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Grand Rounds: Peabody on Rural Care


OR has a law to encourage docs to work away from cities
pay lower in rural areas than in suburban or urban
medicare and medicaid will still pay docs in small communities
money's tight, timber's gone, it's mostly retired people in Oregon's country
docs feel well loved and liked and they do get paid even if its out of pocket
they don't feel like they get funds/time for prevention
main concerns: HTN and DM2

Video from USDA Rural Development
country doctors are family practitioners
shotgun birth, rattlesnake bite, head injuries dt horses, chainsaw accident stories
people stoic, don't come to doc until in dire straits, fix it themselves if possible
man with MI has to finish fence first
refuse to go to specialist "you can do it doc, come on"
choose assistant from family
big deal: telling someone they can't drive anymore
ambulance response time over an hour each way
a bad doctor in a small town doesn't last long
docs in the country are good but in short supply
hard to get or keep docs who do prenatal care and obstetrics dt malpractice
rural hospitals need outside funding to stay open
pts aging, need more healthcare, more dependent on medicare
reimbursement rates are dropping
doc with mobile clinic in camper trailer going to town pop 12
plastic chairs in the parking lot for a waiting room
trailer set up with surgical supplies
rural healthcare districts in Oregon tax themselves to supply docs, mobile clinics
mobile clinic loses money but is good public relations
pt won't use catheter every day
doc sez: "when your kidneys quit workin' don't come crying to me"
rural docs retire late or only semi-retire
local airplanes used for transport, now there's helicopter support
intelligent educated spouse is essential
living in the fish bowl of small community

Peabody back again, struggling with media
brown suit, white shirt
shoulderlength hair brown held back with barette

RURAL AREAS
10% of physicians practice rurally, 25% of people live there, more elders 65+
average per capita income is $19K; $7000 lower in rural areas
lots below poverty level
HTN is higher in rural areas
HTN: Dr P's country doc tx: eat garlic and drink more water
suicide rate is higher esp in men but rising in women
roads are difficult
she says the numbers are skewed, there are more areas that need docs than stats say
24% of rural kids live in poverty
female death rate rising very quickly
much of population has private insurance
no fancy grocery stores, go only 1x-month
can't buy fresh food year round, can't find "organic" at all
eating gluten free is very difficult, helps if they can order off internet
herbs: they can grow their own, fresh is best
docs rely heavily on homeopathy: small space, low cost, "and they work"
people in rural areas love the old medicine: arnica, mustard plasters
must be willing to do minor surgery or pts will do it themselves
must be willing to delivery babies
burnout is a factor, make sure you have support network
"you don't have to guess what people are thinking"
she suggests going into community and selling prevention
developing a tax base for a preventive medical program
be creative, talk to the community you're interested in, they may go a long way for you
when you know whole family you know FHx
doing housecalls cuts questioning because you can see the answers, see how they live
naturopaths do a lot of mental health care, this is attractive to communities
rural people appreciate common sense, are loyal to docs who don't spend their money wildly

USE RURAL HEALTH AGENCIES: state level or private, these are just first findings from web:
National Rural Health Association: http://www.ruralhealthweb.org/

SOUTHEAST
State offices of rural health
TN: http://www.rhat.org/
NC: http://www.ncruralhealth.org/
Virginia: http://www.vrha.org/
West Virginia: http://www.wvrhepahec.org/
SC: http://www.scorh.net/
GA: http://jphcoph.georgiasouthern.edu/crhr/

ROCKY MOUNTAIN WEST
Montana: http://www.montanaruralhealthinitiative.com/
Utah: http://health.utah.gov/primarycare/ruralhealth.html
AZ: http://www.rho.arizona.edu/
WY: http://www.health.wyo.gov/rfhd/rural/index.html


Chip's comment:
--use the language of primary care doctors instead of setting ourselves apart as naturopaths
--"We are primary care physicians, our scope of practice includes x, y, z"
--Join AANP

JO JOHNSON
works with recruitment for medical docs and PAs
how to get docs into communities
she says be strong advocates for reimbursement
even traditional providers are challenged by rural loc low income
she likes the country, things move slower, people connect
communities draw people who want AWAY, more drug trade and other illegal activities
kids may really struggle
and there are the "normal" rural people (farmers, loggers)

MY QUESTION
if you wanted to set up a retreat and draw patients out to the country from the city
how would you present it to the local community?
jobs, money coming in to desperate areas
help for roads
drug and alcohol abuse care
rehabilitation
diabetes
supervised fasting
detoxification in the country

Comments

( 4 comments — Leave a comment )
wildrrrumpus
Feb. 1st, 2010 09:58 pm (UTC)
speaking rural among non-NDs, we repeatedly hear about how DOs have enormously higher rates of rural practice than MDs.
liveonearth
Feb. 2nd, 2010 02:28 am (UTC)
Why do you think that is?
wildrrrumpus
Feb. 2nd, 2010 02:33 am (UTC)
osteopathic philosophy encourages a focus on the whole patient, and i think if you're focused on the whole patient you're less likely to go into speciality medicine (although there are DOs that practice in all specialities and sub-specialties), and specialists tend to congregate more in urban areas where there is a larger patient base whereas primary care physicians are more necessary & useful in rural areas with large patient catchement areas... that's my thought about it... also there is a history of major antipathy/discrimination against DOs, and it seems like if you totally wanted to avoid that and were really concerned about image and social stature that you'd be more likely to go MD vs DO and also more likely to live in a fancified city than in a rural area...

but those are both just random hypotheses...
liveonearth
Feb. 2nd, 2010 02:41 am (UTC)
Good hypotheses. My thought---which is sort of an extension of yours--is that a person with a less-known degree can gain acceptance on the frontier by having actual skill, adaptability and guts. It matters out there, and the letters after your name don't mean a hill of beans if you can't help uncle Joe who when he gets his arm torn off by some farming machine.
( 4 comments — Leave a comment )

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