January 2017 Member of the Month

Member of the Month: Dr. Adrian Billings

By Perdita Henry

Adrian Billings, MD, is a full-spectrum family and community medicine physician providing medical care for underserved rural and frontier medical communities of Alpine, Marfa, and Presidio, Texas. He currently serves as chief of staff of Big Bend Regional Medical Center, medical director of Student Health Services at Sul Ross State University, medical director of the City of Presidio Emergency Medical Services, associate professor of Family and Community Medicine at Texas Tech University School of Medicine’s Permian Basin campus; and supports their rural medical education efforts. He is also a liaison and contributor to all-volunteer organizations such as Frontera de Salud, and a physician advisor for Hard Hats for Little Heads.

Just looking at all he does makes me fatigued, and I still haven’t mentioned his role as a long-time preceptor, who over the years has rotated with over 100 medical students, Dr. Billings is the current program director of the Texas Family Medicine Preceptorship Program. This highly-accomplished medical professional is ardent about bringing attention and support to the people living in these communities. Every aspect of his career has been and remains devoted to helping them thrive.

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Why did you choose family medicine and what’s your favorite aspect of it?
I chose family medicine because of the its maternity care. I truly enjoy helping women bring new lives into this world and I equally enjoy the pediatric continuity of care that maternity care affords in the clinic after discharge from the newborn nursery. It is incredibly rewarding to able to have real conversations now with some of the oldest children I have delivered over the past nine and a half years. The relationships I have with the families of these children is priceless and I feel blessed to have them.

Who inspired your interest in family medicine?
I was inspired by the Del Rio family physician who delivered me and cared for me from birth into college, Dr. Ramon Garcia. When I was a junior in high school, I worked for a veterinarian in Del Rio. I assisted him with necropsies of livestock that died of unknown causes. During this time, I was raising show lambs for 4-H when one of my lambs mysteriously died. I figured I would perform my own necropsy on the deceased lamb and determine the cause of death.

I performed a 10-minute necropsy without gloves and with my scalpel — a pocket knife. I had blood up to my elbows and in the end, I still had no clue what the lamb died from. The county extension agent learned of my necropsy and decided to send off the lamb's head to the Texas A&M Diagnostic Veterinary Laboratory in College Station to investigate whether the lamb had succumbed to rabies.

I will never forget the telephone call I received the following Saturday afternoon from the county agent telling me he had just received a call from the veterinary laboratory confirming the lamb tested positive for rabies! He suggested I seek medical care immediately because of my exposure. Neither of my parents, and none of my extended family members, have a background in medicine; we were all worried. So, I went to the Del Rio telephone book, searched through the White Pages, and found the office number for Dr. Garcia in bold. Just below the office number was his home phone number. Without hesitation, I called him. He answered the phone, I introduced myself, and he knew exactly who I was. I excitedly told him what had happened and asked him very seriously, “Am I going to die?” He calmly reassured me, saying that I did not have a significant exposure and I did not need any rabies immunoglobulin nor the vaccine.

In the span of a 5-minute telephone conversation on a Saturday afternoon, he calmly reassured me. He exhibited the 3 A’s: Availability, Accessibility, and – most importantly – Affability. In my time of need when I thought I was about to be gravely ill, my family doctor was available to me on a Saturday afternoon by listing his home phone number in the phone book. Dr. Garcia was affable and not at all upset with me for interrupting his Saturday at home with his family. Because of this significant experience, I have listed my home phone number in the Alpine phone book for every year of practice here in Big Bend as a service to my patients, and as an honor to Dr. Garcia.

Several years after that rather terrifying experience, I returned home from college and spent the summer working as an anesthesia technician for the hospital. I was fortunate enough to scrub in with Dr. Garcia on both vaginal and cesarean deliveries. From that moment on, I knew I wanted to be a community family physician, just like Dr. Garcia.

What is something the “real world” has taught you about being a family physician that medical school didn’t teach you?
I did not learn how to be an effective leader while in medical school or residency. I did not appreciate how my community and patients would need me to be their advocate and leader outside of the clinic and hospital settings.

I have begun learning how to be an effective leader through my involvement with organized medicine, such as member groups like TAFP. I have had leadership mentors within TAFP that have inspired and guided me on my path to becoming an effective leader for my patients at the community, regional, state, and even international level. This involvement has made me a better physician and citizen. I am indebted to the leadership training I’ve received through my involvement with TAFP.

What one word or phrase characterizes your style of family medicine?
Service to my community.

What interests you about family medicine?
Almost everything. I like the cradle to the grave aspect of family medicine. The cerebral challenge of this type of service keeps my practice interesting.

How can we attract more medical students to family medicine?
I feel it’s important to augment the medical student experience outside the tertiary care setting by precepting them in the community. This allows medical students to discover what other roles family medicine physicians play in society.

Medical students need to experience and observe the relationships patients have with their family physicians. I believe medical students are not informed and don’t get to see how vital and important family doctors are in their patients' lives. I would like to see all medical students rotating in rural, underserved areas very early on in medical school.

What one sentence of advice would you give a new family physician?
Become involved in your patients’ lives outside of the clinic. Realize that your leadership outside of the clinic and hospital can impact public health.

What is the best experience you have had throughout your career?
I have been blessed and humbled throughout my career. I have been fortunate to have an amazing staff and patients. My family has been incredibly understanding and tolerant of my professional life. Dr. Bart Pate, a former Alpine family physician who was my mentor at John Peter Smith Hospital during my residency, gave me some sage advice. He said, “just take care of your patients and the community will take care of you and your family.” He was absolutely spot on. My family and I have been blessed by this community and the Big Bend Region. I feel that we have been given so much more than we deserve.

Also, precepting medical students and residents has been tremendously rewarding. Four former trainees have returned to practice family medicine with me in Alpine since I began hosting these young student doctors. I also feel humbled to have these young and enthusiastic junior colleagues rotating with me. Because of them I have become a better physician and my patients have received better care.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.