MOTT BLAIR, M.D.

April 18, 2000

Interviewer: Beth Nelson

Beth Nelson: Will you start out by talking about pertinent aspects of your background, your education and that kind of thing. I know you grew up in Wallace.

Mott Blair: I was a graduate of a local high school here in town and did part of my undergraduate at Davidson College. I finished and received my Biology and BS degree at the University of North Carolina in Wilmington. We moved to Greenville and did some postgraduate work for about a year and then got into medical school at East Carolina University School of Medicine. I finished there in 1987 and then did my residency with the Department of Family Practice at Pitt County Memorial Hospital.

Beth Nelson: How long were you in Greenville?

Mott Blair: Eight years.

Beth Nelson: So, when you finished your residency you came here to join your dad's practice?

Mott Blair: That's right and I joined my father's practice here and I have been here ever since. I have been here almost a decade now.

Beth Nelson: Was he a solo practitioner when you joined him?

Mott Blair: That's right, this was a solo practice and he had slowed down and he was almost part time at that point and then I joined the practice and it became a full time practice again. He retired about two or three years ago, subsequently he is deceased now.
Now I am in solo practice again.

Beth Nelson: Are you planning to add another partner?

Mott Blair: I think at some point we will add another partner. I would like to as I think there is a lot as obviously practice economics come into play without adding partners and recruitment factors. One thing we have done recently is gone through a complete renovation of our office. We have added more space so we are at the point where when we decide to move in that direction we will be ready but at this point it is sort of an indefinite time, I think.

Beth Nelson: What about you as a solo practitioner, when I think of the life of a solo practitioner I am sure it is very demanding and that kind of thing. How many physicians are there in Duplin County?

Mott Blair: Well, I can't give you an exact number. It is a big county geographically wise. We have a lot of communities and we also have a very large population, close to 50,000. Our practice actually draws from a lot of the neighboring counties. We draw from Pender County and Sampson County. We actually have a fairly large practice area. We are in a rural area as Wallace is kind of an agricultural center where a lot of people traditionally have come to town for their basic needs whether it's buying seed or fertilizer, buying clothes or seeing their doctor. I actually have a pretty busy practice and there are a fair number of physicians in the community. There are not many family physicians in the county. There is probably myself, Derek Crawford, Ben Clayton. We are pretty much the family practitioners in the county. There are several internists here in town and then Rodney and Kim Sessoms. Kim is in Rose Hill and is a graduate of ECU. Did her residency in Pitt. Rodney is actually practicing in an adjacent town but he is also a graduate of ECU medical school and its residency programs. We sort of teeter on the edge of being a health professional shortage. When I came here we were and then we were not. We are probably would be qualified now taking into account the fact that some doctors have passed away or have retired.

Beth Nelson: Let's go over how you came to be associated with the hospital. Why was it that you chose this area to go to medical school when you probably could have gone across the Country if you wanted to but you particularly chose to remain close to home?

Mott Blair: That's a good question. I always looked at returning to a rural family medicine practice and at the time East Carolina had great emphasis on primary care particularly and one of the missions, as you know, was training rural physicians and satisfy the need for physician shortage in eastern North Carolina particularly. For me it was a perfect fit. I knew I was going to come back here in rural North Carolina and I did my training in an area where I would be practicing. Also, to establish connections and referral for when I was out in practice.

Beth Nelson: I am sure you probably remember all the issues around creating a medical school in Greenville and that kind of thing and you were probably too young to be much affected by it, you are probably younger than I am, I think I was about in the seventh, eighth or ninth grade at the point that I remember it being talked about quite a bit, but your father probably has told you quite a bit about his involvement in the fight for the school of medicine. What was his perspective and what have you heard him say?

Mott Blair: Well, I think he was always in favor of it and I do remember times when it was being discussed and obviously it was not well received in other parts of the state.

Beth Nelson: How was it received here?

Mott Blair: It was received here as a positive thing and my dad certainly was very much in favor of it. I always admired the leadership and the visions in an effort to get a medical school in the eastern part of the state. I think the medical school has been a source of regional pride. I think it has done the hospital many good things, not withstanding that it has become a great tertiary care center and it is easily accessible. I talk to parents even today whose children they had to drive for three or three and one-half hours with their child to get care where with the medical school now it would not be an effort. We have seen a lot of benefits. We have seen the benefits of outreach clinics, telemedicine, particularly I think the outreach clinics have been really beneficial in being able to travel to within fifteen miles and you go and they will see you. Cardiologists, specialty care, and to have that available as a primary care doctor having it easily accessible certainly, I think, improves the health of everybody.

