RURAL HEALTH: Profits and Access on the Decline
Rural health care seems to be taking a beating as pools of psychiatrists dry up, hospitals and clinics see skyrocketing costs and emergency response times lengthen. The Des Moines Register reports that more than two-thirds of Iowa counties lack a psychiatrist, and the HHS has already designated 47 counties as mental health provider shortage areas. But even the designation, which forgives the school loans of specialists who practice in shortage areas, has failed to lure enough specialists from the more lucrative urban markets. The shortage takes its toll, the Register reports, particularly among those Iowans who must wait up to two weeks to meet with a psychiatrist who may only infrequently visit a rural clinic. "There's a lot of people that live out in the country, and transportation is very difficult," said Jill Dannenbring, director of the Plains Area Mental Health Center in Cherokee, IA. And even when such residents make the trek to see a psychiatrist, they are often discouraged to learn the doctor knows little about the problems of rural areas, such psychiatric distress related to farm accidents. While rural advocates plead for more psychiatrists, experts say that some physicians shy away because of the isolation and uncertain pay. "We can't ever expect to have psychiatrists in all 99 counties," said Roger Tracy of the University of Iowa's College of Medicine, adding, "There's room for improvement, but you also need to stay within the realm of feasibility" (Okamoto, 6/13).
Rural hospitals and clinics in Washington state are feeling the pinch, with 42% of the state's rural hospitals "considered financially vulnerable," the Spokane Spokesman-Review reports. As clinics see their profits dry up, many must consider inking deals with insurance companies that offer reduced services -- "a political hot potato for a tiny hospitals that needs voter-approved levies to stay open." Administrators are faced with losing patients if they shrug off deals with insurance companies, but signing such deals positions them to alienate their "consumers enough that they vote down the next levy." The problem, said Alice James, rural systems manager with the state's Office of Community and Rural Health, is "if a hospital folds, it's only a matter of time before the doctors leave. Then you have no access at all. In the demand for short-term lower prices, we're risking long-term stability" (Craig/Welsh, 6/13).
Hurry Up and Wait
In a five-part analysis of ambulance response times in rural areas of New York state, the Albany Times Union took a look Sunday at the volunteer shortages and the "turf battles" that plague local emergency response systems. According to a three-month Times Union investigation, the average response times for ambulances in rural areas can be three to four times that of those in larger cities. "A half-hour, 40 minutes is a frequent occurrence," said Paul McLaren, deputy director of the Rensselaer County Bureau of Public Safety. "It's a huge problem, and it's steadily getting worse," he said (Fitzpatrick, 6/13). And while the state health department collects information about local departments' response times, a law prohibits the disclosure of such information. Instead, the health department provides average response times for the entire county. "This information is important to the public because emergency medical services often involves life and death, and the public should have the right to know how well or poorly an ambulance services carries out its duties," said Robert Freeman, executive director of the state Committee on Open Government (Times Union, 6/13). "[P]erhaps the biggest obstacle is the reluctance of proud volunteers to give up turf ... reach out for help" or create part-time staffs. Edward Wronski, director of the state Bureau of Emergency Medical Services, said, "The hurdles are territory and tradition" (6/13).
Today's Chicago Tribune reports that rural Illinois is facing an acute shortage of doctors -- an average of four doctors for every 3,500 residents, while some areas only have one primary care physician for every 3,500 residents. The Tribune reports that the rural health safety "net is fraying under the collective weight of a shortage of doctors and a lack of insured patients, long travel distances and a declining, aging population, plus economic constraints squeezing clinics and hospitals" (Christian, 6/15).