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Pediatrician Derek W. Moss discusses his article, “How natural disasters reveal resilience and the power of community.” Derek reflects on the aftermath of Hurricane Helene, which flooded his Hendersonville Pediatrics practice and devastated his North Carolina community, drawing parallels to the Los Angeles fires. He shares the emotional toll of loss—homes, businesses, and routines—and the challenges of rebuilding without immediate insurance support. Derek highlights the inspiring resilience of community members, from heroic first responders to neighbors offering space and supplies, emphasizing actionable lessons: lean on local networks, adapt to setbacks, and embrace collective strength to recover.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Derek W. Moss. He is a pediatrician, and his KevinMD article is “How natural disasters reveal resilience and the power of community.” Derek, welcome to the show.
Derek W. Moss: Oh, thank you.
Kevin Pho: All right. So tell us a little about the article that you wrote on KevinMD and the story that you shared.
Derek W. Moss: So, I was actually on vacation. I was in Colorado, and the fires in L.A. started, and I sent a text to my friend, a friend of mine from middle school and high school, to ask how she was doing. She also happens to be an editor of Zócalo Public Square, which is an online publication. And she just, like, casually said, would you want to write, like—one of her fellow editors is coming up with this idea of “Letters to L.A.” with other ideas of, you know, people who have gone through natural disasters to send a letter to L.A. So, I do not know if she thought I was going to write the letter. I think now, like, looking back, I have tried to, like, edit and do some other stuff and get so busy practicing medicine; the time and energy to be able to do that is difficult.
So, I think it was kind of lucky I was on a break, so I was able to go back and forth with her and edit it.
Kevin Pho: So sure, sure. And in your article, you talk about your own brush with a natural disaster, your practice, and the Hurricane Helene disaster in North Carolina. So tell us about your article.
Derek W. Moss: So, I think it is kind of interesting because some of the parts of it, I wrote probably more on that article that got edited, edited out, probably because it got too wordy. You can get a little wordy when you start writing these things. And I think, like, I mean, just when you go through something, I think the closest thing was, like, Hurricane Katrina. And it is like, we all knew that was bad, but it is very different living through this. And also, I remember, like, reading stuff with Katrina, just how, how long it took for help to come.
And I think that is the main thing. Like, it was—I mean, I do not think it should take—it was one week shy of four months when we had our first insurance payment. I mean, that is a long time to try to get your business back afloat. It is, yeah, it is very difficult.
Kevin Pho: What was your practice like? And tell me about the disruption that Hurricane Helene wrought on your practice.
Derek W. Moss: Yeah. So, we have two offices: one in Hendersonville, North Carolina—we are about 25, 35 minutes south of Asheville, about an hour or so north of Greenville, South Carolina—and one in Brevard. And the flooding really hit just one office. It was our, you know, the main office in Hendersonville Pediatrics. In that office, we usually, I mean, every day we had, like, four doctors working. We saw about a hundred—more than a hundred patients a day in that office, and then, you know, then you are, like, scrounging to try to find places.
I mean, we actually had another office, so we were able to see some of our patients in Brevard, but Brevard is only so big. That office is not very big, so we had to find places in Hendersonville, too, and just how difficult that is.
Kevin Pho: And in terms of all that flooding, was it a total destruction of your office? How long was that office unusable?
Derek W. Moss: Yeah. So, it was the bottom floor. We have a little bit of a second floor, but the bottom floor was—it was five feet in there, and they took out all the drywall. I mean, it was down to the studs and the concrete slab.
Kevin Pho: So as you were scrambling to move patients around and finding places to practice, just talk about the disruption it had for those hundred patients a day that you would see normally in that office.
Derek W. Moss: Well, I think at the beginning, so many people had such a hard time just traveling anywhere that, I mean, were we getting that many? I mean, even in our Brevard office, we were seeing maybe 15 one day, and then maybe 30—it started building up. But, I mean, people could not get out of their homes. I mean, they were worried about their own families. So initially maybe there was not such an emergent need. You know, people would go to the emergency room as opposed to calling us. But we definitely wanted to find a space to start seeing patients. And so we were—I mean, the local hospital showed us some space, you know, but you do not really think, like, space for physicians: I mean, you need an exam table, you need, like, the ability to wash your hands, you know, you need your everything—labs, swabs. I mean, everything is gone, and you are, like, whatever you are looking for does not have what you are looking for or what you need to completely see, you know, to see a patient where you have, you know, what standards that you set for yourself.