Beth Nelson: You admit to Duplin General?

Mott Blair: Actually right now I have an ambulatory practice, but we do admit.

Beth Nelson: You are kind of geographically located in a spot where you could refer to a number of large centers in addition to ours, and you probably do some in fact. I don't know what percent of your patients you would be referring to us versus other hospitals, but are there some factors that maybe you look for certain specialties that you would refer to Greenville more so than others?

Mott Blair: In all fairness I think often times when you refer people you refer to a place but you also refer them to people. The thing that has always impressed me about Pitt is the quality of the institution from top to bottom and I also can say I have never had a patient who has gone to Pitt who has not come back with a positive opinion of Pitt from top to bottom, from the attending who took care of them to the person who brought in their tray or even to the person who cleaned their room. Their care has been compassionate and courteous and I think patients really respond to that. I cannot say that for all medical centers.

Beth Nelson: Why do you think it is that way?

Mott Blair: I think it comes down to the leadership of your institution. I think that kind of attitude starts at the top and goes down and I think you have a good patient guest relations. That kind of effort begins at the top and goes down. I think it also goes back to the kind of people you have at your institution. An institution is only as good as the people who are running it. It is only as good as your weakest link and I think we have been fortunate to have Pitt and East Carolina and that we have brought in really great people and it shows.

Beth Nelson: Do you come back to Greenville for CME?

Mott Blair: Yes I do. I attend all CME there and usually try to attend a pediatric session once a year. When I can get out of my schedule I always do that.

Beth Nelson: Can you think of some things that you recall about your experience in Greenville, things that maybe in terms of extraordinary things that have happened to patients that you have sent to Greenville. Any indications of how far the medical center has come over the years?

Mott Blair: I have certainly been impressed by the technology and I think the cardiac program particularly I am really impressed with. I think it is exciting to me that in back woods countryof North Carolina we have got cutting edge technology particularly in the use of robotics and other things that Ranny Chitwood is doing that I read about. I think we are fortunate to have that. I am excited about primary care and rural residencies that have kind of evolved and also about the fact that they are meeting their mission which is primary rural health doctors. Just look around our county and see the influences here which are excellent. Getting primary care doctors out in the community excites me. I think that those are just a few of the examples.

Beth Nelson: What about any stories, vignettes, things that stick out in your mind that you can think of?

Mott Blair: I was thinking just the other day about the thing that has always impressed me, of course, is sometimes the technology is not the answer, I mean I think you always come back to high touch medicine and that is what was always told to us was not necessarily technology but it was the high touch medicine that we practice that is important. A lot of times you just use some of that good old country medicine when you practice medicine and it works just as good. The thing that stands out in my mind as an example is Dr. Pories who of course is an excellent surgeon, but he would always have us take our patients who were going to have lung operations and take them back to the stairwells and have them climb the stairs in their pre-op evaluations and if they could make it up two flights of stairs then he felt like they were candidates for surgery. It was ultimately practical and yet it served its purpose. If they couldn't make it up that flight of stairs then they were not going to tolerate the surgery very well and we would have to spend $1,000 to find a practical method but that was a good example.

Beth Nelson: So there was all the technology at his command and he chose to use the stairway.

Mott Blair: He will probably shoot me for telling this but you know it was just ultimately practical.

Beth Nelson: What about incidents where you have patients who have had experiences that might not have had as positive an outcome if they had traveled farther?

Mott Blair: I had one patient in particular that I think about and every time I see her I think that she is really a miracle. She had a cerebral bleed and hemorrhage and assessment was to transport to Pitt. She was actually comatose, no response and was taken there and cared for and now is back talking and walking. For all practical purposes if it hadn't been for the helicopter, if it hadn't been for transport and the excellent care she received, I know she probably would not be alive today. She was in her early fifties and we have talked about it several times and this is her second chance. It was a miracle and she certainly had some excellent care along the way.

Beth Nelson: Can you think of some major obstacles the hospital had to overcome?

Mott Blair: I think the hardest obstacle was the political opposition that they had at the very beginning. I think that has been overcome and I think Greenville in the medical school and the hospital now has its place at the table in terms of respect. I think that certainly was a big obstacle they had to overcome.

Beth Nelson: Which class were you in?

