Born in India, Transforming Rural Md.

Extended Family of Medical Specialists Helps St. Mary's Thrive

St. Mary's County was once a place where no doctor wanted to settle. In the 1970s, the county hospital used decades-old equipment, struggled to make payroll and had no full-time specialists -- not even an obstetrician, although more than 600 babies were born there each year.

Then came Vinod K. and Ila Shah, Bombay-educated and D.C.-trained husband-and-wife doctors who were eager to open a practice in the rural area. They had heard about St. Mary's from Vinod's younger brother and were enticed by the potential impact that even a small practice could have there.

"It was just like miracle workers walked in," said Richard Martin, 92, who was then head of the hospital. "I told them, 'You are the answer to my prayers.' "

The couple was soon joined by Vinod's younger brother, Umed K. Shah, a gastroenterologist. Next came two family friends. A few years later, another brother arrived, cardiologist Anil K. Shah, with his wife, Beena Shah, a neurologist.

In time, Vinod and Ila Shah recruited more friends and family, including the rest of Vinod's eight siblings, each of whom is a doctor or is married to one. They built the largest private specialty practice in Southern Maryland, Shah Associates, which has treated about 90,000 of St. Mary's 110,000 residents.

For many years, foreign-born doctors have been the unlikely medical backbone of rural America. In the 1970s, the United States actively recruited them, promoting the opportunities available in remote areas avoided by many U.S.-born physicians. Then, starting in the 1990s, a visa waiver program promised to fast-track doctors to a green card if they worked in a rural area for at least three years.

Today, at least 23 percent of practicing doctors in the United States attended a foreign medical school, and almost all of those practitioners were born overseas. But recent changes in visa policy have had the unintended consequence of slowing the flow of foreign-born doctors to rural areas, a trend that Shah is, in small ways, resisting.

Two generations of Shah doctors see patients who span several generations of Southern Maryland families. "We come here for everything," Navy retiree Paul Hailor said at their main office in Hollywood, Md. "My fiancee is down the hall waiting for a pulmonary appointment. Kids come here for MRIs, CAT scans."

Nurses and patients have a system for keeping all of the Shahs straight. They use initials for the four Shah brothers: Dr. V.K. the cardiologist; Dr. U.K. the gastroenterologist; Dr. D.K. the child psychiatrist; and Dr. A.K., another cardiologist. The other Shahs, especially the four with names beginning with 'A,' often go by their first name: Dr. Amish the cardiologist, also V.K.'s son; his wife, Dr. Arpana the dermatologist; Dr. Beena the neurologist; Dr. Jyoti the sleep specialist.

"Every once in a while, we get someone calling in wanting to talk to 'Dr. Shah,' " said Betsy Warren, a registered nurse who has worked for Shah Associates for 16 years. "You ask them, 'Which Dr. Shah?' And they say, 'The one with dark hair.' "

To Southern Maryland, the Shah family has imported distinctive aspects of Indian culture: colorful saris, lavish parties for hundreds stocked with huge trays of vegetarian Indian food and recitals featuring classical Indian dances.

Family members say it took years to earn the trust of the community, but once they did, the practice quickly grew. Some local doctors who once viewed the Shahs as competition eventually joined the practice.