Kevin Pho: Take us into some of those patient encounters. Like you said, you did not have your normal workspace, you did not have a lot of equipment. You pretty much had yourself, perhaps some staff members, a stethoscope. So tell us some of those patient encounters in a completely unfamiliar scenario without a lot of equipment.
Derek W. Moss: So, the first—I mean, I felt like we were pretty fortunate. Like, that first week, we were able to kind of get this place at the free clinic, so there was a little bit more of stuff—maybe not our lab equipment. I think people were just so happy that they could see us. Yeah. You know, so our patients, I think they are very loyal to our practice, and they appreciate what we do. You know, when we are—I mean, pediatrics are maybe a little different with internal medicine in the sense of, you know, these are parents who are, you know, worried about their children, and we give them a lot of reassurance and help them, you know, raise their children. So they are so appreciative. And then for us just to have that space to be able to see them. So I think they were very understanding. I mean, there was a lot of times of us, like, we have to, you know, refer to an outside lab and do a lab order. So then they would have to go somewhere else. Or with immunizations, we would have to send them to the health department. I mean, that lasted for several months. Like, that should have been another thing that I thought should have turned around pretty quick, but it is a lot more difficult, all the paperwork that now we have to go through.
Kevin Pho: What about things like electronic medical records that you could not normally use on your standard normal computers?
Derek W. Moss: Well, we lost some computers. A lot of people, like me, had theirs at home. So as far as with our EMR system, we were able to get on, but we did have to buy a lot for our staff—people who had left stuff at the office. So, but I mean, I guess that is one nice thing with EMR, you know. We had been on for over 20 years that I have been here. We have been on for over 20 years with some kind of system. So, it’s nice that our records are in a different location.
Kevin Pho: Now, how long did you have to deal with these temporary circumstances?
Derek W. Moss: I mean, we are still—so we…that first place that I mentioned, the free clinics, we tried to get two physicians in there, but we could not. And then the Blue Ridge Health, which—they rented us a space, so we have two doctors there. I mean, but there are six rooms. Like, usually we have four rooms per doctor, which—I mean, when you have three rooms, you get kind of bottlenecked at times. So, I mean, they are working on our office, but we will not—they said, like, summer. So we will not be back to our office until July or August. You know, I always try not to think about it too much because it is probably going to be longer than that, but…
Kevin Pho: So you are anticipating almost a year outside of your normal office. You mentioned some of the behind-the-scenes challenges, like waiting months to get an insurance payment. Tell us about some other behind-the-scenes challenges that your staff faced during this time.
Derek W. Moss: Yeah, and I—I mean, I do not know. Our staff did amazing, you know. I kind of mentioned it in that I was—I could have named all the staff and all the stuff they have done, because, I mean, I probably should get them on this call, because a lot of stuff they did—setting up our labs, setting up vaccines, setting up our office—they did it all, you know. I mean, they did have some input from us, but I mean, we definitely had employees that went—I mean, they are loyal to us, too, in what we do. You know, it is interesting. We chose this field to go into, but yet, you know, our employees, they…you know, for us, they really support us to be able to do that.
Kevin Pho: Now, is your practice a private practice, or is it a hospital-owned practice?
Derek W. Moss: It is a private practice.
Kevin Pho: Yeah. So you were doing this all by yourself, and there is no playbook for kind of managing through a disaster. So what kind of guidance did you have? Like, how did you know what to do?
Derek W. Moss: I mean, that is interesting. We actually had a new doctor with us for a week when this happened. So it was like, he did not know what we were going to do. And he asked me one time, you know, comparing it to COVID, you know, because, I mean, that was not that long ago and how disruptive that was. But then I think one of the things is everyone was going through that at the same time, you know, whereas this was, you know, my friends or medical school friends or whoever, my family, I mean, they are back to, you know, their usual life, you know, so we are not. You know, so that was different. You also felt like you were going to be supported financially, which—with here, you just, you do not feel that way. You know, it is every day my office manager sends us, you know, how much money is in the bank accounts, you know, like, and how many patients we are seeing, because it is definitely—you know, it made us…I mean, pediatric overhead is, like, greater than 65 percent, you know; you get hit like this, it goes up to 80. You know, so you have got to kind of keep your head above water with the money for sure, which—I mean, you always do when you run a business, but it is a different level than what we are used to.
