MARATHON -- In this age of specialized medicine, Steven J. Smith of the Keys is a rare do-it-all doctor who performs general surgery and treats patients at his family practice for everything from the common cold to cancer.

He's also saved the life of a sheriff's deputy shot four times in the stomach and delivered babies, including triplets, by C-section.

``He really has meant life or death to this community,'' said Kim Bassett, CEO of Fishermen's Hospital in Marathon.

For his extraordinary devotion and care to his patients for 31 years, Smith was named the 2009 Country Doctor of the Year.

The previous 16 winners of the prestigious award for doctors who practice in areas of populations less than 20,000 were all family physicians. Smith is the first recipient who also is a surgeon.

``That combination is very rare to find in a rural area,'' said Phil Miller, vice president of communications for Texas-based Staff Care, a temporary physician staffing company that sponsors the award.

Healthcare reformers in Washington, both Democrats and Republicans, have talked about the need for more primary care to provide coordinated treatment and cut costs, but virtually no one imagines surgeons also becoming family doctors -- in rural or urban areas.

It's a combination that is almost non-existent these days in urban areas.

``I'm sort of a dinosaur,'' said Smith, 61. ``It's very rare to find a surgeon willing to do anything other than surgery. If I had gone to a bigger city, I'd just be doing surgery.''

With his general practice, one of the largest in the Keys with about 3,500 patients, Smith said: ``I feel like a doctor helping people. If I was just a surgeon, I'd feel like a technician, and might as well be working on cars.''

Smith didn't plan to be a country doctor/surgeon. He grew up the son of an OB-GYN in a suburb of New York City, got his medical degree from New York University and did his residency in general surgery during ``the knife and gun club'' days of New Orleans in the 1970s.

``I worked 110 to 120 hours a week, taking care of a lot of trauma -- shootings and stabbings, motor vehicle accidents and fights,'' Smith said.

After his exhausting residency ended in 1979, he wanted to operate in a quieter place near the ocean so he could also fish and dive. He talked his new wife Barbara into ``trying'' Marathon, then a town of 4,000 that was not much more than a gasoline stop from the mainland to Key West.

A GREAT NEED

It didn't take long for the Smiths to realize that small towns need good doctors -- and good surgeons -- as much if not more than big cities.

``A lot of doctors come to the Keys and want to make tons of money, but it is not here and they leave,'' said retired doctor Luis Sala, who worked with Smith for seven years and nominated him for the award.

While the Keys are a vacation destination, it meets the rural definition by medical standards: a shortage of physicians and specialists, isolation, economic challenges and a high percentage of Medicare and Medicaid patients.

For many years, Sala said Smith was the only surgeon in the Middle and Upper Keys, which meant that he had to be on call for surgical emergencies at both Fishermen's and Mariners Hospital in Tavernier, 40 miles apart

In 1989, Smith got a call in the middle of the night about a deputy who was in critical condition with four gunshot wounds after being ambushed during a burglary. In a closet-size operating room in the old Mariners Hospital, Smith stopped the internal bleeding and repaired the damage.