Rob Marsh has a medical practice in Virginia's Shenandoah Valley. He likes the freedom to open his office at night if a patient gets sick.
Marsh wants to make house calls, and he needs to pay a staff that has grown from 2 to 23. But many people in this area lack insurance.
"You've got to make budget to make payroll," he says.
The financial pressures of practicing medicine in the 21st century have led more doctors to take jobs with large hospitals and medical practices. Last year, only 17 percent of doctors were in solo practice.
Wanting to stay put, but feeling the budget pressure, Marsh decided to add a new source of revenue from a surprising source of patients.
About 20,000 truckers pass through Raphine, Va., every day, and the owner of White's Truck Stop asked Marsh to open an office there. At first, the busy country doctor refused.
"But then as I talked to him more, and I looked at it, I realized this may be a good source of additional income for us, so that if I don't want to charge somebody else, I can do that from doing physicals on truck drivers," he says.
So Marsh remodeled a one-story brick building next to White's Truck Stop and opened up an office.
"There are five or six truck stops in the nation that have medical care," he says. "I went to two of them; they were trailers that were parked at a truck stop. I wanted to establish a practice that you would be proud to go to if you were a professional."
Truckers like Christopher Sims of Blountsville, Ala., love the convenience. Sims, 44, has had a virus for several days, but he's got a delivery to make and he can't pull his big rig loaded with new cars into the parking lot of a local urgent care.
"Been sick for three days, so I said, 'Hey, I'm going to stop and check it out,' " Sims says.
Marsh accepts walk-ins who complain of backaches from sitting long hours behind the wheel, injuries suffered while hooking trucks to cabs and headaches caused by endless traffic jams. Marsh says today's trucker is more health-conscious than in decades past, but driving is sedentary, stressful work.
Some patients should be monitored for ongoing medical problems or a risk of recurrence. Sims, for example, was once diagnosed with lymphoma.
"I was told I had two to three months to live 13 years ago, and I told them I'd beat it, and I did — so here I am," he says.
Now that he's found Marsh, Sims says he might make this a regular stop. Marsh says there others who consider him their family doctor.
"There is a significant percentage of truck drivers — I've heard anywhere from 15, 20 percent — that their truck is their home," he says. "So they don't have a home doctor, and we're becoming that. They know that they come through this truck stop once a week or twice a month or whatever, and that we'll be here for them."
Office manager Linda Helmech says she and the other support staff are happy to treat these ailing road warriors.
"They're always very nice," Helmech says. "You ask them where they've come from, and they're always very excited to talk to someone, because I know that's a lonely job. It's enjoyable, because like I say, they're not at home with their families."
Sims gets some medication and is back on the road, hoping to make it to Silver Spring, Md., by the afternoon. The next time he stops for medical care, he'll find another service to keep him in good health: The truck stop plans to add a full-service pharmacy.
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