In rural Appalachia, can health care become the new coal?

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• Amna Nawaz:

  Tonight, we're starting a special series about The Future of Work.

  It's clear robotics, automation and globalization are driving big changes for workers and companies alike.

  Our team has been traveling the country to capture just who's benefiting and who's getting hurt.

  We begin in Appalachia, a region where good jobs have been in short supply and diversification is the name of the game.

  I recently went there to see how one community is dealing with life after coal. It's 7:00 on a quiet Tuesday evening in the mountains of Eastern Kentucky. And Olivia Boyette, a second-year medical student, is studying at her kitchen table.

• Olivia Boyette:

  The main reason I sit here is so that I can see my white coat behind me and use it kind of as like, OK, you have to do this. One day, I want that coat to be a long coat, and instead of just Olivia, I want it to say Dr. Boyette.

• Amna Nawaz:

  Her future may be in medicine, but, for decades, her family and community were built around coal.

  Pikeville, Kentucky, is a small city of 6,700 nestled deep in a river valley in the heart of rural Appalachia. As the coal industry declined, towns across the region struggled to survive. Since 2011, an estimated 13,000 coal jobs were lost here in Eastern Kentucky alone.

  Some experts say to make up for the wages and revenue lost in that time, it would take 30,000 new jobs today. Pikeville is now trying to fill some of that gap by shifting to health care, and investing in its hospital system, serving 450,000 people across three states.

  It also employs 3,100 people, nearly half of Pikeville's population.

  Donovan Blackburn is the hospital's CEO.

• Donovan Blackburn:

  We have some of the sickest of the sick, when you talk about respiratory cancer or heart disease. But, on the other side, we have got some of the best work force, best-trained work force that you will ever find anywhere.

• Amna Nawaz:

  Training that future work force, like Olivia Boyette, is where the local university comes in.

• Burton Webb:

  We have bright students here, and all they need is an opportunity.

• Amna Nawaz:

  Burton Webb is the president of the University of Pikeville.

• Burton Webb:

  One of the major purposes of being in a place like this is so that we can retain people who live here. They can train here, they can learn here, grow here, and then keep their families here. And it helps that we have an enormous hospital in town. It's a regional medical center. And so there's a place for them to come and to practice and to live.

• Olivia Boyette:

  I don't just want to help people. I want to help my people. Pikeville, Kentucky, and the surrounding areas is a very unhealthy area. There's a lot of tobacco. There's a lot of alcohol abuse. There's a lot of obesity. I feel like I want to give back to my community.

• Amna Nawaz:

  And the need here is dire. Life expectancy trails the national average by seven years. And 70 percent of the hospital's patients rely on Medicare or Medicaid.

• Donovan Blackburn:

  The amount of money that is paid to the federal government and to the to the state is very overwhelming, but the amount of money that's generated back to this community, of allowing families to put food on their table — our average salary is around $65,000 a year.

  So, you know, we pay well. But, overall, the center has a huge economic impact to the region.

• Amna Nawaz:

  That impact is the initial return on millions of dollars invested from federal and regional loans and grants, after years of planning by local leaders.

  City manager Philip Elswick:

• Philip Elswick:

  We began to realize and accept the fact that coal wasn't coming back. And then the conversation changed to, well, what is going to be the future of Appalachia, the future of Eastern Kentucky?

• Amna Nawaz:

  Born and raised in Pikeville, Dr. Chase Reynolds didn't think he had a future here.

• Dr. Chase Reynolds:

  In my mind, I was going to go to a big city someplace and practice medicine. I was very surprised as I started looking at job opportunities to see what had grown up in Pikeville since I had left.

• Amna Nawaz:

  Reynolds says the hospital's continued growth and investments, like this $30 million cardiac lab, have convinced him to stay. They have expanded to 340 patient beds, and there are now 100 open jobs.

  One of those jobs went to former coal miner Kevin Little. He started working in the mines at the age of 19.

• Kevin Little:

  Not everybody can crawl back inside of a mountain and, you know, go in and take out the middle of the mountain. You know what I'm saying? It takes a special kind of people to do that.

• Amna Nawaz:

  Kevin worked in the mines for 12 years. When he was laid off, he and his wife, Misty, say times got tough for their family of four.

• Kevin Little:

  It wasn't the fact of not being able to buy everything that we was able to afford, but it was the fact of, what if I don't find another job, or what if I found one that I can't take care of my family good enough with, you know?

• Misty Little:

  So, the job was gone, but our bills were still there. It was scary.

• Amna Nawaz:

  So you were already working in the hospital. When the chance came for your husband to come work with you, what did you think?

• Misty Little:

  I thought it was going to be bad.

  (LAUGHTER)

• Misty Little:

  I really thought it was going to be bad. He's a coal miner, you know, and him working on patients and things. But he's definitely showed me different. I admire the person that he's become and the things he can do.

• Amna Nawaz:

  Kevin entered a year-long training program, and worked his way up from operating room technician to surgical first assistant.

• Kevin Little:

  I think the lord has blessed me so much to be able to have a job like I have now. I see a career now. As before, I had a job working in the coal mines, but now I see a career for myself.

• Amna Nawaz:

  The loss of thousands of coal jobs in just the past few years had a devastating effect across Appalachia. Pikeville thinks it has a plan for the future. The question is, can this work in other places?

  Jessi Troyan of the Cardinal Institute worries that Pikeville, where two-thirds of the tax base comes from health care, is banking on an economic bubble that might burst.

• Jessi Troyan:

  So, when I hear numbers like that, I'm thinking that Pikeville has really capitalized on the Medicaid type of expansion dollars coming from the federal government, and should the political winds shift, you know, does Pikeville have to rewrite their story again?

• Amna Nawaz:

  But hospital CEO Blackburn says health care is just the first step towards a more diverse economy.

• Donovan Blackburn:

  What we're doing is, we're making smart investments in health care to create a healthy working community that has transferable skills, while developing industrial parks to be able to invite industry in.

• Amna Nawaz:

  Smart investments in people like Olivia Boyette, who's grabbing her chance to change her family's future.

• Olivia Boyette:

  I questioned myself. I was like, can I actually, really? Like, am I smart enough?

• Amna Nawaz:

  It must be a lot of pressure.

• Olivia Boyette:

  It is.

• Amna Nawaz:

  To be the first one on that road.

• Olivia Boyette:

  I don't want to let down probably, you know, other than my parents, my little sister. Sorry.

• Amna Nawaz:

  Why is that? Why do you think you might let her down?

• Olivia Boyette:

  Just because I grew up in an area where a lot of people didn't think that they can what they want to do, especially, you know, a girl. I want her to see that she can do what I do.

• Amna Nawaz:

  Has your little sister told you what she wants to do?

• Olivia Boyette:

  She says she wants to do the same thing I have done. And she wants to become a physician as well.

• Amna Nawaz:

  Just like her big sister.

  Boyette is on track to graduate medical school in 2021.

  For the "PBS NewsHour" in Eastern Kentucky, I'm Amna Nawaz.

  Our series The Future of Work continues all week. Tomorrow, John Yang reports on how changes in automation are especially impacting minority workers.

  Follow along with the entire series on our Web site, PBS.org/NewsHour.