In this episode of the Purpose in Practice podcast, ACU’s Jennifer Dix speaks with Dr. Adrian Billings of Texas Tech University Health Sciences Center and Dr. Kyle McDaniel of UNC Chapel Hill about their mentor-mentee relationship, what drew them to rural healthcare, and the importance of serving patients outside of the clinic or hospital walls.
Full Transcript
Jennifer Dix: So welcome to Kyle McDaniel and Dr. Adrian Billings. We thank both of you so much for talking to us today.
Dr. Adrian Billings: Yeah, thank you Jennifer. It’s a privilege to be here and to be with Kyle, so thank you.
Dix: So to start off, I wonder if you would each mind just sharing a little bit about yourselves and your backgrounds.
Dr. Kyle McDaniel: Sure. Thank you so much for doing this, Jenn. My name is Kyle McDaniel. I am a fourth year medical student here at Texas Tech University in West Texas. I’m originally from the Houston area and really got passionate about working with underserved communities there, working in an underserved Spanish speaking clinic in urban Houston, and from there came out to West Texas to do medical school and wound up getting connected with Dr. Billings. And from there, the journey that I’ve had to really be a force for underserved communities has really blossomed.
Billings: I’m a Adrian Billings and I am the Associate Academic Dean of Rural and Community Engagement also at Texas Tech University Health Science Center in the Permian Basin where Kyle trains. My career has really been as a rural healthcare family physician on the Texas Mexico border in rural far western Texas and Alpine Marfa and Presidio, Texas. And I went to medical school on a National Health Service Corps scholarship with the idea of going back to the rural Texas Mexico border. So, shout out to the National Health Service Corps and thank you for your support and the journey that has enabled me to essentially go back home to practice and remain practicing. And so through my affiliation with Texas Tech University Health Science Center is where I came to meet Kyle as a first year medical student on a summer elective family medicine preceptorship program through the Texas Academy of Family Physicians.
Dix: Working in rural communities. Kyle, was that not something that you had thought about doing until you met Dr. Billings or how did that come about?
McDaniel: Really, my first experience working with underserved populations was in internship program in college. I was working in a clinic off of Binet, which is a largely Hispanic Spanish speaking community. And so that’s where I really got the first taste of it. But it wasn’t until coming out to West Texas that I really even thought about what it’s like to be living in a rural community, let alone a physician practicing in those communities. So Dr. Billings was giving a talk virtually it was covid about practicing and what it’s like to be a rural physician. I really was intrigued by what he had to say and stayed connected with him. And like he mentioned, shortly after that, I applied for a preceptorship program through the Texas Academy of Family Physicians and spent a month out in far west Texas with Dr. Billings in those communities that he mentioned, Alpine, Marfa and Presidio, and really got to live for a month as a rural physician.
And it was such an eye-opening experience that I wanted to continue more. So when I came down and started my clinical rotations in Odessa, which is about two and a half hours from Alpine, I took every chance that I could take to go back down and revisit the community that I fell in love with. And a lot of that is because of the passion that Dr. Billings has that he not only has within himself, but instills in other people like myself. When Dr. Billings gave that talk that first semester of medical school, it was just something that was so foreign to me and so intriguing at the same time that I wanted to have that experience. Whether or not I ended up in a rural community I think was second to the fact that I thought that the experience that I would get in a rural community would be so impactful. And so that’s really why I pursued that. And of course Dr. Billings makes it really easy because a great example.
Billings: What I think is really special about Kyle’s story is that, and I think this is a full circle moment, and I think speaks to the importance of hosting trainees and the importance of especially rural healthcare organizations, really any healthcare organization to open up your doors to trainees like medical students and resident physicians is that I also, on the same program that Kyle first came to Alpine on, I also came to Alpine on that same program as a first year medical student as well. So when Kyle arrived, I just saw a younger me from 20 plus years ago having my first rural healthcare experience in Alpine.