Kevin Pho: Now, what about things like reimbursement from health insurance companies, and were they disrupted during this time?
Derek W. Moss: Yeah. I mean, it got disrupted because we did not have the encounters. I mean, one thing I was surprised about—and I did not write in the article, but then I thought about it later—was that I was kind of—I mean, we have had, like, stabilization payments from different insurance companies. I mean, they are not huge sums of money. And then the North Carolina Medical Society, I mean, they gave us 100,000 dollars, which, I mean, I do not know what we would have done without some of this stuff, really. I mean, we would have been in the negative. I mean, we have a pretty good relationship with First Citizens, our bank, but it is, yeah, nice to not have to worry about that because of that, you know. So…
Kevin Pho: So in your article, you talked about how your community really banded together. So tell us more about that. Tell us some of the stories that you could share about how your community banded together after this disaster.
Derek W. Moss: It is—I mean, because you kind of collect those as you go along. Like, you know, you hear—like I said, you hear so many different stories. I mean, but we had no power here for weeks. I mean, no—I mean, the phones would come on and off. You would have three days you would not even have any cell service. I mean, it was…it was really something around here. And we would leave just to be able to get cell service, hot water. You know, it was—so then, you know, you are talking to friends, because you are just kind of dealing with—I mean, we are worried about our office and our, our, you know, our own family. But then you start hearing stories. I mean, we have one of our friends in Fairview. I mean, they lost their house. I mean, they saw—I do not know how much you read the story to this—Craigstown, where all these family members passed away. I mean, they know all of them, you know. And then we have a lot of our patients who live, like—I mean, people always laugh about Batcave, but that is a real place. And I mean, they are—I mean, I had three different families who were, like, helicoptered out of their houses, you know, and they have, like, three and four kids, you know, and they are all getting on helicopters to get—because there is no way, the roads are all gone—to get anywhere, you know. And that is a whole thing, because I think about my business and losing our office, which has been horrible, but I mean, we did not lose our house, you know. There are people who have lost their whole house.
Kevin Pho: Now, this was in the context, of course, of the L.A. fires. Whenever a natural disaster happens, it often catches a lot of people by surprise; it happens very, very quickly. Now that you have gone through this, and are still going through this, what kind of advice do you have for other clinicians to prepare themselves against an unexpected natural disaster?
Derek W. Moss: Yeah, that is hard. I…I mean, you definitely rely, like I said, on your staff and the people that you are around. I do not know how—I mean, it is such a shock to the system. Like you said, you worded it very well, because it is, it is—I mean, you are not expecting that. I mean, who is, like, in the mountain thinking, like, all this flooding, right? They are not thinking, oh, we are going to have all this flooding and huge amounts of water that is going to just destroy all these places. And I think it kind of depends on what kind of natural disaster we are talking about. I mean, the fires—yeah, it is a natural disaster. Like, people can say, oh, there are fires in California, why would you not expect that? But you are not expecting it to affect your houses and all these people and lives. And you hear about it happening in other places, so you know it could happen, but then in reality, it happening is—how do you prepare for that? I mean, I think the thing that you kind of learn from this is—I mean, and one thing I think about with my article is, like, I mean, we need better things in place that would be quicker, you know. I talked to some of my insurance friends. I mean, they used to have a checkbook, and they would give you what was reasonable, and they would figure it out later. I mean, you know, it is like four months for us. I think finding a place to—I do not know what we would have done if we did not find these two places. I mean, that would have been really—you know, we definitely, we have a different place in the free clinics now, and we are renting the space. But I mean, everyone else is still running their business. I mean, they were doing two-year leases. They let us have one year. So that was really nice. I mean, we looked at AdventHealth, which—HCA is, I mean, and HCA, which bought Mission, and it is, you know, it is all for profit. I mean, they are looking at you, and they are like, you are going to be paying this much rent, and you are going to have to fix everything else yourself, and you are—and you are like, we have no, like, cash flow. So, I mean, it is those kinds of things in place that would help, you know, to have stuff. I mean, I think a lot of times with doctors, people are like, oh, they have all this money, and they are fine, you know, so maybe, you know—I mean, my focus is on other people and families who are, like, suffering worse than we are, but at the same time, I think we can have some better structures that can come in place. You know, I mean, FEMA is there, but they definitely get overwhelmed with the amount.
