West Texas Pioneer

Story by Kate Alfano and photo by Jonathan Nelson

When reflecting on rural West Texas, one might picture wide-open sky and arid, rugged land against a mountain backdrop. It’s calm but with a feeling that opportunity abounds, and it’s where the 2019 Texas Family Physician of the Year has called home for most of her life.

Sheri Talley, MD, embodies the West Texas pioneering spirit. She grew up in Midland and excelled in science and human anatomy, leading her to consider becoming a medical technician. A premed advisor plus a summer drawing blood in a blood bank with high turnover nudged her to pursue medical school without a specific specialty in mind. “I’d actually thought about being a pathologist until I realized they don’t see people, they just see specimens and tissue,” Talley says. “The minute I learned what a family physician was and what they did, that’s all I’ve ever wanted to be.”

Talley completed her family medicine residency in San Antonio — the biggest town she had ever lived in — but felt called back to the mountain West and a rural practice. She trained hard with the expectation of practicing full-scope family medicine, including doing an obstetrics rotation in El Paso to get as much experience with Cesarean sections as possible. She hung her shingle in Fort Stockton, outfitting her own practice with two exam rooms and two employees. At the same time, she and her husband, Jim, were starting their family. They moved to the area when their first child, Carlos, was a baby.

There was one other doctor in town delivering babies at the time, a surgeon. Talley planned to assist with many of his Cesarean section deliveries, to build on her knowledge and experience from her training. During her OB rotation, she had performed just 15 elective C-sections and felt she needed at least 60 to be fully confident with the procedure. But being the junior physician in town meant she covered the entire community for holidays and breaks, and it was during one of these times when the surgeon was on vacation — 15 months after opening her practice — that she successfully performed a solo C-section with just a scrub nurse assisting.

But that wasn’t the most exciting delivery. Just six months after starting practice in Fort Stockton, another spring break, a woman arrived at the clinic in labor and completely dilated. Talley, who was at her home at the time, raced to town and made it just in time to catch the baby. The patient still appeared big so Talley examined her — and could feel feet. She made some quick adjustments and the second baby was quickly delivered breech. At this point, the assisting nurse told her that’s if there’s another baby in there, she’s leaving. Talley performed another quick examination, felt a head, and asked for another umbilical clamp “just in case.” The third baby was delivered shortly after and, though estimated to be four weeks premature, all were healthy. “We ended up in the newspaper,” Talley says. The neat part of the story is that the triplets still live in town and she continues to see them and their families periodically.

“The best part to me of being a family physician is being able to take care of people from the cradle to the grave,” Talley says.

“Those who practice in a rural area know what an extraordinary choice that is, being a highly valued member of your community and knowing your patients’ neighbors and the challenges of practicing in a remote area with limited resources,” said TAFP Immediate Past President Rebecca Hart, MD, when she presented Talley with the Family Physician of the Year Award. “It takes a special person to practice on the frontier in a solo practice as she chose to do as a young, female family physician.”

After the birth of her second child, Callie, Talley decided to transition into correctional care for the Texas Department of Criminal Justice facility in Fort Stockton where she cares for the incarcerated. This allowed for a more regular schedule with no holidays or weekends and limited call but a setting where she could still serve the underserved.

“I consider myself passionate about caring for the underserved and helping to reduce health care disparities,” says Adrian Billings, MD, PhD, of nearby Alpine. “I have come to realize that Dr. Talley and I are kindred spirits. Her passion for providing outstanding care to the incarcerated population that she serves is admirable and inspiring. I am a better physician and person for having Dr. Talley’s influence and support through the years. I know that her practice has also blessed her patients, staff, and community.”

Talley explained that prison medicine comes with its challenges. There is a lot of manipulative behavior; she can order things like lower bunks or job restrictions where convicts don’t have to work but she has to keenly discern the potential for abuse of her prescription pad. She determined that pain is not a vital sign in prison long before that was widespread in private practice. There is a lot of chronic care — diabetes, asthma, and high blood pressure — and her patients’ chronological ages tend to be about 10 years less than their physiological age due to life choices before prison. Some of the men can be crude or aggressive and officers have had to intervene.

“But an awful lot of these guys, once they have their substance abuse and mental health issues taken care of, they’re pretty nice, rational people. You have to learn how to say no and be firm and fair, and most of the guys handle that pretty well.” Talley added, “I’m a pretty nice person but I have had to develop that toughness and the ability to say no.”

An important part of Talley’s life is her commitment to organized medicine. Most notably, she holds the distinction of being the first female and youngest TAFP president at age 36, and she drove often between Fort Stockton and Austin during a busy legislative year when her children were ages 2 and 7. She started attending TAFP meetings as a medical student at the encouragement of a faculty member, and former TAFP Executive Director Jim White guided her in how to be involved and stay engaged. She was TAFP’s Student Affairs Committee chair and then resident chair. When she was a resident, the Academy launched constituency group meetings and she served as the first delegate, representing women, and convener of what is now the AAFP National Conference of Constituency Leaders.

“Sheri brought passion and hard work to her efforts at TAFP,” says Nancy Dickey, MD, who was the first female president of the American Medical Association and is the current executive director of the Texas A&M Rural and Community Health Institute. “I particularly appreciated that she, like me, made it a family affair, often bringing her husband and children to meetings. Physicians are busy and adding additional demands on their time — like serving a professional organization — can be more than the calendar can tolerate. But finding ways to weave two or more of these together, like having your family time overlap your professional organization time, helps the busy schedule. Sheri is a quiet leader, a good recruiter, a committed family physician and a steady hand at the helm.”

Billings, her nominator for the award, credits her for his leadership success. As she did with many, she reached out to him at one of his first meetings to encourage him to get involved, telling him “we need more West Texas physicians like you to be involved in the leadership.”

“This was a huge surprise to me as a junior physician that a former TAFP president would see potential in me,” Billings says. “This singular event gave me confidence to get more involved in the community. I wonder how many other current leaders received similar votes of confidence from her. I think that a true leader looks for future leaders so as to hand off leadership and make things better than they were during their own leadership.”

It is true that she continually encourages the next TAFP leaders, even calling for involvement from physicians when she accepted her award and deferring attention to her peers — another attribute of a great leader. “I think that one of the reasons I was nominated was at the time, especially when I had a lot more energy, I was working on inclusion, trying to get our physicians to look like our communities and our leadership to look like our physicians,” Talley says at the awards ceremony. “And if you look across this room … now there are a lot more women and people of color. Looking at all of these people with these wonderful awards, I think the specialty is in very good hands.”