The practice of medicine in West Virginia is both specialized and generalized, urban and rural. Qualified physicians work in solo and group private practices, rural clinics, large and small hospitals, university health science centers, free clinics, health departments, nursing homes, corporations, and HMOs, and some make house calls.

The practitioners include both medical doctors and doctors of osteopathy. In 2003, there were 3,575 MDs and 507 DOs practicing in West Virginia. The overall physician-to-population ratio is 180 doctors per 100,000 people, compared with 198 per 100,000 nationally, ranking the state 29th in the nation. West Virginia has 125 specialists and 54 primary care physicians per 100,000 population, compared with national figures of 139 and 59, respectively. The overwhelming majority of physicians have office-based practices, with 90 percent engaged in direct patient care.

Thirty-six percent of active physicians are graduates of foreign medical schools, one-third came from in-state medical schools and residency programs, and 31 percent trained elsewhere in the United States. Sixty-eight percent of physicians are between 35 and 64 years old, similar to national figures. The average age is 46. Three-fourths of physicians are White. Asians and Pacific Islanders are the second largest group (20 percent), with African-Americans at one percent and Hispanics at three percent. Female physicians were 18.9 percent of the total in 2001, nearly one-fifth. The number of doctors in West Virginia is growing, although at a slower rate than nationally.

West Virginia's physicians serve a population of approximately 1.8 million, 35th in the nation. West Virginia is the second most rural state. Its population is also the oldest, with the highest median age, 38.9 years in 2000. The uninsured population is 17 percent higher than the national average. Lack of access to a primary health care provider (30 percent) is higher than the U.S. figure (17 percent). The percentage of people living below 200 percent of the poverty level is 43 percent, contrasted to 31 percent nationally. Of the 55 counties, the federal government has designated 95 percent as medically under-served or as having a health provider shortage.

West Virginia physicians are trained at three state-supported medical schools. West Virginia University School of Medicine Virginia University School of Medicine was founded in 1902 and is in Morgantown. It has a clinical campus in Charleston affiliated with Charleston Area Medical Center, and another regional campus in Martinsburg. The West Virginia School of Osteopathic Medicine, located in Lewisburg, was established in 1972. It prepares family physicians for West Virginia and surrounding Appalachian states. Marshall University School of Medicine, located in Huntington, was established in 1977. Its mission is to prepare rural primary care physicians through undergraduate and residency training.

All three schools train medical students along with other health science students through the state-funded Rural Health Education Partnerships. In 2004, there were 184 medical school graduates in West Virginia, including 72 graduates of the School of Osteopathic Medicine, with females making up 40 percent of all West Virginia medical school graduates. Students at West Virginia medical schools were 92 percent White, six percent Asian and Pacific Islander, and two percent African-American.

The origins of our state's medical practice may be traced to the latter part of the 18th century. The Appalachian Mountains posed a major obstacle to the practice of medicine, due to travel difficulties west of the Shenandoah Valley. One of the earliest physicians in present West Virginia was Dr. Jesse Bennet, who set up a practice near Point Pleasant on the Ohio River in the 1790s. Other doctors followed, establishing practices near navigable waterways such as the Kanawha, Ohio, and Monongahela rivers. The advent of railways and better roads contributed to the expansion of medical practice in the 19th century.

The scarcity of medical practitioners in West Virginia has fostered a tradition of folk medicine. This is due to the wide availability of herbal cures in the rural countryside, plus the independent, self reliant nature of the Appalachian people. While untrained "granny" midwives and self-taught folk doctors are largely a thing of the past, West Virginians have participated in the recent revival of herbal remedies. Nurse-midwives historically have provided many in-home deliveries, and the tradition continues in modern birthing centers. Several prominent leaders in public health health and community medicine have worked in the Mountain State.

The medical profession became organized in 1867 when Dr. James Edmund Reeves and 32 of his colleagues established the West Virginia State Medical Association. The West Virginia Society of Osteopathic Medicine was established in 1902.

Starting in the late 19th and into the early 20th century, the genesis of the modern system of rural primary care delivery was found in the West Virginia coalfields. There "coal camp doctors" provided needed care to coal miners and their families through pre-paid, per capita financing, a precursor to the modern health-maintenance organization. Since mid-century, the United Mine Workers union and small communities built upon this innovation by providing country doctors through rural medical centers. With help from the Appalachian Regional Commission, private and religious foundations, and state and federal resources, there are today more than 80 rural primary care centers throughout the state.

Major challenges confront the practice of medicine in West Virginia in the 21st century. They include a sluggish economy, large numbers of uninsured patients, inadequate reimbursement, and rising costs of malpractice insurance. Exacerbating the situation, West Virginia manifests numerous unhealthy statistics. For example, deaths (before age 65) due to injuries, sudden infant death, congenital anomalies, diabetes, heart disease, suicide, cancer, and lung disease exceed national rates significantly. Risk factors— smokeless tobacco use, physical inactivity, obesity, hypertension, and cigarette smoking—contribute to excessive rates of premature mortality. Costs are enormous and measured in human, social, and economic terms.

Regardless of obstacles, the medical practice in West Virginia remains healthy. A new generation of medical practitioners is being prepared to advance the cause of patient care while improving the health of the public into the 21st century.