Self-starter, rural role model, community benefactor, and international connector
Self-starter, rural role model, community benefactor, and international connector
Story by Kate Alfano and photos by Jonathan Nelson
Jorge Duchicela, MD, is the embodiment of a successful family physician, though it was with great humility and gratitude that he accepted the honor as the 2017-18 TAFP Family Physician of the Year at the Academy’s Annual Session and Primary Care Summit Business and Awards Lunch last November.
He recognizes that many physicians around the state and country do what he does: provide high-quality, compassionate, and comprehensive medical care for generations of patients and improve their community through active involvement. Duchicela’s brand of medicine, though, extends further. He has been instrumental in leading the Youens & Duchicela Clinic, a rural private practice in Weimar, Texas, that is successful by every metric. He mentors family medicine residents and demonstrates the immense personal and professional fulfillment of rural medicine. He co-founded a nonprofit to improve education for local youth and secured sports facilities to provide safe, dedicated space for young athletes. He founded an international nonprofit to help medical students serve a community in need abroad and learn to better communicate with Latino patients at home. And he is actively involved in organized medicine to promote legislative involvement, physician autonomy, practice innovation, and wellness.
Born in Ecuador, Duchicela was 8 years old when his family moved to Costa Rica and later to Panama to seek new opportunities and escape tensions brewing from the Cold War. His father’s employer, an American food company, allowed their employees’ children to receive their high school education in the United States, leading Duchicela to a boarding school in Wisconsin when he was 13. Though he had an older brother with him for two years, he was on his own during his school years and after, sowing the seeds of independence, self-sufficiency, and persistence that would benefit his future career in medicine.
He originally intended to return to Ecuador after high school, but he won a partial scholarship to play soccer at the University of Wisconsin-Milwaukee, a Division I program. So he stayed, supplementing his income with on-campus work while pursuing a biochemistry/pre-medicine degree.
“I owe my decision to pursue medicine to both my mom and my dad,” Duchicela says. “My dad had very high standards for academic and intellectual development. He instilled that in all six of his children; all of us became professionals. My mom instilled in me compassion, human relations, generosity, and service to people in the community.”
Though playing soccer helped fund his undergraduate education and is partly responsible for introducing him to his wife, Juanita — who saw him play and struck up a conversation in the university cafeteria — he admits it was challenging to maintain an active training and travel schedule along with a rigorous academic course load. He was also anxious about applying to medical school since he didn’t know much about the process; he says he didn’t fit the normal profile for a U.S. medical school applicant in the 1970s. Despite that anxiety, his MCAT scores, high undergraduate grades and “other qualities they must have seen in me” granted his admission to the University of Wisconsin School of Medicine in Madison.
His specialty of choice was not family medicine, though, and because the medical school didn’t have a compulsory family medicine rotation he wasn’t exposed to it during these early years in his education. Instead he wanted to pursue plastic surgery, the specialty he felt would allow him to keep in touch with the culture and people of his ancestors in Ecuador — his longtime dream. At the time he was in contact with his medical school’s chief of plastic surgery who was a good friend of a plastic surgeon at Stanford who was a good friend of a plastic surgeon in Ecuador, and the three of them had created a nonprofit, Interplast, to help children with cleft lip and cleft palate in Ecuador. “I thought that was a great idea, maybe I can do that. I can spend time here in the United States and in Ecuador.”
So when it came time to apply to residency, Duchicela and his young family — his wife and two children who were born during his first and third years of medical school — looked around the country for a surgical program that could put him on his path to plastic surgery. They wanted a location in a warmer climate and a large urban area closer to Latin America, settling on the University of Texas Medical Branch in Galveston.
“Dr. Duchicela is known by all in the Department of Family Medicine at UTMB as one of the most caring, compassionate, and committed family physicians our residents and medical students have been assigned. He is the role model that we highlight to all our learners as he continues to help us with our resident and medical student curriculum.”
– Barbara L. Thompson, MD
chair of the UTMB Department of Family Medicine
During his first year in residency, though, his father became terminal with lung cancer and moved from Panama to Galveston to be closer to his son during his treatment. It was through this experience that he witnessed the comprehensive and compassionate care provided by UTMB family physicians and first learned of the value of “preventive, comprehensive care intertwined with evolving continuity” that family medicine provides.
