| Back to e-WV The West Virginia Encyclopedia

Medicine

The practice of medicine in West Virginia is both specialized and generalized, urban and rural. Qualified physicians work in solo and group private practices, rural clinics, large and small hospitals, university health science centers, free clinics, health departments, nursing homes, corporations, and HMOs, and some make house calls.

The practitioners include both medical doctors and doctors of osteopathy. West Virginia’s physicians serve a population of nearly 1.8 million, 38th in the nation. West Virginia is the third most rural state. Its population is also one of the oldest, with the fourth-highest median age, 42.7 years in 2020. For many years, the uninsured population was much higher than the national average. However, following passage of the Affordable Care Act (ACA), the number of uninsured West Virginians had dropped to 6.1 percent by 2021, two points lower than the national average and the 18th best rate in the nation. Nearly half of West Virginia adults have private insurance (44.9 percent), followed by Medicaid (25.6 percent), and Medicare (19.7 percent).

Lack of access to a primary health care provider (PCP) (19.5 percent) is lower than the approximate 25 percent U.S. figure; this problem is most extreme in portions of southern West Virginia. This is a significant reversal from the early 21st century, when some 30 percent of West Virginians lacked access to a PCP, compared with the 17 percent national average. Some 34 percent of family physicians work in rural counties, compared to the 38 percent of the population who live in these areas; approximately 30 percent of West Virginians live in underserved counties that have more than 2,000 patients per PCP.

West Virginia physicians are trained at multiple locations through three state-supported medical schools. West Virginia University School of Medicine was founded in 1902 and is in Morgantown. It has a clinical campus in Charleston affiliated with Charleston Area Medical Center, and other regional campuses throughout the state. The West Virginia School of Osteopathic Medicine, located in Lewisburg, was established in 1972. It prepares family physicians for West Virginia and surrounding Appalachian states. Marshall University’s Joan C. Edwards School of Medicine, located in Huntington, was established in 1977. Its original mission was to prepare rural primary care physicians through undergraduate and residency training programs. That mission has been expanded in the 21st century to include biomedical science graduate study, biomedical and clinical science research, academic scholarship, and public service outreach. All three medical schools train students in medicine along with other health science students through the state-funded Rural Health Education Partnerships.

The origins of our state’s medical practice may be traced to the latter part of the 18th century. The Appalachian Mountains posed a major obstacle to the practice of medicine, due to travel difficulties west of the Shenandoah Valley. One of the earliest physicians in present West Virginia was Dr. Jesse Bennet, who set up a practice near Point Pleasant on the Ohio River in the 1790s. Other doctors followed, establishing practices near navigable waterways such as the Kanawha, Ohio, and Monongahela rivers. The advent of railways and better roads contributed to the expansion of medical practice in the 19th century.

The scarcity of medical practitioners in West Virginia has fostered a tradition of folk medicine. This is due to the wide availability of herbal cures in the rural countryside, plus the independent, self reliant nature of the Appalachian people. While untrained ‘‘granny’’ midwives and self-taught folk doctors are largely a thing of the past, West Virginians have participated in the recent revival of herbal remedies. Nurse-midwives historically have provided many in-home deliveries, and the tradition continues in modern birthing centers. Several prominent leaders in public health health and community medicine have worked in the Mountain State.

The medical profession became organized in 1867 when Dr. James Edmund Reeves and 32 of his colleagues established the West Virginia State Medical Association. The West Virginia Society of Osteopathic Medicine was established in 1902.

Starting in the late 19th and into the early 20th century, the genesis of the modern system of rural primary care delivery was found in the West Virginia coalfields. There ‘‘coal camp doctors’’ provided needed care to coal miners and their families through pre-paid, per capita financing, a precursor to the modern health-maintenance organization. Since mid-century, the United Mine Workers union and small communities built upon this innovation by providing country doctors through rural medical centers. With help from the Appalachian Regional Commission, private and religious foundations, and state and federal resources, there are today more than 80 rural primary care centers throughout the state.

Major challenges confront the practice of medicine in West Virginia in the 21st century. They include a sluggish economy, inadequate reimbursement, and rising costs of malpractice insurance. Exacerbating the situation, West Virginia manifests numerous unhealthy statistics. For example, deaths (before age 65) due to injuries, sudden infant death, congenital anomalies, diabetes, heart disease, suicide, cancer, and lung disease exceed national rates significantly. Risk factors—smokeless tobacco use, physical inactivity, obesity, hypertension, and cigarette smoking—contribute to excessive rates of premature mortality. The opioid epidemic has also had a major impact on the state. Costs are enormous and measured in human, social, and economic terms.

Regardless of obstacles, the medical practice in West Virginia remains healthy. A new generation of medical practitioners is being prepared to advance the cause of patient care while improving the health of the public. A 2021 study showed that West Virginia had the highest percentage of medical students per capita in the nation. In 2022, there were 4,460 MDs and 985 DOs practicing in West Virginia.

Based on a 2018 study, there were 69 PCPs per 100,000 people, a lower ratio than the 76 PCPs/100,000 nationally. Forty percent of family physicians and PCPs were women, lower than the 45 percent national rate but a dramatic increase from the 18.9 percent documented in 2001. Increasingly, nurse practitioners and physician assistants are serving as PCPs. According to a 2022 report, West Virginia had the fourth lowest rate in the nation of physicians serving as PCPs: 29.9 percent. Another major trend of the early 21st century has been the consolidation of the state’s hospitals under the corporate umbrellas of major health care networks, primarily WVU Medicine and CAMC/Vandalia Health.

Written by Lamont D. Nottingham

Sources

1. The West Virginia Board of Osteopathic Medicine: The 2021 Annual Report. Charleston, WV: West Virginia Board of Osteopathic Medicine, 2021.

2. West Virginia Board of Medicine: Annual Report to the Legislature July 1, 2019 through June 30, 2021. Charleston, WV: West Virginia Board of Medicine, 2021.

3. West Virginia Board of Medicine: Annual Report to the Legislature July 1, 2020 through June 30, 2022. Charleston, WV: West Virginia Board of Medicine, 2022.

4. Robert Graham Center. The State of Primary Care Physician Workforce: West Virginia. Washington, D.C.: Robert Graham Center, 2018.

5. West Virginia Department of Health & Human Resources. Helping Prevent and Manage Chronic Disease. Fast Facts. West Virginia Department of Health & Human Resources, 2018.

6. Hill, Nancy. WVSMA Historical Monument in Rivesville Restored: Replica Placed at WVSMA Office. West Virginia Medical Journal, (July-Aug. 2000).

7. Nottingham, Lamont & Michael Lewis. Back to Rurality: AHEC in West Virginia. Journal of Rural Health, (Spring 2003).

8. Bureau of Health Professions, National Center for Health Workforce Analysis. HRSA State Health Workforce Profiles: West Virginia. Report. Washington: U.S. Department Health & Human Services, 2000.

9. Point, Warren. The Country Doctor. Robert C. Byrd Health Sciences Center of West Virginia, Charleston Division, 2001