Some fathers pass down a family business. One doctor passed down a calling. In this conversation, Southwest Health's Kevin Carr, M.D., family medicine physician, and Melissa Carr, M.D., OB/GYN, reflect on the joy of practicing medicine together, delivering babies side by side, and caring for generations of families in rural Wisconsin as a father-daughter duo. Their story offers a powerful look at the importance of rural maternal health care and the deep connections that make community-based care so special.

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Tom Haederle

Welcome to Advancing Health. In this episode, we hear from a father-daughter physician team who are delivering babies in their hometown, keeping care in the family, and exploring what it means to care for families across generations.

Julia Resnick

It's not every day you get to practice medicine alongside your family, let alone deliver babies together. Today's guests are doing just that. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association. Today, I'm joined by a father-daughter duo from Southwest Health in Platteville, Wisconsin. Dr. Kevin Carr is a family medicine physician who also provides obstetric care, and his daughter, Melissa Carr, has returned to her hometown to practice as an obstetrician and gynecologist.

Julia Resnick

We'll talk about what it's like to work and even deliver babies together, and what it takes to provide high quality maternal care in a rural community. Drs. Carr, welcome to the podcast.

Kevin Carr, M.D.

Thank you.

Melissa Carr, M.D.

Thanks for having us.

Julia Resnick

So this episode feels especially meaningful as we think about Father's Day. And the two of you are not only colleagues, but father and daughter working side by side. What has it been like to build a professional relationship alongside your personal one? Kevin, I'll start with you.

Kevin Carr, M.D.

Well it's awesome. It's obviously very exciting to see your daughter do well and be well liked in the community. She's actually now starting to deliver people that I actually delivered. So I think fair amount of those has happened. It's also very nice to have somebody very knowledgeable that I can walk down the hallway and ask questions to that I think knows more than I do right now.

Kevin Carr, M.D.

So it's pretty it's pretty awesome all the way around.

Julia Resnick

Amazing. Melissa, what's it been like for you?

Melissa Carr, M.D.

Yeah, kinda just to reiterate that, I think it's just it's really an amazing experience. I mean, he's such a great role model and just an overall mentor. I mean, he's been practicing medicine here at this location for 35 plus years. So, you know, with that, he brings a wealth of knowledge and all the experience that comes with it.

Melissa Carr, M.D.

And he's just so willing to offer that advice both clinically and, you know, from a personal standpoint as well. So, you know, there's just so insightful. And it's like you said, his office is down the hall. So, you know, you can just pop in and, you know, ask questions and bounce ideas off of him. And it's just it's so such a nice resource to have, you know, readily available to me.

Melissa Carr, M.D.

So I take advantage of it as much as I possibly can.

Julia Resnick

That's amazing. And my dad used to work in the building next to us, so we'd have lunch all the time. But that's different than being in the same profession and actually working together.

Kevin Carr, M.D.

And I'll have one more little anecdote. My dad was a veterinarian, and so for many years when I heard Doc Carr, I was looking around because it was my dad they were talking to. And I think Melissa will share that same anecdote that it's we're used to having that in the background.

Melissa Carr, M.D.

Yes. In fact, I had a patient this morning bringing up Doc Carr, who is Grandpa Carr, the veterinarian.

Julia Resnick

I love that. And I imagine that your dad being in this field influenced your decision to go into it as well.

Kevin Carr, M.D.

I was not sure if I was going to do veterinary medicine or people medicine, so obviously I made what I think is a very good choice.

Julia Resnick

And Melissa, you stuck with delivering babies.

Melissa Carr, M.D.

