PAGING ALL DOCTORS
Diagnosing and curing what ails rural healthcare in Illinois
By Les O’Dell
Dr. Andy Riffey (left) gives Aaron Wright, one of his regular patients, an annual checkup. Riffey, who grew up on a 400-acre grain farm near Virden, now provides family medical care for the town’s 3,488 citizens. As a family physician serving a rural area Riffey is a rare breed. Just 10 percent of our nation’s doctors serve the 25 percent of the population living in rural areas. With the closest specialists 50 miles away Riffey’s patients depend on him for a wide range of medical services.
There’s no such thing as a typical day for Dr. Michael McFadden. He’s the only physician in Stockton, Ill., a village of 1,900 located about halfway between Galena and Freeport. After the alarm clock goes off around 5:30 a.m., the only certainty is that it’ll be a long day and he’ll see cases ranging from ingrown toenails to terminal instances of cancer and everything in-between.
McFadden is one of a dwindling number of physicians practicing in rural areas, a disturbing trend throughout Illinois. In fact, if the rural healthcare system in Illinois was a patient, its condition may be described as critical.
A shortage of physicians, other healthcare providers and hospitals is leading some experts to say that there is a rural healthcare crisis in Illinois. Rather than offering last rites though, many leaders and organizations are looking to cure what ails rural healthcare.
The challenges facing rural healthcare are numerous: Only about 10 percent of all physicians in the U.S. practice in rural settings, despite the fact that nearly one-fourth of the population lives in these areas, according to the National Rural Health Association. Additionally, rural residents tend to be older and have less disposable income than people with urban addresses, and it’s estimated that 35 percent of rural Illinoisans are without private medical insurance. When added to the sometimes vast distances these patients live from doctors’ offices and hospitals, it’s easy to understand why analysts see a looming healthcare emergency in rural areas.
“We’re probably approaching what I’d call a ‘dire straights’ situation,” says Alice Foss, of the Illinois Rural Health Association. “We’re at a crossroads.”
One of the biggest problems for healthcare both in Illinois and across the country is simply a lack of providers.
“We have a shortage of medical professionals in both urban and rural areas, but it’s a greater shortage in rural areas,” says Tim Skinner of the National Rural Recruitment and Retention Network for Healthcare Professionals. In fact, 80 percent of rural counties in Illinois are considered to be medically underserved.
The reasons why so many rural communities are left looking for physicians range from political to social to simple economics.
“There are a number of factors in play right now,” Foss says. “One issue is malpractice reform and award caps. Those caps are now being challenged in a case before the Illinois State Supreme Court.
“If a physician can go into practice in another state that has malpractice reform, it’s difficult to keep them in Illinois,” Foss adds. “We’re losing doctors to other states because Illinois doesn’t look too appealing.”
State reimbursements for physicians who treat patients on public assistance is another issue according to State Representative Mike Bost (R-Murphysboro).
“When you look at rural healthcare, you’re looking at a large population of individuals on Medicare or Medicaid; and right now the state is running months behind in reimbursing providers,” he says. “If just a few of your patients are public aid recipients, and payments are delayed, it’s just a pain,” he adds, “but if a majority of your patients are on Medicare, not receiving those payments can put you out of business.”
Skinner says there are other economic factors as well.
“When medical students come out of school, they often do so with great amounts of debt. For that reason, many choose specialties that pay more than primary care and then locate their specialty practices in urban areas,” he says.
Skinner adds that smaller communities often can’t afford to compete with urban centers to attract physicians.
“The cost to recruit a physician can be as much as $30,000 per hire, plus salary. Smaller communities often don’t have those financial resources.”
Another factor, says Skinner, has to do with the students that apply to medical school.
“Medical schools accept more students from urban areas than from rural areas, simply because there are more urban applicants,” he explains. “Once the students graduate, these new doctors tend to practice in surroundings they’re familiar with, so if we don’t have rural students applying and being accepted, that means we don’t get rural physicians.
Not only do doctors who choose to practice in rural areas bring with them health and medical benefits to their communities, they also are a tremendous stimulus to the local economy. A recent report by the Kentucky Center for Rural Health Professions indicates that each rural physician generates as much as $343,000 annually in economic impact for his or her community. This economic boost comes in the form of other jobs, related businesses like pharmacies and household spending.
Jim Nightingale, mayor of Carthage, a town of about 2,700 people in western Illinois, says the economic benefits of having physicians are very important.
“There are a lot of pluses,” he says. “Healthcare creates jobs and that means money stays in the community.”
Skinner says physicians are a key piece of the economic development puzzle for rural areas.
“The smaller the community, the more important it is. If you’re going to have a viable community and grow it, you have to have jobs, schools and medical care,” he says.
“Without a physician,” explains Cynthia Struthers of the Illinois Institute of Rural Affairs at Western Illinois University, “you’re going to have a hard time attracting other people to your community. “It’s as critical as local schools. It’s one of the things that’s most important to people.”
A shortage of healthcare providers and facilities in rural parts of the state puts a greater emphasis on first responders and other services like helicopter ambulance programs.
“We average 250 calls per year for our ambulance service,” says Kevin Day of the Kinmundy-Alma Fire Protection District. Day and 13 other volunteer emergency medical technicians cover 148 square-miles of Marion County.