Mott Blair: I was in the class of 1987.

Beth Nelson: So you would have been about the sixth graduating class?

Mott Blair: I am trying to remember. It was two years at first and then it was four years and I am trying to remember and sixth was probably right.

Beth Nelson: You took a little bit of a gamble going to a medical school and residency program that were both new and untested and that everybody in the state said was going to be a joke academically and would never succeed. As it turns out, what has been your experience there? Has that been a fact that you had to prove yourself maybe because of the reputation that ECU had to overcome?

Mott Blair: I think I don't know if it was a gamble for me. I made my choice based on what I felt like I needed, the kind of training I needed and what I wanted to do and so in that sense I don't think it was a gamble for me. I think by the time I graduated from medical school and started to go into residency, East Carolina, particularly the Department of Family Medicine, had established itself as a program of national prominence, and particularly by the efforts of Jim Jones who was President of our North Carolina Academy, who went on as President of our national academy, I think his efforts and energies really brought a lot of respect to our program to where we were one of the premier family practice programs. Not only were we the premier program in the state but one of the top programs in the nation as well. I felt pretty confident about my choice of residencies. One thing to Pitt's credit, I think, is that family medicine particularly has always enjoyed kind of an equal seat at the table, especially it has been well respected and we have been treated as equals in all rotations and I think that has been unique and in the past and might still be different in some centers where we have not had the acceptance that we certainly deserve.

Beth Nelson: You were just recently at the beach for a meeting with your colleagues. Looking back over your choice and that kind thing, with interaction with your colleagues, do you feel like your choice now looks as good as it did going in?

Mott Blair: I think so. I am satisfied with my choice. I quite happy with it and actually a lot of my colleagues there did train in Greenville so there are a lot of Greenville connections. It is interesting to me when you look back, years ago they wanted a closer primary care program and yet now today they are turning an about face. They really need to have their own health network and I think that a lot of medical centers are realizing now in retrospect is that the real value in primary care, particularly in giving good quality health care, and now are making great strides and investments in it, and we have known that all along in the eastern part of the state. That has been an initiative priority from the day the first stone was laid for the medical school. So, we were ahead of everybody.

Beth Nelson: What do you think are the reasons for the hospital's success?

Mott Blair: Number one, I think that they have a mission and they stuck to the mission; I think they deliver good quality health care; I think they are in an area of geographic need; I think that they have done the things that they need to do to be successful. I think it is a simple formula, if you do a good job of what you need to do you are going to be successful and they are.

Beth Nelson: Speaking of need, I talked to your brother quite a bit about this and he said your dad had quite a bit to do with your choosing family medicine and your choosing to come back home to practice. Talk a little bit about that.

Mott Blair: I think that certainly he was a great role model for me and certainly influenced me a lot in my career choice and my career path. Particularly, I always thought he was the best family doctor. He had various points in his career but he delivered babies, home deliveries, home visits. This was probably twenty or twenty-five years ago. He would be riding out in the country and he would say he wanted to tell me a story about a certain house where he went out to one time and he would go into a story about what he did or what happened. He had a lot of really great stories about primary care. I think he really influenced us all a great deal, me in particular I think. I really wanted to go into family medicine.

Beth Nelson: It seems like in talking with your brother he kind of chose a different route before he discovered that it was what he wanted. Anyway, he described you as being the more cerebral one. He seemed to sense that you always knew that was what you were going to do and you set that for your path and never veered from it where he went into it after trial and error I think.

Mott Blair: That's right and you know I always knew from my high school days that I wanted to go into medicine. I always enjoyed people; always enjoyed science a lot; I enjoyed talking to people, interacting with people and was challenged by science particularly. To me, it was an ideal fit and my dad was an appropriate role model so it just an easy fit to make. I can't remember a time when I didn't want to be a doctor. I just cannot remember that.

Beth Nelson: Your brother definitely saw you as being more willing to make the sacrifice academically.

Mott Blair: Well, although we took different paths, we sort of came to the same conclusion but clearly I had decided a long time before that it was what I wanted to do.

Beth Nelson: What was the appeal about going to an underserved area versus of going to another area with the attractiveness and challenge of that?