Yeah, same thing. I mean, I had a front row seat to, you know, to healthcare from a very early age. Growing up, I just remember seeing, you know, number one, seeing, you know, get up in the middle of the night to go deliver a baby or, you know, that side of things. But then, you know, you'd walk into the grocery store or to a ball game and there would be a patient that would track him down and telling stories about their family members or their loved ones that he took care of, and just or just being thankful and expressing their gratitude for the care he provided them, you know,

Melissa Carr, M.D.

so I saw from a very early age kind of how meaningful that was. And I feel like that's kind of a perspective that not a lot of people get going into healthcare. If you haven't been exposed to that, especially in more rural type setting.

Julia Resnick

Absolutely. So as you've been working together, what have you learned from each other, both as clinicians and his family members? How does that shape how you're caring for patients?

Melissa Carr, M.D.

Well, again, to kind of just like as I mentioned, you know, I saw the relationships that he developed with patients, both in the clinical setting and outside. You know, how patients just felt so grateful for their care. And I just I got to see how, you know, how you played that role in their lives. And I would just, you know, thought that was really pretty amazing.

Melissa Carr, M.D.

And so that really kind of impacted, number one, me to go into medicine. And then, you know, continuing to build those types of relationships with my own patients.

Julia Resnick

And Kevin.

Kevin Carr, M.D.

Well, again, I kind of go back to my parents again, I think kind of I was always taught you show up, be there and care for people and the rest will take care of itself. We're small town of 10,000, and it's just different care out here than using the big city because of that. And I think the patients see that.

Julia Resnick

Say more about that. What makes providing maternal care in rural communities special?

Melissa Carr, M.D.

So our model for maternal health care here is a little bit different than what you're going to get in some of the bigger health care systems. And we tend to have one provider that follows their patients through their prenatal care from the first visit through delivery and then postpartum. And so because of that, we really start to build these relationships with patients.

Melissa Carr, M.D.

You get to know them at a much more personal level. And I just think that that brings a whole other level of care to these moms and babies. So it is a little bit more of a unique experience here. And I think that that's part of what makes us special.

Julia Resnick

Kevin, anything you want to add to that?

Kevin Carr, M.D.

Yeah, I think especially with OB, once you take care of somebody and see them 12, 13, 15 times, they kind of remember you forever because it's one of the biggest days of their life that they're going to remember for every single day. And you're a big part of it.

Julia Resnick

Absolutely. And it's one of those few times in healthcare where you're getting care for a happy reason, and it's amazing that you get to be there for them throughout that entire journey. So, Kevin, I know you're an FM who does OB and Melissa, you're an obstetrician/gynecologist. And you know, how does that work together, working as a care team?

Julia Resnick

And how can those kind of collaborations help improve care for patients?

Kevin Carr, M.D.

Yeah, it works amazingly well. We have five family practice docs that deliver OB patients, and one of the family practice docs actually does C-sections, along with three of the OB doctors here. We still take care of our own patients. Obviously, they're very available for any consult, anything that happens, and if a C-section happens on their patient, we're also there first assisting.

Kevin Carr, M.D.

We're helping out and taking care of the baby. So it absolutely works very seamlessly. There's no turf battles. There's a lot of helping each other out and very willingness to answer questions if there's any problems or concerns about any kind of care.

Melissa Carr, M.D.

And we are located in the same building. We're two separate clinics or two different offices, but we're separated by hallway. So people will pop into my office all the time just to bounce ideas or ask questions, and vice versa. I'll do the same thing. I'll put my head in and say, okay, I got this patient. What do you think of this?

Melissa Carr, M.D.

And everybody is always so willing to, you know, to help out and provide advice and, you know, just kind of help coverage. And like you said, it's, you know, we're a pretty well oiled machine and it works really well for us.

Julia Resnick

That's amazing. And in a lot of rural communities these days, we're hearing about hospital closures or hospitals that are having to retract their OB services. But it sounds like you all are doing the opposite of that. So what do you think has been driving that growth and how are how are you adapting to meet that need?

Melissa Carr, M.D.

