NO MEDICAL CARE IN SMALL TOWNS

if patients can’t get access to their doctor. there is no way  health care reform  can work in small rural towns in America With the new pressures on solo practice and push for large medical groups, seniors will continue to be deprived of local medical health care in small towns and rural areas.

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MEDICAL   CARE  IN  RURAL  TOWNS

if patients can’t get access to their doctor. there is no way  health care reform  can work in small rural towns in America With the new pressures on solo practice and push for large medical groups, seniors will continue to be deprived of local medical health care in small towns and rural areas.

With the new economics of medical practice, the age of a sole practitioner is gone.  Census data shows the country's most rapidly aging places are not places that people flock to in retirement. They are really the remote places many people flee from. Young people leave those areas for education and jobs and most never returned.

The old remain, are isolated and stranded, have no public transportation, cell phones are unreliable, and medical care is rarely accessible. They wait in hopes of a new doctor to replace the one retired several years ago.

 Being churchgoers, the older people find their churches closed, and they become separated from their children, grandchildren, and friends. With age comes expiring driver's licenses that are difficult to renew with age. Socialize becomes difficult in town.  Many areas of the country need medical care that's not available to them.

REGIONAL DISCREPANCIES

Regional discrepancies are creating a nation of areas that have great health care and those that have none. This is likely to grow because doctors gravitate to affluent localities in the United States that have more than the medical help they need.

For every doctor who lives and practices in a poor area, four other doctors settle in an over served area. This poor distribution of our valuable and expensive healthcare resources has put great strain on areas that need doctors.

MONEY NOT THE ANSWER

We certainly must invest in more doctors and additional costs to cover the 46 million added to the insured patient payroll.  Students and doctors have great financial pressures, the smaller the town the larger percentage the economy that is involved in rural health care.

Provision to encourage more cooperation among doctors would not apply to areas needed like chronic diseases and diabetes and congestive heart failure. The Senate has great ideas but their execution is problematic.

Primary care doctors are offered great  loan incentives and loan  payments to locate in rural areas.  For the doctor who is truly interested in rural practice, the cost of living is not an issue.

MEDICAL SCHOOLS KEEP CONTROL 

Medical schools must do a better job with the right admission policies, the right students. Small colleges that prepare pre-professionals can help them stay connected with rural areas. Medical schools don't want to give up the control they have and don't want to change existing studies.
 Many doctors who would choose to serve in rural areas. Medical education does not select and train doctors who can locate in rural areas.  Medical education programs that choose the right students are able to meet underserved inner-city and rural needs. Here there is limited or no access to physician services.

Choosing students who demonstrate emphasis on service in their education, volunteer work, admission essays and so forth, might be provided incentives for students who have the right attitude and characteristics. They need the right mindset.

There still are physicians who are hungry to serve in communities who want the best care. but increasing the supply of general practitioners to those areas will not happen without the right  incentives given to students who show the right attitude and characteristics

NEW HEALTH REFORM INCREASES SMALL TOWN SHORTAGES

Unlike the past, the doctors are likely to take salary jobs in group practices, clinics and help networks. The age of a sole practitioner is gone. Shortages now occur in some specialties as general practice, internal medicine, and OB/GYN

How can the new ObamaCare health system strengthen the provider workforce and make available  high-quality hospital services so that people in rural areas have access to the best of medical care?  With the new pressures on solo practice and push for large medical groups, seniors will be deprived of local medical health care.

Medical leaders have received government assistance to increase the size of their classes saying this would trickle down more students into the underserved areas. This was not successful, and the funding for these efforts have dried out.

A major issue for serving these underserved communities, is the economics of medical practice. Training in world areas that would deliver economic benefit to them has not been supported. There are no training programs for doctors in rural areas. There is no support for better paid for general practitioners in rural areas. Doctors considering practice in underserved area asked themselves whether it is economically feasible to do so.