Mott Blair: I think it was very challenging to come back to an area where you grew up. Some of your patients are your friends. Particularly first starting out that was very challenging to me being in a different kind of role than what you were before. I think the benefits certainly outweigh things. There are some days you are visible. People stop you in the drugstore and want to know what's wrong with their back and this kind of thing. People drive up to the yard and blow the horn at you. The other positive is that you are a member of the community and you know people, you know who they are, and you know the family and you are involved and you can contribute in a lot of other ways. People have known you since you were growing up they think they can trust you because they know who you are. They know what you are like. I think it was really positive to come back to a rural area.

Beth Nelson: Talk a little about some of the key individuals who you think contributed to the success of the medical center.

Mott Blair: Honestly, I think everybody applauds Leo Jenkins even though I didn't know him. I think just from what I know he had was one of the first, if not the first, people who had the political forethought to push the agenda of having a medical school in the eastern part of the state. He certainly was probably bucked in every corner of the race. When I look back on the formative years of the medical school certainly who influenced me the most, I think a number of people. Certainly Jim Jones I would mention again as somebody who was a leader in the medical school in primary care and I still remember that picture of Dr. Jones standing outside of a little trailer with his nurse and that was the family practice. He took it and built that foundation, that program and certainly when we were there as residents he certainly had a big influential role. I think Dr. Pories probably did the same thing with the surgical program and I think there were a lot of other people who had that role as community doctor and then rolled over to the medical school and built it up to what it is. I think a lot of the community doctors have really gone on and become medical school physicians. Community physicians going into the role of being medical school physicians have had a big impact because they had really laid the groundwork for what has happened now.

Beth Nelson: What about any private practitioner who had a good deal of influence. Can you think of anyone in particular?

Mott Blair: I think as far as influence in the medical school or in my career, I think the private practitioners to jump in my mind I think who had influence for me in my career are the ones I have named already. Chris Brown, a physician in Kinston, who came to the medical school and was very involved. Some of the physicians who contributed a lot to my education were community physicians. People like Dr. Jack Rose certainly contributed a lot. The ENT docs, Dr. Bost, Dr. Camnitz contributed a lot. Those are the people who come to mind. The may not have had much to do with the formation of the medical school but they certainly impacted me when I did my training. Those are the people who kind of stick in my mind.

Beth Nelson: What do you think are the challenges for the future?

Mott Blair: I think the biggest challenge for Pitt is not going to be any surprise. I think it is going to be at this point managed care. What I see right now in the state particularly is that hospitals are getting very aggressive and getting territorial in establishing territories. I think the challenge for Pitt, which it is already focusing on particularly with the evolution, is establishing that referral base and that referral pattern and retaining its influence in the east because certainly lots of other medical centers would love to step in. I think this is probably the biggest challenge for right now. I think another challenge is to continue to be true to your mission. I think it is easy sometimes to lose track and sight of how you came in to being to begin with and I think we cannot forget that one of the reasons you are there is because there to serve the rural communities and I think with the increase of pressures of HMOs and territorial squabbles, it may be easy to kind of forget that this is our mission and we need to continue to remember this as to why we are here. This is one of the reasons why we came into being. Needs change over time but that one should continue to be an ongoing need.

Beth Nelson: I think it is very important to be true to your mission and feeling that essentially it was the main reason you were created.

Mott Blair: Right and I think if you look at organizations and why organizations fail, as often times they fail when they forget their mission. I think that is a challenge for any organization whether it is a hospital, medical school or institution; it is easy to get lured away from that mission. I think that will be a challenge. I don't see that Pitt is forgetting its mission, I think the medical school and Pitt are remembering that mission but I think that it will be a challenge to keep true to that mission.

Beth Nelson: Tell me a little about your family, about your children.

Mott Blair: I have three children. One is a rising second grader and the other one is a rising fourth grader. I met my wife at Pitt and she was a beautiful nurse coordinator who came around and looked at the charts. I always admired her and she was bold enough to sit down with me at lunch one day. Being a lowly medical student I didn't think that this nurse could possibly be interested in me but eventually we crossed paths and became an item and we got married. After I graduated from medical school I sent her a postcard and I didn't sign it with my name but signed it with my initials. Actually she had just moved to a different position but the girls there forwarded the postcard to her and it took her a while to figure it out. So she calls me and at the time I was doing the intensive care unit and it was about 4:30 p.m. and I had been on call all night. My patient started to have chest pains so I am over here talking to her, hadn't talked to her since, the nurse would come out and tell me my patient was having chest pains. Finally I told her to give me her number and I would call her back. It took me about a month or two to call her back and she was still a little bit mad about that.