So we've seen that firsthand. We had a hospital in a neighboring county closed their maternal health services probably about ten years ago, give or take. And so those patients now had to travel further for their obstetrical care. Many of them do come our direction now. Another hospital, neighboring hospital, has also lost some of their OB providers and their gynecologist for whether it was from those providers relocating or retiring.

Melissa Carr, M.D.

So there's just less access to care. And so we have seen more patients coming our direction because of just there isn't as many options available to them. And they're now having to travel further. So to kind of combat that, number one, we've increased our OB providers since I've been here. We have more physicians that are providing OB care, whether it's family medicine, physicians and OBGYNs.

Melissa Carr, M.D.

And we've also opened outreach clinics through our organization. So that's where OB care is available. So people aren't having to drive as far for their prenatal care visits. They still come to our main hospital campus for deliveries, but at least for their visits, they're not having to travel as far.

Julia Resnick

Fantastic. Kevin, anything you want to add?

Kevin Carr, M.D.

Kevin Carr, M.D.

after one of the meetings, we learned at the Rural Health Leadership Conference. And our hospital does that, and patients that walk in the door from the outside can tell the difference in every single employee the attitudes, the smiles, the willingness to help out everybody from the janitor to the CEO, every single step along the way. Every person is important.

Kevin Carr, M.D.

And it shows in how we take care of patients and how patients respond to what we do. And it's every single one of our sort of different programs, you know, OB, ortho, everything has literally exploded because of some of the things we've done.

Julia Resnick

That's fantastic and really just speaks to, you know, your organizational culture and how that exudes between providers and also to the people you care for.

Melissa Carr, M.D.

And I think there's a lot of word of mouth that spreads too, you know, people are very grateful for their care here. And they really enjoy their experience. And they spread that to their friends, their family members. And, you know, so that catches on. And we're starting to see patients that are willing to travel further for their OB care, even if they have options that are closer to home, because they're choosing to come to our facility to come to deliver and coming to see us for their prenatal care.

Julia Resnick

That is great. And so you've both really been talking about like, the human piece of this. And I know a lot of hospitals, including yours, are using technology to help extend care. Can you talk about how you're thinking about incorporating technology into your work?

Kevin Carr, M.D.

They are starting to do AI to help with notes here. We just started six months ago. So we're learning from many of the providers. There's some very good things about it. There's some things they got to learn. But it sounds like so far so, so good that it's saving some time so they can spend more time with the patient and do those things.

Kevin Carr, M.D.

So that's one of the things they're doing.

Julia Resnick

And wasn't there a piece about a telemedicine program for neonatology.

Kevin Carr, M.D.

Oh yes. We were the first - and it might still be the only program in the state - that has a telemedicine NICU program, neonatal intensive care unit program associated with University of Wisconsin-Madison. And it's been going on for a couple of years. It took us a while to tweak and fine tune some things, and it's really nice in the sense of in our newborn nursery, we have computer set up, we have cameras set up, and we basically call a number and usually within minutes we have a neonatologist on the phone.

Kevin Carr, M.D.

We can see them, they can see us. There's a video on us, there's a video on the baby. And back in the day where we take care of lots of babies who need a little bit of oxygen, need a little bit of help, a little CPAP to help them get through the breathing, and you kind of sit there and try to decide, okay, is this baby sick enough to be transferred?

Kevin Carr, M.D.

Can I watch for another two hours? Well, now we make that call right away and we talk to them and we go, hey, I'm pretty comfortable with this, but I just want to make sure that I'm doing the right thing. And you have them on the phone, they assess the baby, they help you sometimes in making the decision, do we order a few tests and then, hey, we'll keep an eye on things and get back to us an hour.

Kevin Carr, M.D.

And if the baby transitions and looks great, wonderful. If the baby doesn't do well, then we already have the numbers in and they're ready to send the transport team.

Julia Resnick

That sounds incredibly helpful for rural hospitals that probably don't see a ton of cases like that.

Melissa Carr, M.D.

