Q&A with Robert Shelly

An alumnus returns to the Rochester area to utilize the biopsychosocial approach to medicine he learned at the School of Medicine and Dentistry.

Robert Shelly, M.D. (M ’93, R ’98) recently was appointed chief medical officer for Geneva Community Health and Finger Lakes Community Health. He previously served as medical director of Quincy Community Health Center in Quincy, Washington. Finger Lakes Community Health, which has five health centers, was founded in 1989 as a provider of health care for agricultural workers. It has expanded to provide comprehensive health care for all in the region. The organization also administers a federal migrant voucher program to provide health services to farm workers in 42 Upstate New York counties.

How did you become interested in rural community health?

Serving the rural poor is a part of my family heritage, a core value for three generations. My grandparents served as physicians in India with the Mennonite Church for 30 years, and I spent my early childhood in rural Congo, where both of my parents also were physicians serving under the Mennonite Church.  I always have enjoyed surrounding myself with people from a variety of cultures and backgrounds, and feel an affinity for those living on the margins of society.

Why did you pick Rochester’s School of Medicine and Dentistry?

I learned of the University of Rochester from my older brother, Mark, now an infectious disease physician at Highland Hospital. He was finishing his internal medicine residency in Rochester, and spoke highly of the School of Medicine and Dentistry. I appreciated the personable and collegial atmosphere at the school, and valued the biopsychosocial model of care.

I value the mentors I had at the School of Medicine—Tim Quill and Ellen Gellerstedt, and many others.  The basic elements of the biopsychosocial model—listening to the patient with curiosity about their context and perspective—are also the core elements of the “cultural sensitivity” skills that are encouraged in medicine today.

What did you do after you completed your residency in Rochester?

My wife, who is a registered dietitian, and I spent 4 ½ years in the Central American countries of El Salvador and Nicaragua. We worked in isolated rural areas, providing basic primary care and training local health workers. I taught local health workers, often with only a few years of formal education, to manage a medicine kit of about 10 medications and provide basic primary care in their communities.

After practicing without labs, x-ray support and the trappings of modern medicine, I decided that if I wanted to keep up my skills, we had come back to the United States. But I very much wanted to continue working with the underserved in a rural setting.  That’s how I landed in rural Washington State, in an agricultural area with a large Latino immigrant farm worker population. It worked well for me as a transition from international work, as I was immersed in Latino culture and the Spanish language for the majority of my day. During my eight years in the town of Quincy, it was rewarding to see the clinic grow from small beginnings to the largest health care provider in our area. 

What brought you back to the Rochester area?

While we very much enjoyed our work in Washington State, we felt a need to be closer to our families living in the northeast. Again, we sought out work in rural, underserved communities and Finger Lakes Community Health has been a good fit. As a Federally Qualified Health Center, we receive grants that enable us to provide medical care at low cost for folks who lack access for economic, language or geographic reasons. We serve a large population of immigrant agricultural workers from Mexico, Central America, Haiti and Jamaica, and serve the year-round residents of our communities as well. We are the only local providers for those without health insurance. To reduce barriers to care, we have outreach services that provide transportation, translation, home/in-camp visitation, and assistance with “navigating the system” for those who need it.

As medical director, I have my own clinical practice and supervise eight clinicians in five small clinic sites.  We have plans to expand service to two additional communities in the upcoming years.

What do you see in the future for your clinics?

I hope to see the rural Finger Lakes region dotted with a growing network of small Community Health Centers that provide quality primary care where it was previously unavailable.  What appeals to me is the opportunity to participate in this growth—not in profits, but in meeting needs.

One of our greatest challenges in this work is attracting physicians who share an appreciation for work in rural areas, given the shortage of primary care physicians in general and the lack of urban amenities in small towns.  For me, the rewards of rural practice are many.  I have the chance to know a community intimately, to place the medical needs of the individual in the context of their life story and their culture, and to fill unmet needs. This is the essence of the biopsychosocial approach that was modeled for me at Rochester.