Touchingly, he describes the moment when one of the founding physicians of the UTMB Department of Family Medicine, Alice Anne O’Donell, MD, “saw my father die, and with compassion and tenderness she turned the machine off.” Later the following year, while he was still in the surgery program, O’Donell, Angela Shepherd, MD, and another family physician colleague delivered Duchicela’s third child and took care of the newborn at St. Mary’s Hospital in Galveston.
“That’s how I became acquainted with family medicine, not only the specialty but actually how family physicians take care of patients and their philosophy of care,” Duchicela says. “I learned a lot in surgery in the year and a half that I was there but in retrospect I felt that I was always a family medicine doctor at heart, I just didn’t know it. It was a great match for me for what I wanted — intellectually challenging, scientifically based, but also humanistic in its execution.”
From Galveston, Duchicela spent a year with Bill Gonzaba, MD, of the Gonzaba Medical Group in San Antonio that he likens to a fellowship —long hours but invaluable experience and knowledge about how to grow his own practice. He was looking for his own place, though, and soon found himself in a Dairy Queen meeting with the longhaired, boot-wearing Robert Youens, MD, who at the time was exhausted from a period of relentless and fruitless recruiting to his rural town of roughly 2,000 located halfway between San Antonio and Houston.
Jorge Duchicela, MD, instructs Leah Mikesky, a second-year medical student at the University of Texas Southwestern Medical School, as they conduct an examination of George Berger, one of Duchicela’s longtime patients.
“Youens defined the 24/7 work of the mystical country doc of yesteryear’s lore,” Duchicela said in his acceptance speech for the award. “Running a solo practice amidst farmers, ranchers, laborers, migrants, students, business owners, the wealthy, the poor, the illiterate, the erudites; he took care of them all. He, a third-generation family physician, had inherited a wealth of medical and business knowledge, scales that I doubt he himself was aware of the magnitude of this legacy. He was a great teacher to me and I admire him most.”
“He was like my soulmate,” Duchicela says. “It was a good match because we were very progressive in a lot of ways, in our thinking, socially and economically; we respected each other. The same things that I held to be valuable he also held to be valuable. … We took pride in seeing patients, in being available to our patients and in getting involved in our community. We thought it was our duty, our responsibility, as family physicians.”
His sister, Olga Duchicela, MD, joined them in the year 2000. “She has always been there to help us with our patient care, has been involved with the community. She fit right in with our philosophy of patient care, bringing new skills, innovation, and a refreshing energy to the culture of our workplace.”
The physicians worked hard, embodying their slogans, “if it ain’t broken, break it; be innovative, stay ahead of the game, change things; and if something is working well, see if you can make it better.”
One major component of their business model was employing the use of medical scribes 25 years ago, well before it became common practice, so the physicians could keep their focus on the patient as the scribes input data to the paper medical record and eventually the electronic medical record. “That model continues to be there and is a well-oiled machine. I am the physician, I am not supposed to look at the screen,” he says. “I am listening to my patient, having significant, culturally appropriate high contact and examining my patient, not diverting my attention. When you do that, you save at least 50 percent of the time.”
“For example, if a doctor is able to see 25 patients in a full day, I’m able to easily see — with better amounts of attention because it’s not diverted ’ 50 patients a day. The workflow is good. The patient feels they have had enough of me during the visit and I can see more patients.”
As the movement toward forming groups for better coordinated care gained speed, forward-thinking Duchicela co-founded Alliance ACO, a clinically integrated network of more than 60 family physicians to manage population health for more than 17,000 Medicare beneficiaries and commercially-insured patients in value-based care contracts. The Alliance ACO providers are all independent, community-based family medicine physicians in solo or small-group practice in Kerrville, Gonzales, LaGrange, Shiner, Victoria, Weimar, and Yoakum.
“I learned a lot in surgery in the year and a half that I was there but in retrospect I felt that I was always a family medicine doctor at heart, I just didn’t know it. It was a great match for me for what I wanted — intellectually challenging, scientifically based, but also humanistic in its execution.”
– Jorge Duchicela, MD
“As co-founder of the Alliance ACO, Dr. Duchicela is responsible for bringing significant financial resources to these communities including several million dollars in federal funding from [the Centers for Medicare and Medicaid Services] to support the delivery of quality health care in underserved rural areas,” wrote David Spalding, chief operating officer of TMA PracticeEdge, in a nomination letter for the award. “Working with his fellow co-founders and board members, Dr. Duchicela is today ensuring the foundation being built with the support of these investment funds is based upon the best principles of family medicine: continuity of care, comprehensive attention and preventive medicine. Dr. Duchicela has been a driver of this vision, which he believes provides the best health care outcomes for rural communities and a healthier quality of life for all the citizens in rural central Texas.”