So what does mentorship look like? Well, I think if you’ve seen one mentor mentee relationship, you’ve seen one mentor relationship. I think just as teaching, just as education is bi-directional, I give a challenge to every trainee on their first day that I hope I’m going to be able to teach you something on the next two to four weeks that you’re with me. But I certainly expect you to teach me something and I know that you will. And I think the mentor mentee relationship, I would argue is also bi-directional. You think of hopefully the mentee getting some benefit out of the relationship. But I can tell you that as I’ve become more gray haired and more balding and more senior in my age, I have been put more in the mentoring role. And I can tell you that just as much as I benefited from being a mentee, I think I more robustly benefit in the mentor role because I learn my tank gets filled up, my inspiration is increased by mentoring and learning from a mentee.
And it just makes me realize why I went into medicine and why I’ve remained in medicine and has really allowed me to remain invigorated and especially hopeful in the future for our healthcare system. When you have incredible mentees, Kyle, you have mentored me just as much and probably and certainly more than I could have ever mentored you. So just a shout out that it’s really, I think in many cases, a pretty level playing field in the sense that we get as much benefit as the mentor out of the mentee. And in my case, oftentimes I get more benefit than the benefit that I’m sure that I provide.
McDaniel: I really appreciate you saying that, Dr. Billings. I do want to go back to just what you said about the bi-directional relationship of this and saying that when you see one relationship, it really is one relationship because each mentee and each mentor has certain things to offer and certain things that they’re seeking. And so it’s really important for people to go first off, recognize what those needs are, if they’re the mentee and what they’re looking for in a mentor. And likewise for the mentor to look at themselves and say, what can I provide to the mentees? When I was thinking about going down to Alpine for that preceptorship program, I was really looking for a preceptor that was going to give me a lot of experience that was going to provide me with a lot of opportunities, and I certainly got that. So there’s all sorts of different types of mentor mentee relationships. I think starting from that place of what do you want from this relationship and what do you have to offer is really important.
Dix: Talk about if you could discuss maybe some of the unique challenges and characteristics of mentorship in rural underserved communities specifically, what makes that challenging?
Billings: I can certainly think from the perspective of a rural school board member, rural school board trustee, and also the father of three rural educated sons, two of which who are old enough to think they want to become physicians. And if you’re not of privilege of having somebody in the healthcare profession, like my children certainly are privileged and have me to reach out to ask kind of healthcare related questions of how do I become a physician or a nurse or a behavioral health worker. Most rural students that are in middle school and high school, they often don’t have that luxury or that privilege if it’s not their own doctor that they can reach out to and many of them just don’t have that access to. So I think for rural students, which is kind of my wheelhouse that I’m always thinking about, just the lack of local mentoring opportunities to help students navigate getting through high school.
And if I want to become a physician that should probably be taking calculus and physics and Spanish as a second language while I’m in high school so that it makes those subjects easier in college, and what does it mean to go to medical school? What major do I have to have and how do I navigate the economic and academic challenges of going into higher education and just that length of time that it takes to become a physician and what is a residency, what is a fellowship and how can I afford to spend this much time and go to medical school? And I think that you just need somebody locally that you can trust. And oftentimes it doesn’t have to be locally, but trying to connect these rural students with both rural physician and or academic advisors is something that’s really important. And some efforts that now in my academic position, we are beginning to operationalize to serve a mentorship program for our rural high school students that are interested in healthcare professions.
McDaniel: I think on top of that, talking more specifically about the postgraduate or even the graduate health profession training programs, a lot of them are concentrated in these large urban, well-resourced areas. And that silos a lot of the training to these places where you don’t have to contend with the problems that you face in rural or underserved communities. And so a lot of people, by the time that they’re in training or even after training, they’re looking for places to go work. All they know is where they were trained. And whenever you’re trained in a place that’s in a large academic urban area, that tends be where you go practice. And so the more we can encourage people to seek out opportunities, not in these large academic institutions, which do have great opportunities, but don’t offer the lens sometimes of what is practicing in a rural community like what is practicing in an underserved community actually. And so my message is to every student, regardless of the profession, to go seek out opportunities in rural or underserved areas that you feel a connection to because that will be so impactful to not only your training, but also your future career.
Dix: What specifically draws you to working with rural underserved communities? What’s the difference to you in serving in a rural community versus more of an urban one, and why does that call to you so much?
