— Wade Lamb knew from the moment he began studying medicine that he would return to his rural home here in the heart of Pee Dee farming country to open his medical practice.

He's a rarity. Most rural communities in South Carolina can't attract doctors if they try.

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Just one doctor serves as many as 10,000 people in some rural parts of South Carolina. That compares with as many as 74 physicians for every 10,000 people in Charleston County, home to the state's highest ratio.

Lamb also knew he would be giving up money, because rural primary care physicians typically make upwards of 5 percent less than their urban counterparts.

But for Lamb it was a no-brainer. He wanted to come home. He grew up just a block from where his office is located off Main Street.

Much has changed since then; the farming town's once vibrant downtown no longer hums with shoppers. Most of the shops near his practice that he began 10 years ago lie empty,

“They all closed after Walmart opened,” Lamb says. His Live Oak Clinic, where he works with several other physicians, is the only open business in sight.

“Yeah, I could go other places and make more money. I had offers in other places, but I always knew I was coming home.”

Lamb received a lot of help to make sure that happened. Lake City Community Hospital offered to pay off his medical tuition and books if he returned to practice.

And while in residency after graduating from medical school at the University of South Carolina, he learned of a special state grant program that would give him $40,000 over four years if he practiced in a rural community.

In the high-priced world of physicians where seven-digit incomes are not uncommon, a $40,000 grant does not seem like much. But for Lamb, the grant and the tuition payoff provided the financial confidence that he could do what he planned to do anyway.

Lake City Community Hospital no longer offers the tuition payoff, but the state grant program run by the Medical University of South Carolina has been increased to $70,000 over a three-year period for primary care physicians who move to underserved, rural areas.

The program was cut off in 2011 and 2012 during the Great Recession, then was restored by the Legislature.

The program has $500,000 this year to lure physicians, nurses and physician assistants to rural areas, down from an all-time high of about $925,000 in 1993.

The grant program operates under MUSC's Area Health Education Consortium, which describes its purpose as “to recruit, train and inspire” health professionals of all types to work in rural and other underserved areas.

Their service remains desperately needed. Rural areas of the state suffer abysmal health conditions:

Infant mortality can run at double or more the national average.

Two of every five adults are obese.

Heart disease is near epidemic.

Premature death takes lives at double the national rate.

Since 1990, when the grant program began, more than 350 physicians have settled into practices in rural or underserved areas of the state with the aid of the grant money.

The grant offerings for nurses and physician assistants began later and have settled 26 nurses and nine physician assistants into underserved areas.

Program officials say doctors tend to stay put after working in a practice for three or more years. About 69 percent of doctors still actively practicing in South Carolina have remained in the original county where they were placed by the program, administrators say.

The program is not just for new medical school graduates. Neal Shealy practiced medicine for years in the mountainous western North Carolina town of Crossnore, but wanted to return to South Carolina, where he had completed his medical studies at MUSC in 1979.

He obtained a $70,000, four-year grant to join a practice in Hampton County.

He said he likely would have made the move without the grant, “but it made it more attractive.”

Shealy said he finds it “more rewarding when you go somewhere you are needed.”

Despite the successes, luring doctors and other health professionals to rural areas is not easy.

Dr. David R. Garr, the health consortium's executive director, knows the difficulties all too well. He was a small-town doctor and his wife worked as a midwife.

The first problem is pay. Most rural physicians practice primary care as family physicians, among the lowest paying of all areas of practice.

Not only do rural family doctors make less than their urban brothers and sisters, but physician specialists, such as those in diagnostic, radiology and orthopedic surgery, make $250,000 more in median annual income, according to one study. That's a difference of $7.5 million over a 30-year career.

But the biggest hurdle to recruiting rural doctors may be lifestyle. Garr said the vast majority of physicians come from upper-income families with little exposure to small-town life.

They have a hard time adjusting to places with little to do, no fine dining and a general lack of social life and intellectual interaction. Then, he said, add to that the needs of a spouse, children and school.

It takes a person with a love for small town and country life, or a physician with a missionary zeal, Garr said.

Lamb is both. “I don't see it as being stuck here,” he said. “I'm pretty happy. I just wish we got paid better.” Still, he loves the familiarity. “I know everybody in town, and if I don't know them they know me.”

In Lake City, Lamb said, “I felt like I could make the most difference. All my family is here, and my wife's. This was my calling. This was what the Lord wanted me to do.”

Reach Doug Pardue at 937-5558