BOSTON – As a former active-duty cavalry officer in the U.S. Army who served a 15-month tour in Iraq in 2003, Adam C. Byrd, MD, isn't easily rattled.
On any given day, as the only dermatologist in his hometown of Louisville, Miss., which has a population of about 6,500, he sees 35-40 patients who present with conditions ranging from an infantile hemangioma to dermatomyositis and porphyria cutanea tarda. Being the go-to specialist for hundreds of miles with no on-site lab and no immediate personal access to Mohs surgeons and other subspecialists might unnerve some dermatologists, but not him.

Dr Adam Byrd (third from left) poses with University of Mississippi Medical Center rural dermatology residents Dr Hannah Badon, Dr Ross Pearlman, and Dr Joshua Ortego.
"They're a text message away, but they're not in my office," he said during a session on rural dermatology at the annual meeting of the American Academy of Dermatology. "I don't have a mid-level practitioner, either. It's just me and the residents, so it can be somewhat isolating. But in a rural area, you're doing your patients a disservice if you can't handle broad-spectrum medical dermatology. I consider myself a family dermatologist; I do a little bit of everything." This includes prescribing treatments ranging from