“It’s a big commitment you make,” he says. “Communities like ours can’t afford to pay first-responders; we’re all volunteers. It’s a tough job, but when the tone goes off, we don’t stay home. We have to value the service above everything else.”
It’s estimated that a majority of Illinois communities, especially those in the rural areas of the state, rely on volunteer first responders to treat medical emergencies.
“Our goal is to provide the best critical care as soon as possible, but a trip to a hospital might be as much as 35 miles,” he says. “If we had a doctor or hospital closer, that would sometimes make all of the difference.” EMTs like Day rely heavily on air transport to quickly get severely injured or ill patients to the treatment they need.
“Often in the most extreme cases, a helicopter ambulance has already been notified before we ever leave our station. We land them right on scene and they can quickly get the patient to a class-one trauma center,” Day noted.
Ellen Sowders of Arch Air Medical Services says flight crews are making more trips to rural areas.
“We’re getting called to the rural areas because of the distances involved,” she explains. “When there’s a need for specialty medical care that’s time-critical, that’s when we get called.”
With all of the challenges, it would be easy to discount the future of rural healthcare, but Dr. Andy Riffey, a family practitioner in Vienna, says that there’s still a place for the small-town family doctor.
“We’re the gateway into medicine for many people. We’re the only medical provider many of our patients will see,” he says. “But that means we get to connect with people on a very personal level.”
For that reason, rural doctors like McFadden and Riffey have to be self-sufficient and confident.
“Many older patients are used to family doctors who do everything,” McFadden explains. “They’re not going to travel to a dermatologist or to a surgeon to have a mole removed; they’re going to the same doctor they see for a regular check-up or for a twisted ankle. My friends from medical school who practice in cities don’t see the diversity we do.”
Riffey agrees. “My days are very diverse. I see anything from newborns to people older than 90, and common colds to well-care visits,” he says.
Being a country doctor in town can be a challenge and time-consuming.
“I spend an hour a day in the car, just going to and from the hospital for rounds,” McFadden says. “Plus, there are nursing home visits, seeing patients in the office and the occasional house call. Also, I’ll often get calls at home, asking if I could meet a patient at the office after hours. I would conservatively say I work 60 to 80 hours a week.”
He adds that it’s sometimes tough to have a private life.
“Sometimes you want to go to the ball game and just blend in, but everybody wants to ask questions. You’re trying to watch the game and the guy sitting next to you wants to talk about indigestion.”
Riffey, who was raised on a 400-acre grain farm near Virden, and McFadden, who grew up milking cows on his family’s farm near Apple River, are exactly the kind of physicians that most experts agree rural Illinois needs. That’s why programs, like the Rural Medical Education Program (RMED) at the University of Illinois College of Medicine at Rockford, were established in 1993. The program actively recruits and trains students for careers in rural, primary care medicine.
“The total emphasis is on students from rural areas,” explains Mark Meurer, Assistant Director of the program. “Students from rural areas tend to go back to practice in rural areas.”
The efforts seem to be working. So far, more than 60 RMED graduates are serving as primary care doctors in rural parts of Illinois, including McFadden.
“I turned down offers from clinics in much larger cities, in order to practice here,” he says. Lori Williams of the Illinois Hospital Association says rural hospitals also are reaching out to help identify and recruit students to enter healthcare professions. Some are even working to provide resources necessary to produce graduates.
“We have to develop a pipeline of people with a desire to enter rural healthcare,” she says. “And we have to make sure we work with medical schools to prepare students for rural areas.”
Other creative approaches are being implemented to overcome the lack of specialty providers in underserved regions. According to Riffey, as it is now, getting patients to see specialists can be troublesome.
“Often the closest specialist is 40 or 50 miles away,” he says. “Sometimes it’s hard to convince patients to go to the ‘big town’ for specialty care.”
For that reason, Williams states that many hospitals that used to compete for specialists and for patients are now entering cooperative agreements.
“Hospitals now are beginning to share specialists who can come into areas on occasion to provide services.”
Other solutions may include a move toward telehealth or telemedicine, where diagnosis or consultations are provided through the Internet or closed-circuit television.
“We are starting to see more telehealth applications in Illinois,” reports John Record of the Southern Illinois University School of Medicine. “Specific areas that are gaining application include radiology and mental health.”
Record says it’s common for X-rays and other diagnostic images such as those from CAT scans and MRIs to be interpreted by physicians in other cities. He points out that psychiatrists or counselors don’t necessarily have to be in the same room with their patients, and can often work with individuals through a video connection.
Regardless of whether healthcare providers serve a rural population through their own office or through video conferencing, what many rural patients look for is someone who has an affinity for the country lifestyle and for their community.
“People want a doctor who is like a neighbor,” WIU’s Struthers says. “It doesn’t matter where the doctor lives, as long as he or she is considered part of the community where they practice.”
That being said, when Dr. McFadden gets home tonight, finally eats a late supper and begins to work on the stack of patients’ charts he carried home, he can do so knowing that he’s making a difference.
“Serving a small town is very rewarding because you’re not only taking care of the community; you’re one of their own and people are genuinely glad to have you,” he says. “It can be tough, is sometimes humbling, but always is very rewarding.”
© 2015 Illinois Country Living Magazine.
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