We also have a new SIM lab here as well, so we can run different types of simulations for both physicians and the rest of the hospital staff that are on the OB unit. And that's been really helpful, especially in a rural setting, because, you know, our volumes are lower, which also means that our types of high risk clinical scenarios are also going to be lower.

Melissa Carr, M.D.

So you may have a nurse that might not experience a postpartum hemorrhage or a shoulder dystocia or those types of situations, but have only heard about it. So this allows people to, you know, get that training and doing that repetition through simulation, even if we don't necessarily see it very often to keep those skills up.

Julia Resnick

Absolutely. And to close, I just want to bring this back to Father's Day, since that's when we're releasing this. And you are a father-daughter duo, so can you just share a moment or a story that reminds you why this work is so important to your community?

Kevin Carr, M.D.

Kevin Carr, M.D.

You just get gut feelings if something isn't right. And I basically did a chest X-ray and she had an apple sized lesion by her heart. And I immediately had my nurse call her mom, said I want her mom here now. I want to talk. I want to get her here before I get my CAT scan. I did a CAT scan. The next day

Kevin Carr, M.D.

I got her in with the hospitals at UW hospital to get a biopsy, and she ultimately had lymphoma. She did take six months in nursing school off and is now cured. Now, to add to that story, three years later she came, wanted to see me and she was somewhat tearful, so I wasn't sure what was going on until she got here and found out she was pregnant. And she was somewhat tearful because she just is finishing school.

Kevin Carr, M.D.

She's not married yet and she's worried, how are my parents going to take this? And we had a long discussion, and I kind of used some old quotes from my former nurse who was outstanding and said, this won't define who you are as a human and won't define who you will be in your lifetime. And she asked if she could give me a big hug and two days later told her parents and her dad was in tears,

Kevin Carr, M.D.

he was so excited. Because three years before that, they're worried they're going to lose their daughter. And now their daughter is bringing a life into this world. And so there's a huge turnaround. And that's why we go into medicine. Now I'm going to add to one step further to that I know this, I know her very, very well.

Kevin Carr, M.D.

I know this family very well. She told me there is nobody else that's going to deliver her baby except for me. Except unfortunately, that few days I was in Canada fishing. So guess who delivered my baby?

Julia Resnick

The other Doc Carr?

Kevin Carr, M.D.

The other Dr. Carr. And so she got to experience the best of both worlds. And now she had her second baby about eight months ago. And so I did deliver that one. So she was thrilled that both of us had an opportunity to care for her. And to be blunt, when I called her and asked if I could use her story today, I could tell she was in tears on the phone.

Kevin Carr, M.D.

She's an outstanding family, just core the earth people from southwest Wisconsin.

Julia Resnick

Amazing. And Melissa, on your end.

Melissa Carr, M.D.

One that comes to my mind is so my very first delivery that I did as a brand new grad or fresh out of residency was a C-section that I did with my dad. It was his patient and she needed a C-section. And so I was the primary surgeon. And then he was my first assist.

Melissa Carr, M.D.

So, you know, looking back, you know, you're just you're eager to do the delivery and, you know, be there for your patients. But at the same time, you know, looking back, it was just such a special cool moment. And now the other really neat thing is that particular patient, she takes care of my kids at daycare. So, you know, I see her every single day when I drop my kids off and, you know, so it's just it comes full circle.

Kevin Carr, M.D.

And to add to that story, the grandmother of that patient was an OB nurse here that I have delivered 500 babies with. And so she was in the operating room. And this is one in the morning, we're doing the C-section. And she thought it was the coolest thing ever, that her granddaughter was in there in the room with both of us.

Julia Resnick

That's amazing. And it's keeping in the family, both your blood family and your community family. So, Doc Carr, Doc Carr, thank you both for the work you do for your communities, for sharing your stories. And Happy Father's Day to all of our listeners out there.

Kevin Carr, M.D.

Thank you. Thank you very much.

Tom Haederle

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