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Real Doc Hollywood impacts primary health care system

Photo by Casey Dixon

Photo by Casey Dixon

ALBANY -- Three decades ago, Dr. James Hotz became part of the public health service. Since then, he has made developments to the health care system that, at least to Southwest Georgia, have made a significant impact.

Hotz may not look much like Michael J. Fox, but he inspired Fox's character in the 1991 movie about a big-city doctor coming to a small, Southern town known as "Doc Hollywood."

Trained in internal medicine at Emory University in Atlanta, Hotz found himself in Southwest Georgia somewhat unexpectedly. He eventually opened a clinic in Leesburg, which hadn't seen a doctor in some time.

"I was assigned down here during the Carter administration," Hotz recalled. "I ended up getting matched to the community."

The idea behind tweaking the health care industry during the 1970s was to improve the system of delivery, Hotz explained. From that came the construction of the community health center system, designed to take care of people who otherwise might not be able to afford a doctor's visit.

"The idea behind the community health center model is a medical home owned by the patients you serve," the doctor said. "You have to see people based on ability to pay.

"A lot of what we do is how we address the needs of the community. Unless you have quality access, all these medical breakthroughs mean nothing to you. You will be disconnected."

In so doing, Hotz became a key figure in crafting the National Health Service Corps -- which since 1972 has involved more than 30,000 clinicians with the goal of expanding access to health services and improving the health of people who live in urban and rural areas where health care is scarce. Through it all, the overall goal was to shrink the gap between the least and most fortunate in terms of access to care.

Through the Albany Area Primary Health Care system, clinics were established throughout the region. The results have been tremendous in areas such as Baker County, where residents had very few, if any, opportunities to seek medical care.

"It's a bit of a unique model," Hotz said. "It's the fastest growing area of the health care delivery system. In areas that we are highly functioning, we are seeing lower death rates. We know primary health care works."

Because this model is in existence, Southwest Georgia communities such as Newton and Edison now have geographic- and economic-efficient access to health care they might not have otherwise.

"It's about developing a model of care to better serve the needs of the community," Hotz said.

The story behind "Doc Hollywood" came into being when the person who recruited Hotz wrote a book based on the junior physician's experiences.

"I told him (Dr. Neil Shulman) I was frustrated because there was no place in the country that wanted to follow the public health model," he explained. "The bottom line was there were thousands without physician or primary care access."

While a good deal of progress has been made, Hotz said there is still much left to be done.

"We are now facing an even greater crisis," he said. "The situation has not changed. We are now 30 years into this thing. People still have to have a primary care home to plug into. It is very hard to have a community without health care."

In his talks to health care associations, Hotz has gotten into the habit of asking those present who have gotten experience working in rural areas if they think a movie could be made about them. The response he has gotten from this shows that, despite all the work he has done personally to develop the medical care delivery system, the effort has been bigger than him as a human being.

It's the physician's hope this effort will continue after he is gone.

"The reason the movie was well liked was because it was not about me, but because it's about an important part of the American infrastructure," Hotz said. "We need to have a person, a body to be the next Doc Hollywood to provide the next primary health care access point.

"You would like to think this is going to stay. This is an important part of the medical infrastructure. When there wasn't a system, we made it happen. I'd like to think we made a difference."

That does not mean to imply Hotz doesn't feel grateful for the recognition he has gotten.

"I feel blessed that what I considered a basic fundamental human right (is being met)," he said.

It would seem he has influenced at least a few members from the next generation.

"My kids all say this is the kind of medicine they would like to do," he said.

In the end, it is about understanding what the patients need, Hotz said.

"Only by understanding and accepting the community can you deliver the best care," he explained. "It brings people together when you have common goals and needs, and it allows the infrastructure to bring people together."

As of now, Hotz estimates we are roughly 10,000 doctors away from getting the job done -- something that is being relieved by expanding medical school opportunities to hopeful doctors in the area, such as through the recent developments with the Medical College of Georgia School of Medicine Southwest Georgia Clinical Campus or the Pathway to Med School program based in Albany.

"It's a multi-tier investment," he explained.

This is a cause Hotz has continued to be active with. Several years after the "Doc Hollywood" release, he and Vic Miller wrote a sequel, "Where Remedies Lie," a title that was inspired by a Shakespearean quote: "Our remedies oft in ourselves do lie/Which we ascribe to heaven."

The idea behind the book was to show that the effort to equalize opportunities for medical care access will to take more than one physician, Hotz explained.

"We tried to show that the public health hospitals have to work together," he said. "Health care can trickle down from heaven, or we can solve the problem."

Now working as a general internist, Hotz is married and has four children.