The residents of Glendive, Montana, know when Joan “Mutt” Dickson, MD ’97, is in the office, because they recognize her grey Ford Escape. Kids come by just to play ball with her black Lab, Jemma. She regularly runs into her patients at the grocery store — and they notice if she puts junk food in her cart.

Dr. Joan “Mutt” Dickson

“If you like anonymity, you should not practice medicine in a rural area,” says Dickson wryly.

But living in a small town has unique benefits, too. It means closeness. Support. Patient relationships that last a lifetime. “When you’re in a smaller, rural community, you end up taking care of your friends,” she says.

Dickson’s path to medicine has been a long road with many stops along the way: carpenter, truck driver, paramedic, nurse, family physician and psychiatrist. To honor the role models who inspired her — and to help address the growing physician shortage in rural areas like Glendive — she created a scholarship to support medical students in Montana. Now, she’s calling on her colleagues and fellow alumni to help expand educational opportunities for the next generation of medical leaders.

A winding path to medicine

Dickson grew up in a farming family in Scobey, Montana. As the kid sister tagging along after her much taller big brother, she was nicknamed Mutt, after the old comic strip “Mutt and Jeff.” To this day, it’s the name she prefers to go by.

Dickson’s first career plan was to be a plumber. However, upon receiving a full academic scholarship, she enrolled at Montana State University at Bozeman — only to drop out after two years, when they tried to make her declare a major.

After a brief detour into carpentry, Dickson became a truck driver. The accidents she regularly saw on the road inspired her to train as an emergency medical technician, so she could help care for the injured. During her seven-year career as a paramedic in Las Vegas, she also became a registered nurse.

While on a temporary assignment with the Department of Energy to the Republic of the Marshall Islands, Dickson fell in love with the islands. She returned to work there for three years and became fascinated with the pathology she saw. She decided to become a physician and enrolled at the University of Washington School of Medicine.

Dickson’s first role model in medicine was her childhood family doctor, Dr. Clyde Norman. “He sewed me up on his kitchen table more than once,” she recalls. “I really wanted to be as kind and caring and skilled as Doc Norman.” Like him, she planned to become a family practice physician.

But during medical school, another influential figure sparked her interest in mental health care: Dr. Nicholas Ward, her second-year behavioral medicine professor and later her attending physician during her third-year psychiatric clerkship. Inspired by Ward, Dickson did a combined residency in family medicine and psychiatry at West Virginia University.

Eventually, Dickson brought her two passions together when she moved to Glendive, in eastern Montana, where she is in private solo practice as a general family practitioner and a psychiatrist — both of which the community desperately needed.

Expanding mental health care in rural communities

Montana has the second-highest suicide rate in the nation, according to the Centers for Disease Control and Prevention. Some of the most frequently cited causes are rural isolation and economic stress on farmers. In addition, Montana has a high percentage of veterans, so post-traumatic stress disorder (PTSD) and depression are common.

In 2002, Dickson became the founding director of the psychiatric unit at Glendive Medical Center. But after four years, she was burned out. Every night, she says, she would get calls from emergency rooms or law enforcement agencies from one of the 17 counties in the region, expecting her to help them handle a suicidal person. She resigned in 2006. Unable to bring enough providers to their isolated town, the medical center was forced to close their psychiatric unit for several years, and anyone needing mental health care had to travel several hours to a larger city.

Today, Glendive Medical Center has reopened with several therapists on staff, which eases the burden in the area. While she doesn’t think COVID significantly affected mental health in her community, because most people didn’t alter their routines, Dickson says she’s noticed other changes in the community’s overall mental health since the pandemic.

“I would say the changes now are even greater financial pressure on farmers and ranchers,” says Dickson. “The suicide rate has probably stayed the same — and probably always will, while we fight the rural stigma of mental illness and easy access to alcohol and guns.”

One bright spot is that telemedicine is beginning to transform mental health care throughout rural America. Dickson spends 20 hours a week providing outpatient psychiatric care at the Montana Veterans Administration (VA) community clinic, about 85% of which is done remotely via video call. Although she prefers face-to-face conversations, Dickson acknowledges that telehealth consultations help to meet the urgent and ever-growing need statewide.

“The rewarding part of the VA work is helping someone with their PTSD or depression, understanding as best I can what they’re going through and what struggles they have daily as a result of their meritorious service to the country,” Dickson says.

Lessons learned — and shared

Since the very beginning of her career in medicine, Dickson has known firsthand the importance of work-life balance and well-being.

Her older brother, Richard “Pete” Dickson, MD ’81 — the Jeff to her Mutt — also became a physician and threw himself into his career. But after a difficult divorce, he began self-medicating and writing himself prescriptions for drugs. The state board of medicine gave him two options: go into treatment or lose his license. Faced with the possibility of losing his medical license, Richard died by suicide.

Now, Dickson makes it a priority to take care of her mental health. She makes time to meet friends for coffee or to go for a morning hike at the nearby state park with Jemma. She appreciates the simple things, like the fresh scent of laundry dried on a clothesline. And she’s quick to point out that while she loves practicing medicine, it’s not how she defines herself.

Dickson frequently mentors medical students, and she makes sure to pass on what she’s learned. “I tell every med student what my brother taught me,” she says. “Know what you know and what you don’t know. Have a long list of smart friends that you can refer to. Care for yourself and your patients and be willing to go the extra mile.”

Helping WWAMI students succeed

Dickson has also found another important way to help students: by supporting scholarships that reduce their burden of debt. She established the Nicholas Ward, MD, Endowed Scholarship to help medical students from Montana enter into what have historically been lower-paying specialties with less debt. The scholarship honors the mentor who helped put her on the path to psychiatry.

“Medical school is so expensive,” Dickson says. “My goal is to help med students enter into what has historically been a lower-paying specialty with less debt.”

Reducing financial barriers to medical school is also an equity issue, she adds. “I was on the UW admissions committee for WWAMI students from Montana and we had some underrepresented students apply who were awesome candidates, but they chose to go elsewhere because they could get more financial support. I would love to keep those folks within the WWAMI system, and I’m hoping the scholarship will help do that.”

Now, Dickson is making another generous gift to grow her scholarship fund. She invites donors to join her in helping Montana students train for medical careers and hopefully return to serve rural communities.

“When I get older and need more medical care, I want there to be a physician available to provide that care,” Dickson says with a laugh. But, she adds, that day is still far off in the future.

“I love my practice and what I do,” she says. “I don’t think I’ll retire any time soon.”

By Stephanie Perry