35 Years of Service, Leadership, and Advocacy: Dr. Cindy Smith's Impact on Rural Health

Cindy Firkins Smith, MD, began her journey in August 1989 while completing her dermatology residency at the University of Minnesota. Each month, she made the drive to west central Minnesota to see patients in Willmar, filling a critical gap left by the retirement of the area's only dermatologist. The charm of the lakes, the beauty of the area, and the proximity to family drew her and her husband, both with rural roots, to settle in Willmar.

"When I first started, I was the only dermatologist, and we generally mixed specialties together on stations.  I was assigned to an area with Bob Hodapp and Bob Kaiser, family medicine docs, Wilson Salter, internist, and Rob Kruger, general surgeon, so it was the guys and me," Smith recalls fondly. "I loved sharing cases and was desperate to talk to other physicians about the amazing things I was seeing. My colleagues at the U of M thought I had fallen into a long-lost nirvana of rare dermatology diseases in west central Minnesota. The guys had no idea what I was talking about but listened anyway."

Supporting Change

"I've witnessed an incredible evolution in healthcare over the past 35 years," Smith shared. Among the most significant changes has been the rise of technology, which has revolutionized but also complicated care.

"The electronic medical record was a game changer," she explained. "While it's improved patient access to their own health data, it has also reduced face-to-face time with patients and contributed to clinician burnout. The world, including health care, has become much more impatient."

She highlighted the dual impact of telehealth, accelerated by the COVID-19 pandemic. "Telehealth has been a godsend for rural patients, but COVID will remain one of the greatest tragedies of my career," she reflected.

Advances in treatments, especially in dermatology, have also stood out. "I now have medications that can improve lives and save the lives of melanoma patients who, decades ago, would have died of their disease. But challenges remain due to expensive drugs and barriers to access."

Despite her specialization in dermatology, Smith has been a fierce champion of primary care.

"Family medicine is the cornerstone of rural health care," she emphasized. "I've always worked to ensure our primary care physicians felt supported. They don't always receive the recognition or respect that they deserve for the incredible work they do to care for our people."

Empathy Born from Personal Experiences

Smith shared that she has a disabled child that has profoundly shaped her approach to medicine and leadership. She generally doesn't speak publicly about this to protect their privacy, but as a mother this has made her deeply empathetic to the struggles and incredible expense often required to care for people who are physically or mentally disabled, those who face drug addiction, or those who simply don't fit into society's norms.

"While I wouldn't wish these struggles on anyone, living with them has made me a more empathetic doctor and a less judgmental human," she explained. "As a leader, I see the world from the lens that you cannot pick yourself up by your bootstraps if you don't have any boots."

The Call to Serve

Over 35 years, Dr. Smith has worn many hats: physician, leader, advocate, teacher, and mentor. Each role, she says, "filled my bucket."

Her philosophy of servant leadership has guided her work. "I lead in service to others, not for personal gain," she explains. "I have always been a doctor first, but as time went on, my colleagues and partners often asked me to lead."

Throughout her career, Smith led many initiatives and groups when asked to do so.  "I stepped up because I thought I could make a difference in achieving a common goal or inspiring colleagues to reach that end," she explained.

Smith served on many local committees, Affiliated Community Medical Centers' (ACMC) Board of Directors, as well as regional, state, and national medical organizations.  After she finished her year as the Minnesota Medical Association's president, ACMC's then president/CEO was nearing retirement. Her colleagues asked her to consider the position.

"Healthcare is always in a state of flux," she said. "At that time ACMC was facing big challenges in recruitment and reimbursement. My main charge as president/CEO was to chart a path into the future that ensured we survived to provide health care to the rural patients we serve."

Transforming Care Through Collaboration

A key initiative with lasting impact was the collaboration that brought ACMC, Rice Memorial Hospital, and CentraCare together to create Carris Health and then officially affiliate with CentraCare. Later Redwood Area Hospital, Family Practice Medical Center, Swift County-Benson Health Services and via contractual agreement, Meeker Memorial Health, were brought into the system.

"I've heard many who wish for times past but given the challenges of rural health care delivery and reimbursement, working together collaboratively helped to secure health care delivery and essential services for those areas."

