ORANGE BEACH — When some of the best long-distance runners in the world toe the starting line in Hopkinton, Massachusetts at the 129th Boston Marathon on Monday, Orange Beach resident Joshua Miller will be among them.

This year’s race will be old hat for the family medicine doctor who will be making his fourth-straight appearance in the world’s oldest annual marathon.

“It's so amazing to be there, it's the Super Bowl of our sport so it's just a privilege to be there but it is familiar,” Miller said during an April 10 interview. “Even though I grew up in the south and have lived in the south for most of my most of my life, it feels like going home to me now because I have all these places that I like to go to and things that I like to do in Boston.”

It will also serve as his 27th official marathon, although he also unofficially counts a 26.2-mile run he did through Gulf State Park during the pandemic. Despite his age of 48 years old, he said he has no feelings about his running career ending and it’s not simply because he enjoys running.

“I think that doctors and dentists and healthcare providers in general have a capacity to spend all their time caring for others and not investing in themselves. I think that some of us get to a point where we realize that you have to take care of yourself in order to be able to take care of others,” Miller said. “It is the best medicine. There is no prescription, there is no surgery, there is no self-help book that can give you quality and time in your life that an hour a day of exercise can.”

Good memories in Beantown

His very first Boston Marathon in 2022 secured Miller’s spot in the Abbott World Marathon 6-Star Hall of Fame with medals from the other five major marathons in New York, Chicago, London, Berlin and Tokyo.

As he conquered Heartbreak Hill and entered the homestretch of the 2022 race, Miller was reminded of the efforts that led him to achieve his long-term goal. He estimated that he logged nearly 10,000 miles just to reach that point.

“It seemed like something that would be really, really difficult because to keep doing something for five years or seven years, that's a big commitment. And then it's not easy to get into these races between the expenses to get to some of these places so it seemed achievable, and I didn't think that I would give up on it, but it still was so long,” Miller said. “It ended up, at the end, not feeling as much about the races themselves as I thought more about just the hundreds and hundreds of hours getting up early in the morning to run.”

A seventh star on the horizon

The Sydney Marathon in Australia was recently added as Abbott’s seventh major event and Miller said the race is “absolutely” in his sights because he could collect a couple of big check marks on his goal sheet. Not only would it be the seventh star, but it would also serve as another country as well as the penultimate continent he’s run a marathon on.

“I've always had this secondary goal where I wanted to run a marathon on all seven continents so it'll give me an opportunity to check off two boxes with one trip: the new race that's being added in Sydney, plus adding Australia. It's not going to be in 2025 but probably 2026,” Miller said. “I've loved it. (Traveling is) another reason that running has been so important to me the last 10 or 15 years is that it's given me an opportunity to see cities like Berlin and London and Tokyo, of course New York and Boston.”

An extra special fundraising mission

And when he goes to Boston, he partners with the Dana Farber Cancer Institute to help doctors and researchers identify new techniques and processes to attack different angles of certain cancers. Miller said the partnership hits home because his father passed away from lung cancer in 2021 and his running partner, Adam Wende, was diagnosed with leukemia but has since been in remission.

Over four years of fundraising, Miller said he’s helped contribute over $40,000 to cancer research.

“There are so many types of cancer that we've come a really, really long way on, especially in things like melanoma and leukemia, but there's other types of cancer that we still have a long way, like colon cancer and lung cancer. So the research that they do, the money that goes into it, is really giving hope to not only us, but our family members,” Miller said. “We all, at some point in our life, are going to have a family member impacted by cancer. Dana Farber and the Jimmy Fund are organizations that take funds and literally put them to work. It's not one of these organizations where forty percent of it's going to administrative costs; it's going straight to the scientists that are developing these new and novel approaches to treating cancer so it is important to me.”

From his perspective within the medical industry, he said he was even more impressed with their output when he visited the hub himself.

“Unbelievable. There's the clinical side, the hospital and treatment side, but there's also the bench lab research side and it's all amazing,” Miller said. “But meeting the people that are there and talking to the people — that's their daily work — does give you extra motivation and emphasis when you're thinking about what we're doing.”

New job, new home

But the Birmingham native has called Orange Beach his home since 2020 when he decided to make his vacation city his next full-time residence. Miller has also since moved from the most hands-on type of care where he made home visits all over the Birmingham area to now being fully remote in one of the southernmost points in Alabama.

“I never could have imagined a physician working remotely prior to COVID, but things have changed a lot. It's a different world and a lot of healthcare is delivered electronically now,” Miller said. “There are parts of it that I like, I don't ever miss anything with the kids' sporting events or school. But there is something lost because I could go into a patient's house and open their refrigerator and see what they were actually eating, or I could smell the smoke or see the ashtray.”

From the office to the spotlight

All the while, he spends his spare time rubbing elbows with running royalty from each corner of the globe. A prime example was when Miller shared the Berlin course with Kenya’s Eliud Kipchoge who went on to set the first of his two marathon world records in 2018.

“The other thing about majors is, you're toeing the line with these athletes that you've seen on TV. It's not just the amazing American athletes, but also the amazing Kenyans and Ethiopians,” Miller said. “To say we like playing baseball or softball, we're not going to go out on a baseball or softball field and play with big leaguers. But marathons, you do. And there's places — Tokyo is probably the best example of this — on the course where even if you're not spectating and you're racing that you'll see these elite runners, of course way out ahead of you, and you're participating in the same sport as them, on the same day as them, on the same course as them.”

The ultimate learning experience

Miller described marathons as the ultimate learning experience where each runner can garner plenty of new information about him or herself over the course of 26.2 miles. Over the course of about 27 marathons, Miller said he has learned just how far the human body can push itself.

“Your body is physically capable of doing a lot more than your psychological mind tells you that you can. It's often in life and sport that your brain tells you that something can't be accomplished long before your muscles and bones are actually really ready to give up,” Miller said. “If you're ever at a marathon, you see the struggle that people are at in mile 21 and 22 and you see the defeat on their face. But if you were to ask, all of them have run a 10k before. All of them have run six miles before. If you were to ask them that morning, ‘Can you run a 10k?’ But in that moment, their brain is telling them that they can't do another mile, and it's not actually true.”

He’ll push his body and mind past its limits once again on Monday, the 250th anniversary of Patriots Day which commemorates the inaugural battles of the Revolutionary War. While he does know what to expect from the day’s events, Miller said the end of the road always feels better in person.

“I’m excited to see that finish line. When you take that left onto Boylston Street, it's hard to picture but you can kind of hear the crowds but you can't see them quite yet. Then you take that left and there's so many people and it's so loud and it's so powerful,” Miller said. “Then you can see the finish line 200 yards away, it's just the most amazing feeling to know that you're there, that you're part of that moment, that they're going to put that medal around your neck and you're going to be celebrating with all the other finishers that night at some great Boston pub.”