by Johannah Cornblatt

A patient who couldn’t pay Dr. Regina Benjamin in cash once dropped off a sack of oysters to thank her for treating him. The gift didn’t come as a surprise to Benjamin, who after medical school started a family practice in her hometown, the small shrimping village Bayou La Batre, Ala.

Dr. Kim Edward LeBlanc, who worked with Benjamin on the Federation of State Medical Boards, recalls how Benjamin would laugh, telling colleagues that she loved seafood—while understanding that shellfish were sometimes all that her patients from the “seafood capital of the world” could give. “She sees anyone,” LeBlanc says. “It doesn’t matter if you can pay or not.” 

Since starting her practice in 1990, Benjamin, 52, has become an advocate for patients everywhere. She became the first African-American woman to lead a state medical society and has won numerous awards, including a MacArthur Foundation "genius grant" and a Nelson Mandela Award for Health and Human Rights. Still, she never strayed far from her roots, and currently serves as the CEO of Bayou La Batre Rural Health Clinic, which she founded. This week, President Obama tapped Benjamin to serve as surgeon general. Specialists in rural medicine say the experience she gained as a small-town physician will translate well to the high-powered world of Washington politics.

Often called America’s top doctor, the surgeon general oversees the 6,000-member Commissioned Corps of the U.S. Public Health Service, shares the latest developments in public-health science with the American people, and calls both the public's and the president's attention to selected issues in health and health policy. Most previous surgeons general have come from either government or academia. While Benjamin has credentials worthy of the position, she has committed her life to primary care in underserved rural communities. 

“I think her experience in rural America as a primary-care physician is going to be really critical to health-care reform in this country,” says Dr. David Satcher, who was surgeon general from 1998 to 2002 under Bill Clinton and George W. Bush. “Many people in America don’t know what it's like to get health care in this country. And she knows.”

In fact, it’s Benjamin’s broad experience in medicine that rural specialists think will allow her to speak effectively to—and on behalf of—a wide range of Americans.

“Most family physicians, but particularly those in rural America, take care of a 99-year-old with pneumonia, then run downstairs to deliver a baby, and then run to the office to take care of a broken arm,” says Dr. Elisabeth Mock, president of the Maine Academy of Family Physicians. “That kind of breadth of experience would prepare someone to switch gears quickly and see things from a broad perspective in Washington.”

Rural doctors, on call 24/7 with little or no support system, must work creatively and tirelessly to overcome obstacles. Benjamin has made headlines for rebuilding her nonprofit clinic in Bayou La Batre not once but twice: first after Hurricane Katrina in 2005 and again after a fire on the eve of the clinic’s reopening. In the face of adversity, colleagues say, Benjamin never complains. “She’s a great problem solver,” says LeBlanc, who also chairs the Department of Family Medicine at Louisiana State University.

Dr. Tony Miksanek, who has had more than 20 years' experience as a rural physician in Benton, Ill., says Benjamin would bring the “self-reliance” she developed as a family doctor to an office that must sometimes take a stand against the White House’s political agenda. “Dr. Benjamin has been in the trenches, knows how tough it is, and can shine some light on the problems associated with delivering health care to underserved and poorer communities,” he says.

The ability to work independently and fend for herself and her community’s needs will serve her well in Washington. Satcher recalls, for example, that he had to speak up about the scientific benefits of needle exchange in the battle against HIV when the White House refused to support the initiative for political reasons.

“The surgeon general is not supposed to communicate based on politics, or his or her religion, but the best available public-health science,” Satcher says.

Rural doctors acquire an understanding of patients and their needs, says Mock, who expects that Benjamin will take that ability to relate to people with her to Washington. “You can’t go to the grocery store and not see some of your patients,” Mock says of family doctors in small towns. “You can’t go to a high-school sporting event and not know the intimate personal history of about 50 percent of the people who are present.” As surgeon general, of course, Benjamin would communicate more often through speeches and reports than face to face. But rural doctors suspect that she will pay particular attention to how policy will affect those without a support system in small-town America.

LeBlanc says that Benjamin will remember the challenges facing rural doctors and patients when she advocates for health-care issues. “The politicos and bureaucrats in Washington are so insulated sometimes from what’s really happening in rural America,” he says. 

Although Benjamin will be leaving the bayou for a more high-profile gig, LeBlanc says she won't leave her roots behind. “When you practice in a rural area, you forget about money. You forget about glamour,” he says. “She’s going to Washington because she cares, because she has a heart and believes that she can make a difference.”