and sincere thanks.

"I was so proud of him," said 83-year-old Anna Lockwood, who has been a patient of Smith's since he arrived in the Keys.

"I never even thought about going to someone else," she said on a recent Tuesday morning while having a fatty tumor on her neck examined. "I immediately had faith in him. I've trusted my life to him a few times. ... I am so glad that we have a doctor with such talent who stayed here in the Keys."

Lockwood was not the only patient that morning who was quick to mention that Smith saved their life at one time or another, including a woman in the next room who was recovering from emergency bowel surgery.

Throughout the morning, Smith danced between his two exam rooms, delivering lab results, examining wounds, removing stitches and delivering the occasional bad news, including a woman who may have breast cancer.

In between exams, he ducks into his office to dictate notes into a digital recorder because his "handwriting is so terrible," he said. At the end of every dictation, he includes personal notes about people, including their new jobs, new boats, pets or an 11th great-grandchild on the way so he doesn't forget to ask about them next time he sees his patients.

In exam room 1, a patient having a follow-up exam after gall bladder surgery a week earlier presented him with a bag of homemade cookies baked by his wife, beaming with thanks as Smith examined his stitches.

In exam room 2, Richard Charron, 71, tried to persuade Smith to join him on his boat when Smith asked if he had any more questions following his test results. The news today was good: An MRI revealed he doesn't have a brain aneurism.

"The only question I got today is why don't you knock off early and come fishing with me?" Charron said with a laugh.

Charron has been a patient since he moved to the Keys full time 10 years ago.

"He's a good doctor and I wouldn't go to anyone else," he said. "He talks the way we do. He don't consider himself elite -- although he is."

Philip Schneider, 78, had similar things to say.

"He's one of those wonderful, no-nonsense guys," Schneider said, hopping off the exam table. "He's just awfully good at what he does. Even though we live in New Jersey half the year, I consider him my primary physician."

Smith said he was surprised and honored to receive the award -- he didn't even know he'd been nominated.

"It was a tremendous honor," Smith said. "It's wonderful to get recognized for the work we take for granted and do every day."

Smith represents a unique departure for the award, according to Kurt Mosley, vice president of strategic alliances for Staff Care. All previous recipients have been family physicians. Smith is the first Country Doctor of the Year who is board certified in general surgery. Rural hospitals rely on general surgeons to remain viable, and general surgeons are in increasingly short supply in rural areas, Mosley said.

"We have a lack of a variety of specialists that are abundant on the mainland," Smith said. "We find ourselves taking care of situations that a general practitioner would never encounter on the mainland."

As part of the award package for being named the 2009 Country Doctor of the Year, Staff Care provides a temporary physician to fill in for Smith for two weeks at no charge. But Smith -- who can't imagine taking two weeks off -- has proposed another alternative. He suggested Staff Care donate the money they would have paid a doctor to replace him for two weeks -- he's guessing $5,000 -- to a cancer fund to pay for people's cancer treatments. And Smith plans to match it with a $5,000 donation to a Haitian relief fund.

The doctor also has no plans to slow down or retire anytime soon.

"The problem is, I don't know what I'd do if I retire," said Smith, admitting that he gets antsy on holidays and the rare vacations he allows himself. "I imagine working up until the day my health mandates I quit or I stop enjoying it."

Free Press Editor Marc Phelps contributed to this report.

amswary@keysnews.com