At that time, no one could have predicted that within two years we would face a worldwide pandemic. "I can say with complete confidence that the collaboration we created not only saved health care delivery for our area but allowed us to save many lives through collaborative patient care as well."

Overcoming Challenges

Over the years, resource limitations, recruitment struggles, and perceptions of rural medicine posed significant challenges.

"I've worked hard to keep up to date on evidence-based medicine and therapeutics and provide the care locally that my patients needed. An example was setting up and providing specialized surgical care (Mohs Micrographic Surgery) for skin cancer patients so patients wouldn't need to travel 100 miles," she said.

Recruiting rural physicians has always been a challenge and remains a top priority. "The best way to recruit a rural doctor is to start with a rural student and we simply don't have enough rural students entering medical school," she explained. Her lifelong dedication to teaching and mentoring students to show them how great it is to practice in rural Minnesota is one way she has addressed this issue.

"My commitment to the University of Minnesota CentraCare Regional Campus St. Cloud has been fierce because I believe it is key to ensuring that health care professionals are inspired and trained to serve rural communities."

The Impact of Advocacy

Dr. Smith's passion for advocacy extends beyond the clinic and hospital walls.

Many people may not recall there was a time in Minnesota when children had unrestricted access to tanning booths, despite the direct correlation between tanning bed use and an increased risk of melanoma.

"The fact that children were increasing their lifetime risk of this life-threatening malignancy was unacceptable to me," Smith shared.  "This was a reality I saw in my clinic on a regular basis."

Early in her career Dr. Smith had two young women die of this disease, both who attributed their diagnoses to tanning booth use during their teenage years. "One of the women, heartbroken to leave her young daughter, urged me to share her story and pleaded with me to do something for change."

 

Motivated by these experiences, Dr. Smith led the Minnesota Dermatological Societies' efforts to ban tanning booth access for minors. Eleven long years of work led to Governor Mark Dayton signing legislation on May 22, 2014, making Minnesota the 8th U.S. state to ban tanning booth access to minors. Smith recalled that she wept when she heard the news.

Her advocacy also included championing rural health care, ensuring that patients in Greater Minnesota receive care equal in quality to urban areas. "I've been vocal locally, statewide, and nationally that rural Americans should not be forgotten," she said.

"I often tell medical students and residents that as physicians we have the privilege to make a difference for at least one person every single day of our careers," she explained. "But if we also take our voice, our efforts, and our passion outside of our offices and into the legislature or a courtroom or an insurance office, we can make a difference for thousands of people for generations."

Career Highlights

Smith has given many presentations throughout her career. Shortly after completing her year as MMA president, students at the University of Minnesota asked her to speak to them on physician leadership. They entitled the presentation, "How to get Sh*t Done as a Woman in Medicine."

"I've given iterations of that talk many times over the years and had some interesting feedback," said Smith. More than once she had a medical student tell her, "When I grow up, I want to be just like you."

"My greatest achievement is to have set an example or inspired others to want to be rural physicians, advocates, volunteers, educators, and mentors," she shared. "And to want to get sh*t done."

Finding Balance in Retirement

Retirement won't mean slowing down entirely for Cindy Firkins Smith, MD. "I plan to continue mentoring students, teaching, and maybe even writing about leadership in medicine," she said. "I don't know what my next role will be, but I know I need purpose. I expect to fail retirement quickly."

For now, she's looking ahead to a real vacation and spending more time with family. "I'm looking forward to spending more evenings and weekends with my family, instead of at my desk. I've driven myself hard for decades, always striving to be better," she reflected. "I'm curious to see what ideas will come to mind when I'm not consumed by unfinished work or worries. And, hopefully, I'll finally catch up on some sleep."

A Legacy of Connection and Care

Dr. Smith leaves behind a legacy of service, innovation, and advocacy. Her colleagues and community celebrate not just her accomplishments, but her ability to connect with people on a personal level.

"I always put patients first. I cared deeply. I did my best, always," she reflected.

Her career may be winding down, but her passion for rural health, her patients, and the physicians she's mentored will continue to impact and shape health care for generations.