Bloomberg Businessweekthe office of a public defender. The plush carpet softens the
footfalls of Jemma, a 6-year-old black lab mix. Dickson doesn’t
work with a nurse, an assistant, or a secretary. It’s just her and
the dog.
Dickson, who’s 60, walks through the office with a short and
choppy stride. Her hair is cropped and simply styled, and her
uniform is likely to consist of a T-shirt, jeans, and dusty New
Balance sneakers. If anyone calls her “Dr. Dickson,” the words
never fail to clank in her ear. She much prefers people to call
her Mutt, and almost everyone does. It’s a nickname with famil-
ial roots: Growing up, she was as short as her older brother
was tall, so as kids they were always Mutt and Jeff, like the two
mismatched friends from the old comic strip.
She recently picked up a microwave for $5 at an estate sale.
Earlier, she’d picked up a TV for just a little more. Sometimes
she keeps such finds, but more often she gives them away to
friends. Two days ago, at another estate sale, she paid $5 for a
giant mess of agate, a type of quartz that’s found in local river
bottoms—two 5-gallon buckets, one coffee can, and a couple
plastic bags full of rocks. She donated the lot to her friend
Skinny, who wears a Make America Great Again hat and who
likes polishing and cutting stone. Several times during her
career, in lieu of payment for her medical and psychiatric ser-
vices, Dickson has accepted turkeys and pies. Colleagues affec-
tionately speak of her idiosyncrasies as if they’re a feature of
the local landscape, as particular to the region as the peculiar
rock formations outside of town.
“I think some people can’t figure me out,” she says. “But
I’m just not one of those people who’s motivated by money.”
To narrow down exactly what did motivate her, she under-
went years of far-flung self-exploration. She grew up in Scobey,
a town of 1,000 about 20 miles from the Canadian border.
She was salutatorian of her high school class, which in those
days meant an automatic free ride to a public university in
Montana—and that threw her career path off-kilter before it
even began. “I really wanted to go to Wahpeton, North Dakota,
to become a plumber,” she says. Instead she dutifully attended
Montana State University at Bozeman for two years, until they
made her declare a major. She promptly dropped out and went
to work in New Mexico for a summer as a framer-finisher car-
penter. Next came a stint driving trucks for a road construction
outfit in Minnesota, where she took her first paramedic class.
She moved to Las Vegas to become an emergency medical
technician. The 1980 MGM Grand hotel fire that killed 85 peo-
ple happened on her second day on the job. She stayed on for
seven years before curiosity—“I felt I just needed to know more
about medical care”—drove her to enroll in nursing school.
After holding down a full-time job while completing the course
load, she became a registered nurse for the county trauma
unit, and that led to a position in the medical unit at the fed-
eral government’s nuclear test site in Nevada. She eventually
found herself on the medical crew of a Department of Energy
ship that traveled to the South Pacific to drill core samples
into the craters left by nuclear bomb tests in the 1950s. In the
Marshall Islands, she mixed with the locals, liked them, andtook a job as a nurse for a company that had a health-care con-
tract with the Marshallese government. She stayed three years,
doing everything from stitching up cuts to treating malnutri-
tion to delivering babies and was, in everything but title, a full-
fledged doctor. She made it official by returning to the U.S. to
enroll in medical school at the University of Washington. She
graduated in 1997.
She envisioned herself as an old-fashioned small-town doc-
tor, like her family’s beloved Doc Norman in Scobey, who,
during a house call years before, had stitched up her bleed-
ing left elbow at the kitchen table. But the deeper she got into
her studies and the more she talked with her teachers and
colleagues, the more she realized that psychology was an●
FEW PROVIDERS, MUCH DESPAIR
Some 13% of the U.S. population lives in rural counties
with a shortage of psychiatrists. The U.S. Health
Resources and Services Administration assigns counties a
score* that measures the severity of the shortage. Higher
scores mean more unmet need.
◼NON-RURAL COUNTY 0 SCORE◼1 TO 10◼10 TO 15◼ 15+Rural areas
Noncore
(County with no city
above 10,000 people)
Micropolitan
(County with a city with
population of 10,000-50,000)Urban areasSmall metropolitanMedium metropolitanLarge fringe metropolitanLarge central metropolitanSUICIDES PER 100,000 PEOPLE BY METRO AREA TYPE ◼ 1999 ◼ 01720 10 20GLENDIVE MEDICAL CENTER*COUNTIES GET HIGHER (WORSE) SCORES FOR MULTIPLE FACTORS: FEW MENTAL HEALTH DOCTORS, A HIGHER SHARE OF POOR RESIDENTS, AND LONG TRAVEL TIMES TO CLINICS. DATA: U.S. HEALTH RESOURCES AND SERVICES ADMINISTRATION