McDaniel: Yeah, that’s a good question, and I think it comes back to why we get into this profession in the first place. For me, I was drawn in from an early age because of service. I knew I wanted to help people, and I figured that if I’m going to truly live up to that mission, then I need to go where the most need is. I think that it’s really important as healthcare practitioners to look within ourselves and recognize those qualities that drew us to this profession and ask ourselves if our current roles are really living up to that mission, and if not, how can we better live up to that mission so that we can expand healthcare access to communities that are in most need. And also we can raise the next generation of healthcare practitioners because when you have these healthcare practitioners in these rural underserved communities, at that point you provide a perspective of the patients to say, this person is working in my community.
I know I can do it too, and vice versa. If you don’t have it, then students are going to go throughout all of high school, all of college, never imagining their selves in a rural or underserved community because they were never shown that in the first place. Last year I was in Marathon, Texas, which is not too far from the communities that Dr. Billing serves, and I was talking to high school students there and discussing what a pathway to medical school or other health professions would look like. And that was the first time that someone had ever come down to talk to that community of 200 people and say that for you, healthcare jobs are a real opportunity that are obtainable through things like the National Health Service Corps, which supported Dr. Billings and is currently supporting myself through medical school, through other programs that are here in the state of Texas. And really just educating them and empowering them to know that these opportunities are available to you. I think what’s really important for the healthcare community is to provide resources to provide mentorship opportunities like the Texas Academy of Family Medicine Preceptorship Program so that there are opportunities and resources available for these students.
Billings: I always kind of feel that when I have a trainee working with me, I always see that as a mentoring opportunity, and not only do I want students to understand the challenges of rural healthcare, but also the joys of rural healthcare, but I also want to offer them an opportunity to see my personal life. How do I balance my family life with my wife and my three children and my professional life, and how is it that I interact with the community in things that I do socially and in community leadership roles? I think it’s really important to demonstrate that it is possible to be a rural physician and be embedded within a rural community and have roles outside of the walls of a clinic or a rural hospital within the community that are very meaningful and really do provide significant benefit to me and hopefully to the community where I live. Kyle will be familiar with this term of the term of practicing medicine outside the walls of a healthcare facility. That’s probably, I think, where we can most impact those social determinants of health that really do impact that healthcare pillar of the social determinants of health, probably more broadly and more impactfully by us being involved outside the walls of our healthcare facilities.
I had a, last Friday when I was in clinic in Alpine, I had a Texas tech physician’s assistant student, a PA student with me, and we went in and saw the adult son of one of my long-term patients. And she told me, or he told me, I’m sorry that it was his mom’s birthday. She was also my patient and had been a patient for a long time, and I had taken care of her husband and did hospice care for him in his home until he passed away. But I called, I didn’t realize it was her birthday. And so I called her and the PA student was with me. I said, let’s call her and let’s sing her happy birthday over the phone. And I did, and she seemed so touched and so appreciative, but she mentioned that she did not have a birthday cake. And so I hung up the phone and it was the afternoon.
And so my seventh grade son was home, and so I called him and he bakes cakes and cookies. He likes to do that. So I said, Colt, would you mind doing me a favor and a favor for one of my patients? Would you make her a birthday cake? It’s her birthday. And she told me she didn’t have a cake, and so he agreed to it. I told the PA student We’re going to go do a home visit, and I said, home visit with air quotes. It was really a social visit, but it was just such a touching moment to deliver that birthday cake to my patient of 17 plus years and to share that with a trainee that this is part of the art and the practice of medicine. It doesn’t all happen again within the walls of the healthcare organization or facility. It needs to also happen outside of the walls and to happen within the homes of our patients to understand their social challenges. And so anyway, that experience really was contributing to my resiliency again, because of having a trainee and being able to share that and try and plant that seed with her for her future career as an opportunity that she could do to also accompany her patients and her communities wherever she chooses to serve in the future.
McDaniel: I will tell you that those are the kinds of experiences that stick out in a trainee’s mind. It’s those little experiences that happen in these rural and underserved communities that really make a lasting impact. I know certainly multiple things like that happened while I was, well, the multiple times I’ve been working with Dr. Billings, things like that have certainly happened. So those are the kinds of things that students should be exposed to early on to know that medicine is not just what you learn within the walls of academia.
