For the past 10 years, Dr. Raymond (Rocco) Monto’s morning commute has been out of the ordinary.
Three times a week the orthopedic surgeon, one of just two on Martha’s Vineyard and the only one on Nantucket, drops off youngest son Rocco at school while daughter Siena boards a bus to Nantucket Elementary (older sons Alex and Nick are at Cape Cod Academy and the University of Connecticut, respectively).
Dr. Monto then boards a Cape Air plane and takes off for an island-to-island flight, heading to Martha’s Vineyard. Often he’s the only passenger.
But come May 31, Dr. Monto’s commute will lessen considerably in mileage, as he relocates full-time to Nantucket. The move was formally announced by his office last week, and comes in response to a decision by the Nantucket Cottage Hospital, which acquired Dr. Monto’s private practice five years ago.
“What’s happened in the five years since then is that the Nantucket hospital has been . . . underwriting this whole practice here on Martha’s Vineyard, and that’s not really a sustainable model [for them],” Dr. Monto said in an interview on Wednesday.
The Vineyard orthopedic practice was the first of its kind to be established here. Dr. Monto first washed ashore in 1996 from Philadelphia, where he began his medical career out of residency. A New York University medical school graduate, Duke resident and fellow at the Steadman-Hawkins Sports Medicin Clinic in Vail, he realized early on that working in a large hospital was not for him.
“I couldn’t give the care I wanted to, so that led to me coming here,” he said. An emergency room doctor at the Vineyard hospital had let him know the Island was searching for an orthopedic surgeon, and Dr. Monto applied for the job. At the time, he didn’t know where the Vineyard was.
“There wasn’t any established orthopedics on the Island,” he said. “There had been visiting surgeons, and they had done a great job, but there are limitations [to that].”
Any Island resident, physician or patient, knows there are built-in difficulties to providing and receiving medical care in an isolated area. For patients, there is often the matter of supply and demand: many patients, few doctors. For physicians, there is the matter of support — a stark change for doctors used to walking down the hall and finding assistance — and of privacy.
“You’re in a community with people you care about . . . if you’re uncomfortable taking care of people you know [outside of work], you can’t work here,” Dr. Monto said. “You’re involved all day. It’s the same on Nantucket.”
Nantucket had also been experiencing the visiting-surgeon dilemma for some time, and in 2004, the hospital began to send patients to Dr. Monto’s practice on the Vineyard. As with the Vineyard practice in its early days, there was no shortage of patients.
“It started out as a trickle and became a stampede, to the point where it was getting expensive and not practical or safe for all of these patients to be coming over from Nantucket,” Dr. Monto said. He opened a practice across the Sound, and began the morning commute. After five years, the Nantucket hospital brought the practice under its umbrella, a boon for its patients, Dr. Monto and his employees.
“We were faced with the reality of trying to run a [private] practice in Massachusetts, which is extremely challenging,” he said, describing the job as “all of the challenges of being a surgeon, plus all the challenges of running a small business.” Wife Jennifer is the office manager for the Island practices. “Without her, running one practice, let alone two, wouldn’t happen,” Dr. Monto said.
Dr. Monto arrived at his specialty of choice because of his own sports background as an All-American collegiate soccer goalie who dabbled in professional leagues. His soccer involvement continues today both locally (last year, his team in the men’s recreational program on the Vineyard won the league) and nationally (since 1993, he has worked for the American national soccer teams).
“I had been hurt enough times [and] thought my surgeons were not that good, so I thought I could do better,” he said.
The field of orthopedics has seen immense changes since its inception, and especially over the past 20 years. “Everything I do today is different than when I started,” Dr. Monto said. Advances in arthroscopic surgery, soft tissue treatment, and imaging stand out among the myriad small changes. Arthroscopic work has become “the bedrock of what we do,” he said.
On the Vineyard, one of the more common injuries treated is a fifth metatarsal fracture, the small bone that runs along the outer edge of the foot. Dr. Monto has said that particular injury occurs in significantly higher numbers on Martha’s Vineyard than anywhere else in the world, leading him to dub it “the Vineyard fracture” in a 2006 Gazette article. The term was later publicized by the magazine The New Yorker.
“That’s a unique thing here on the Island; no one believes me,” Dr. Monto said.
Fifth metatarsal treatments may decrease with the move to Nantucket, but Dr. Monto stressed that Vineyard patients would always be welcome across the Sound.
“We’re not closing the practice, it’s just this branch of it,” he said. “That door’s always open.”