The working day begins at sunrise on a family ranch in northeastern Montana.

There are horses to feed, cattle to graze and the garden to tend. Weekday or weekend, there’s plenty of work to be done, and everyone is expected to help.

Justinn Lahaye grew up here. It’s where she learned to ride horses and rope calves. But today, she’s more of a visitor. Because today, she’s a busy and ambitious third-year student at the UW School of Medicine.

“My parents work hard, and it’s motivated me to do the same in every aspect of my life,” says Lahaye.

Life-or-death Struggles

Ranch life is unabashedly tough and unpredictable. Before Lahaye was born, the ranch flooded; this past year, there was a drought. The work is constant, and the animals get sick. Some days, it’s a life-or-death struggle.

Unfortunately, life-or-death matters have been a constant presence in Lahaye’s life. Her father, Dale Marshall, has been sick as long as she can remember. She was 2 when he was diagnosed with leukemia, and even though a bone marrow transplant cured the cancer, that wasn’t the end of his medical troubles. He had a heart attack when Lahaye was in high school. A sextuple coronary bypass surgery followed, and, a few years later, kidney failure.

Throughout her father’s health issues and the challenges of ranching life, working with horses was a comfort to Lahaye. “I grew up with them, almost like siblings,” she says. From junior high school on, Lahaye participated in rodeo, eventually making national finals and putting herself through college with scholarships.

Lahaye says ranch life and rodeo taught her discipline, teamwork and the value of persistence. “Hard work can get you a lot of places,” she says.

From Montana to Medical School

Lahaye was always interested in a career in medicine; her mother suspects that it was all those hours she spent with her dad at medical appointments. She was in college when she realized she truly wanted to become a doctor.

There were hurdles to overcome. For one, there was the question of money. Rodeo and academic scholarships had gotten Lahaye through college, but now she would have to take out student loans. Fortunately, she also received scholarship funds from the Friends of the UW School of Medicine, which eased the financial burden somewhat.

Her father was also a consideration. Despite her dad’s worsening health, Lahaye’s parents supported her decision to apply to medical school. When he was hospitalized with kidney failure, she had to leave his bedside to attend her medical-school entrance interview in Bozeman, hundreds of miles away.

“It was really hard, knowing that my dad’s health was poor and I wasn’t able to come home and help as much as I used to,” she says.

Lahaye worried about the future of the family ranch, too. It had always been assumed that she would take over from her parents one day, but medical school — and a career as a doctor — could take her far away from home. Together, the family rallied to find solutions, and Lahaye’s oldest sister and her husband agreed to move home to help their parents.

Now, their three children are growing up on the ranch, learning to ride and work the cattle, and Lahaye teaches them riding and roping skills when she visits.

“I’m trying to pass on as much knowledge as I can about ranching and rodeo, because they are the next generation, and hopefully, one day, they’ll take over the ranch,” she says.

The Challenge of Rural Medicine

For Lahaye, who grew up inspired by the family doctor’s connection to rural communities, the UW School of Medicine’s WWAMI program was a perfect fit.

This five-state medical education program emphasizes educating students from the region — Washington, Wyoming, Alaska, Montana and Idaho — for the region. Founded in 1971, the program is a response, in part, to the growing need for doctors in rural and other underserved areas. Students are exposed to medical care in all sorts of situations: from the tiniest clinic in rural Alaska to large urban hospitals.

Following 18 months of classroom work, students like Lahaye start rotating through various sites, learning about different medical disciplines, meeting patients and getting to know the community. Lahaye has been on rotations since early 2017. She also took part in the WRITE (WWAMI Rural Integrated Training Experience) program, which offers additional training in a rural setting.

One of Lahaye’s rotations took place at Frances Mahon Deaconess Hospital in Glasgow, Montana — the same place where she was born. Under the guidance of her preceptors, she helped treat patients while learning about family medicine, internal medicine, OB-GYN, psychiatry and pediatrics.

“Justinn has a good rapport with patients; people like to talk to her,” says Anne Millard, M.D., one of her preceptors. “They will tell her things that they might not tell somebody else — including me.”

Millard is all too aware of the physician shortage in rural areas like hers. “Our biggest issue is keeping doctors,” she says. “They’ll come out here for a couple of years, and then they leave. It’s not a lifestyle everybody wants.”

Moving a family here can be difficult, as career opportunities for spouses — outside agriculture — are limited. And with fewer specialists in rural areas, doctors sometimes feel overwhelmed at the wide range of medical issues they manage.

But, Millard adds, there are compensations. “This is a very tight community, as most rural communities are. People help each other and take care of each other.” She hopes that, after Lahaye graduates from medical school and completes her residency, she’ll come back to work at the clinic.

“The fact that she’s willing to come back to a rural area and do this kind of medicine is just wonderful,” says Millard.

Rural Living, Rural Doctors

Although medical school doesn’t leave much time for riding, Lahaye stays connected by cheering on her husband, Kody, a professional rodeo competitor who coaches rodeo at Montana State University. And, after graduation, she’s looking forward to settling down permanently in a community like the one she grew up in.

“I’ve learned how important rural physicians are to these communities. People like my dad struggle with access to healthcare in rural Montana, and the growing physician shortage means it’s going to be harder to get the medical care you need,” she says.

“I want to be able to give back to those small communities,” says Lahaye. “I can help people like my parents and our neighbors continue to live the rural way of life.”

By Stephanie Perry