“You must be Dr. Talkington’s daughter! I recognize you from the pictures in his exam room.” My sisters and I heard this countless times growing up in Franklin, and each time I felt a surge of pride when they would tell me how much they loved my dad. I knew he was a gifted provider, but it took becoming a midwife to truly understand the depth of his commitment to his vocation.
I can see the parallels between our careers that are unique to only those serving as independent health care providers. I can see that one of the reasons I am a good midwife is because I watched my dad. I watched him welcome, laugh with and care for hundreds of community members over 48 years of practice. I watched him listen. I learned that providing health care is so much more than doing an eye exam or, in my case, a prenatal visit.
When asked why he became an optometrist, he simply said he’s never wanted to be anything else, but having had glasses starting at age 3 “probably had something to do with it.” Any time I have asked him to explain any part of his work, his eyes sparkle and his mouth carries a smile behind his words. I watch him talk about the eye and can see the same fascination I feel when I talk about the body’s ability to birth. We are both driven with innate experience and interest in what we do.
My father was licensed in 1978 and my parents chose Franklin as their place to settle. The local optometrist, Dr. Zeigler, was selling his practice. Franklin’s downtown was bustling. There was JJ Newbury’s Department store, Dan’s Pharmacy and Grevior’s Furniture. There were clothing stores for both men and women, a shoe store and various professional services. My father shared a building with Dr. Kropp, a medical doctor. The building, now demolished, sat across from the famous Brother’s Donuts and next to Keegan’s Hardware.
As their community roots in Franklin grew deeper, my parents purchased a building next to the post office for the practice. I have glimpses like a slideshow of the renovations — friends and family all pitching in — and I remember my father’s excitement. I was a kid, goofing off on the spinning exam chair and playing hide-and-seek in the cupboards. Looking back, I have an overwhelming sense of pride for the vision (pun intended) they had for their lives and the community. I had the same feelings of pride and community investment when I bought Concord Birth Center.
We spent countless hours at “the office” and I was given the gift of witnessing the life of an independent health care provider. It was a true family business: my mother was answering phones, scheduling, cleaning and teaching people how to put in contact lenses. Dad would receive night and weekend calls at home and went to the office to repair broken glasses or assess a case of conjunctivitis. He connected with people and had immense satisfaction in improving people’s lives with better vision and, more likely than not, a silly dad joke. He showed me that providing care was more than assessment and prescription. Providing care was seeing the humanity in every patient.
After 37 years, my dad closed his practice and has worked for Laconia Eye for the past decade. When I asked him why he ultimately made the move, he told me that technological advances in optometry required the purchase of expensive equipment in order to maintain standard-of-care practice, and combined with poor reimbursement rates from insurance, having his independent practice was no longer a viable business model. He noted that most optometric providers have chosen group practice for these reasons.
I, too, had to make the decision to close. My freestanding, independent birth center provided quality, individualized care for low-risk people at an affordable cost. We accepted insurance, including Medicaid. We had good outcomes and high client satisfaction. We saved private insurers and New Hamsphire Medicaid hundreds of thousands of dollars compared to hospitals. Despite all this, we were consistently undervalued with poor insurance reimbursement and high insurance costs.
I began to realize I was burning myself out working for a system that didn’t value or support me — so I closed. While I still am a practicing homebirth midwife, I have stopped taking insurance and significantly scaled back my business. Closing was an agonizing decision, and once again, I felt connected to my dad.
Both of us have, over the course of our careers, seen the erosion of independent providers in almost every field. Unfortunately, this has led to a system where many providers lack the control to be able to provide the type of care they envisioned when they entered their field of practice. Sometimes we’re bound by strict protocols due to fear of malpractice lawsuits. Sometimes it’s the inability to see your patients for enough time to give them individualized care or answer their questions. Sometimes it’s having so much demand on your time and energy that you begin to harden yourself to the people you are meant to care for.
I have spoken to many providers who work for hospitals or larger health care systems who are daydreaming about leaving for an independent practice. It’s not an easy decision to leave a secure, well-paying job to practice independently. It’s risky to put yourself out there with no safety net, which is why many choose to stay in a larger system.
But if you look, you’ll see us. We are physicians, mental health providers, physical therapists, dentists, veterinarians and more. We made the decision to be independent so that we could care for you fully, on our time and on our terms. I’ll meet with you for an hour each visit, and the time we don’t spend talking about your pregnancy, we’ll be getting to know each other better. If you call, I’ll be the one answering the phone — whether it’s to set up an initial visit or letting me know your water broke.
When you see Dr. Talkington, congratulate him on a decades-long career serving the community of Franklin, and remember that when people deeply care about people, a healthy society is formed and humanity flourishes. When you see your medical providers, whether they practice within the system or outside of it, remember that they became providers to make people’s lives richer and healthier.
Dad, I love you, and I am so proud of you.
Kate Hartwell is a New Hampshire certified midwife based in Concord.