QUALITY OF LIFE SEEMS INFERIOR TO DOCTORS
 
Most rural people work hard to support the quality of life they have and do not see it as inferior. They do not understand why people put up with urban culture. Inner-city as many obstacles about personal safety, dealing with intractable social problems, and working in poorer surroundings.  The Midwest has fewer divisions where children of all economic levels get a decent chance at college or medical school. Yet most of them leave and serve the coastal areas.

Are we willing to take funds away from high-cost cities like Los Angeles and New York and give underserved cities more money?  If Obama is right, and the US healthcare system wastes over $500 billion where will this waste be cut from?

THE ISOLATED RURAL DOCTOR

In rural areas, the doctor is isolated, there is a lack of employment opportunities for his spouse, limited educational options for his kids, and lack of satisfying cultural and civic output.  All of these negative factors affect  the young doctor's  practice options. Rural life is a different culture, not a lack of culture. We need to deemphasize the necessity for doctors to permanently settle in areas unattractive to them. 
 
Doctors  don't go to rural areas because of less control over work hours, isolation from other medical doctors, and social reasons.  Doctors, who are self-employed, must provide their own health insurance retirement insurance and malpractice insurance

SMALL TOWNS NEED THE BEST DOCTORS 
 
The suggestion has been made to expand the national health service and have new doctors spend two or three years in public service, perhaps in return for substantial education loan forgiveness. The rural patients will refuse to go to any new and inexperienced or bad doctors in contrast two urban patients who don't know about these areas. Medical schools may be forced to match extra dollars for their funding.

 This problem can't  be solved  by supplying general practitioners to the area.  Some suggest placing doctors in underserved areas for substantial periods of time.  Rural communities do not  want temporary doctors or doctor rejects.   Areas lacking in physicians are forced to offer visa assistance for foreign doctors and medical school repayments to entice doctors to practice in those areas.

The small town needs the best and not the worst doctors. The general practitioner would not be able in a pinch to call a specialist, an expert, nor a nurse. His own skill, knowledge and resourcefulness are needed by the patient.

SMALL TOWNS DON’T NEED TEMPORARY DOCTORS
 
By pushing the most inexperienced doctors and to rural areas, we are ensuring net rural people bypass those held services in favor of those in larger towns. People leave rural communities for health reasons and this causes problems for the rural economy in many ways.
Many people want to have a lifelong relationship with a single doctor. Having two or three-year relationships with fully trained doctors is better than nothing. 

We can't rely on temporary doctors, and must develop training and distribute doctors were needed. We need to graduate more role doctors.  Doctors and patients must guess to know each other, the environment, and populations they serve. Rural practices, like marriages, are found through courtship, and become effective after three or more years of experience.  Doctors are not trained to work in rural setups nor are they given proper facilities and service structure to work there. Doctors  should be given financial and professional incentives and given a conducive environment to keep them there.
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SMALL TOWNS MUST CHANGE THEIR THINKING

Doctors in rural areas must receive the backing of the community to avoid and control frequent transfers and postings of doctors. Duty time should be fixed for the doctor so that he could take rest and perform his other responsibilities, otherwise payment for overtime should be made.

COMMENTARY

There is no way health care reform can work in rural America if patients can’t get access to their doctor.  These are tough economic times for rural America and great budget woes exist. Young people may leave and Main Street may close, but Seniors will stay in their rural homes no matter what, because they are rooted and anchored to the land.

They may have one foot in the grave but the other foot keeps fighting. They had one plan, but our government has another.  They played their cards the best way they could . They look around familiar surroundings that they've known since they were young, and they see memories everywhere.

Hardship has become the norm in their lives. Friends tell them they might besoon in an assisted living community somewhere. But this goes in one ear and out the other ear. Seniors want to stay where they are.

The town’s Main Street and cafés are empty. They sit and look out their picture windows and the landscape is drenched with memories. Sitting and watching TV becomes today's activity.  Health care seems everything to them.  They wait for the next election to right things again.

Visit  www.drneedles.com for more commentaries on contemporary controversial medical subjects.

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 Source: American Medical Association, Physician Characteristics and Distribution in the US, 2007.