Kevin Pho: Now, what about the other medical practices in your area—how are they faring in comparison to how you guys are doing?
Derek W. Moss: So, in our little—our Beverly Hanks, where our office is, there are dentists in that area. And I mean, I actually have one of my close friends who is a periodontist, and they have reached out to other dentist offices that are not using their space at certain times, so they have been able to work that way. You know, I am laughing because dentists do not work on Fridays. So these offices all have places to work on Fridays. But I mean, you know, it is very disruptive, too. There was Allergy Partners next door to us, but their main office is in Asheville. I mean, this is kind of a satellite office, so they have other offices that they can…yeah.
Kevin Pho: Now, you mentioned that you received support from the North Carolina Medical Society. Do you feel that you received the appropriate support from your fellow colleagues, your fellow medical colleagues in the community?
Derek W. Moss: I mean, that is a—I mean, that is good. I was not expecting that, you know. I think that…I think what is hard is, like, people call you or talk to you, and they want to help, but what are they going to really do? Yeah. Yeah. You know, they…I appreciate it, but it is hard. It gets down to it. It is like, I mean, we have to do this stuff, you know. We have to be the ones—money definitely helps, but, because I think for us, you know, money-wise, we are—as owners, there are, what, how many of us now—seven owners? And we are going to—we are paying our employees first, you know. We want to make sure…I mean, they are not making…they really rely on their paycheck every two weeks more than we do. I mean, we do, but we want to make sure they are taken care of. So, you know, you are doing all that first. So it definitely helps to have that monetary support, you know, and also the space. I mean, we—you know, with Blue Ridge Health, I mean, we had the physicians there; they had built this space for pediatrics they were not using. I mean, if we did not have them helping us, I, you know, it is just…yeah, so that kind of stuff helps, you know, from the physicians.
Kevin Pho: Now, once you fully recover, hopefully later this year, any changes that you are going to make to your practice, just in case something like this happens again in the future?
Derek W. Moss: Yeah, that is hard, right? Well, we have talked about moving our office in Hendersonville, you know, because regardless of—this is…they say, you know, one in 500. I mean, they say one in 500 years because of whatever we are in this Point Two field, whenever they determine that. But, you know, in reality, that could happen any year. Any year, you can go and say, oh, that could happen again, even though that was…you do not see that happening again, but you do not want to put yourself in that position. It is kind of hard because we were actually building a different space in Brevard, like, started in the summer for our clinic there. And so, I mean, all our resources…I mean, we did not have the money to be able to start even thinking about doing a different office in Hendersonville now. You know, sometimes people are surprised, like, are you going back there? And it is like, well, we do not really have a choice because we cannot do this for two to three years as we find a space to be able to build an office as big as we are. You know, we are not just one clinician. We are, like, four of us and seeing a hundred kids. I mean, that is a big space, and to find that space and build it, it is going to take time.
Kevin Pho: We are talking to Derek Moss. He is a pediatrician, and today’s KevinMD article is “How natural disasters reveal resilience and the power of community.” Derek, let us end with some take-home messages that you want to leave with the KevinMD audience.
Derek W. Moss: I know I—you sent that to me in email, and I was trying to jot something down, and my take-home message…I know, I think it is interesting how, like, different people interpret my article. They will say different things to me. I mean, you—how you titled that, I mean, it is very true, and I hear that a lot. Talk about…I never know how to say it myself. I have lived here for 20 years, but to say it, Appalachia or Appalachian, but the people here are very strong and resilient, and, I mean, it is the community that holds us together. You know, so I think we kind of can forget that in the world that we live in, because, you know, social media and the internet, and we are all interconnected with the world, but you are still where you live. And the people that are here are very—they are proud and strong. And, and I think, you know…I get all emotional about that, but it is—I mean, there is truth to it. You know, I think we…things happen to us. You hear in the past, like, things happen in the United States, and we bounce back and get strong or stronger, you know. So that does occur. You know, you do not want to have to go through this, but that is, I guess, the gift that is there if you are open to it.
Kevin Pho: Derek, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.
Derek W. Moss: Oh, thanks, Kevin. It was nice to meet you.