In concert with maintaining a successful family medicine practice, Duchicela and Youens held their families sacrosanct and would cover for each other if one needed to be away from the practice. “That made it a very pleasant, idyllic kind of life that we lived,” Duchicela says. “Our families were not suffering at all. His kids and my kids did very well even though they were raised in a small community.” Two of Duchicela’s children are family physicians and his youngest daughter is a computer scientist. One of Youens’ children is a family physician, another is a pathologist, and another is a nurse anesthetist.
Leah Mikesky observes as Jorge Duchicela, MD, sutures a patient’s laceration.
Despite the demands of his practice and dedication to his family, he kept the promise to his rural town and has continued to contribute significant time to community betterment and philanthropic endeavors. “The communities of Weimar and Schulenburg are wonderful to live in and I’m very humbled by the fact that I’m able to add a little bit to it because they’ve pretty much got everything they need,” Duchicela says.
Duchicela started the local soccer program more than 20 years ago — a nod to the sport that allowed him to obtain his U.S. education — and along with Ken Yoder, MD, a local retired surgeon, was instrumental in acquiring 19 acres of land for the city to develop a multiuse sports complex for soccer, walking trails and other recreation. His clinic organizes an annual 5 kilometer fun run during the local Gedenke! Weimar German Festival with proceeds benefitting the sports complex.
He co-founded SWIFT (Schulenburg and Weimar In Focus Together), a community-based nonprofit to support and enhance the education of local elementary school children by bringing in funding and volunteers from AmeriCorps. “Recognizing that any youth not reading at grade level by third grade has a very high probability of ending up in the welfare or judicial system, the vision was to raise funds for tutoring students struggling with reading and math in the local public and parochial elementary schools,” wrote Sylvan Rossi, longtime SWIFT executive director, in a nomination letter. “Dr. Duchicela realized that to make long-term improvement in the local quality of life, the effort had to begin with our youth.”
Duchicela also founded Cacha Medical Spanish Institute (Cachamsi) that brings medical students to Chimborazo, Ecuador, to help them learn or improve their medical Spanish, and improve medical care for Latino patients in the United States and the native people. This allowed him to realize his longtime dream to serve the people of his ancestors in Ecuador while also helping his larger community of Latinos in the United States. Since the organization’s founding, more than 1,000 students have participated in the immersion program.
Dr. Duchicela is proud of his team at the Youens & Duchicela Clinic in Weimar, Texas.
“Dr. Duchicela’s program is truly a leader in what can and should be done to improve the ability of U.S. physicians to work both more effectively in their local communities as well as gain a deeper understanding of global health,” wrote Yvonne Maldonado, MD, professor of Pediatrics and Health Research Policy and chief of the Division of Pediatric Infectious Diseases at Stanford University School of Medicine, in a nomination letter.
And throughout much of his career in Weimar he has taught medical students and residents in his clinic. He and Youens hosted family medicine residents through UTMB’s Rural Training Track Family Medicine Residency Program, and later this program developed into the Integrated Rural Training Track Program, of which Duchicela served as medical director. The training track produced 17 graduates from 2000 to 2015, and more than 70 percent of these graduates selected a rural or underserved location for their first practice location.
“Dr. Duchicela is known by all in the Department of Family Medicine at UTMB as one of the most caring, compassionate and committed family physicians our residents and medical students have been assigned,” wrote Barbara L. Thompson, MD, chair of the UTMB Department of Family Medicine, in a nomination letter. “He is the role model that we highlight to all our learners as he continues to help us with our resident and medical student curriculum.”
On the statewide level, Duchicela is active in TAFP, the Society of Teachers of Family Medicine and the Texas Medical Association. He is the chair of TAFP’s Commission on Legislative and Public Affairs and a member of the TMA Council on Health Care Quality. “I learn from my involvement in these organizations and take it back to my practice to medical students who rotate through my clinic.”
As for the future, he is recruiting younger physicians to join him but he hasn’t made plans to retire. “I really enjoy this too much and I’ve been fortunate that my health is good,” he says. “There are so many things we need to do for our patients in this country. I think family medicine is the answer to galvanize what we need to do in order to change for the better.”