Travel back
to a much simpler time when medical care consisted of a kindly man
in a black overcoat visiting your home with his worn black medical
bag, filled with cold steel instruments, herbs and plenty of lollipops.
He drove his shiny black Ford (the only one in your small town at
the time), and spent more time at patients' homes than at his office.
He may have come to your home to treat your chicken pox or sniffles,
or he may have even been delivering your baby sister. Because you
were miles from the nearest hospital, he was rural medical care
to you and your neighbors. Changing rural
demographics, insurance costs, Illinois laws and declining pools
of qualified employees have jeopardized the availability and quality
of rural medical care today. While cooperation has always been the
answer to many rural problems, ingenuity and technology are proving
increasingly vital in ensuring that our children and grandchildren
won't compromise their healthcare by living in Dr. George Mitchell
of Marshall is the epitome of the doctor with the shiny Ford and
worn black medical bag, and he's served patients in Clark County
for nearly 60 years. He's seen medical care evolve over the years,
all the while experiencing the trials and tribulations of struggling
to maintain quality healthcare in his small community. Always a
progressive thinker and someone who didn't believe that rural healthcare
should be sub-par to urban healthcare, Mitchell is indeed considered
a healthcare pioneer. In 1968, when the 16 doctors who had been practicing in Clark County dwindled to just four, Dr. Mitchell was the only physician left to serve 6,000 to 7,000 patients throughout the eastern side of the county. Marshall townspeople, frantic to bring in another doctor, called a town meeting to discuss the problem. Dr. Mitchell knew that Marshall couldn't compete with neighboring hospitals to attract a young doctor to the area, so during the town meeting, he brought up the novel idea of a medical center. Such a center
would group a number of doctors together, and the facility would
include laboratories, physical therapy and emergency services; things
that none of the doctors could afford to fund alone - a cooperative
of sorts. One medical center would be located in Marshall and another
on the opposite side of the county in Casey, both attached to existing
nursing homes. The Marshall
townspeople immediately embraced the medical center concept, and
Mitchell took the idea to the Illinois State Medical Society, who
financed a consultant to conduct a feasibility study. The consultant,
intrigued with the concept, gave them the green light, and the race
to raise necessary funds began immediately. Dr. Mitchell says that
neither medical center was financed by government or state money.
It was the community that stepped up to the challenge, with its
citizens bankrolling the $550,000 required for each medical center.
The kids even got caught up in the excitement, donating their allowances
and selling candy to support the idea. Dr. Mitchell
says, "If you are going to draw doctors, you must have something
like this to attract them. Today's solo practitioners are coming
right out of medical school, and they've got maybe a $100,000 debt
before they even start practicing. To just be starting out and have
to invest in equipment and pay office rental is simply not that
attractive." He said the idea was to put doctors together in
one building so they could cover each other's appointments when
necessary, share expenses, and have partners with whom to consult. When the new
medical centers opened, Marshall was besieged with people who wanted
a glimpse of this revolutionary idea. Dr. Mitchell recalls, "We
had people from as far away as North Carolina coming to see the
medical centers. They said we were the first ones to give the idea
a try. It was called the new concept in rural medicine." The
medical centers still operate at full capacity today. Dr. Mitchell
is also very committed to doing what he can to help grow the number
of rural physicians in Illinois. He is actively involved in the
Rural Medical Education (R-MED) program, offered through the University
of Illinois College of Medicine at Rockford. The purpose of the
program is to admit and prepare medical students from Illinois who
plan to stay in the state as primary care physicians. The program
is limited to just 48 applicants, and with the help of medical school
faculty and the selection and recruitment committee, on which Dr.
Mitchell serves, that number is whittled down to just 15-16 students
who will enter the rural medical program, along with traditional
medical students. The program offers students the opportunity to work alongside rural physicians, participate in summer internships at rural clinics, take part in rural health seminars, and gain patient experience during internships with rural hospitals or clinics. The hope is that students will like the atmosphere and return to practice there upon graduation. Mitchell says, "Statistics have shown it's been a very successful thing. Most of those students come from towns of less than 20,000 populations, and they're going back into those areas. You've got to grow your own. I've found that
to be true, and I've known it all along."
Physician vacancies
aren't the only healthcare positions that are becoming increasingly
difficult to fill. With an ever-decreasing pool of qualified service
employees, it's a fight for rural healthcare facilities to draw
the workers necessary to provide patient care and keep the doors
open. And nursing shortages are now widespread in all areas of medical
care. One contributing factor is that in the past, women only had
two career choices, nursing and teaching. Now, women have many career
options, and not as many are pursuing nursing. And service
employees have more alternatives than ever from which to choose.
Barbara Bock Dallas, Senior Director of the Illinois Hospital Association,
agrees, "Rural people are really scrutinizing these new possibilities.
With more glamorous employers, such as riverboats, moving in, medical
facilities have to fight to be employers of choice." Communities
must be advocates and support their local healthcare providers to
keep them there. Hospitals are often the largest employers in the
town, or even in the county, employing 22 percent of the rural population,
so it's vital to keep them there. Dallas says
if you pick up on a rumor that someone got bad emergency room care,
you can't just turn around and tell that to the next person. Even
one malicious rumor can do irreversible damage to a facility. She
advises, "You need to call the hospital administrator and tell
him what you're hearing. And get straight answers. This is your
hospital and you want to keep it there. Just like everything else,
if you don't use those rural providers, you'll lose them."
With the number
of medical facilities on the decline, the healthcare industry will
be scrambling to accommodate the growing number of baby boomers.
Representing a whopping 30 percent of our population, baby boomers
are now skating close to retirement, and will soon begin experiencing
increased health issues. Sheldon Keyser, recent retiree of the United
States Department of Agriculture Rural Development, says, "Something
like 80 percent of your health costs are incurred after age 65."
That, coupled
with the fact that nearly 25 percent of rural America is uninsured,
will not only flood medical facilities, but those facilities will
see a growing percentage of uncollectible accounts and accounts
receivable. Often when patients are uninsured, they cannot afford
to pay for healthcare. Hospitals are mandated to accept any patient
who is referred by a physician. If the medical facility can't collect
the medical bill from the patient, it must pass those costs to wherever
it can. Unfortunately, that could be to you. Emergency services,
which have also been disappearing from many communities, will be
necessary to serve our aging population. Most emergency services
are supported by the local tax base, and in a number of rural counties,
especially in southern Illinois, the tax base is decreasing. That
means the affected medical facilities must cut back on emergency
services and training, replacing equipment, or worse yet, be forced
to close altogether. Keyser recalls, "I know of one county
in Illinois where their ambulance broke down, and they were driving
a personal vehicle that didn't even have the necessary equipment
for transporting patients. It's better than nothing, but not much."
Probably the
most difficult hurdle to overcome in medical costs and medical care
is the dirty little "m" word - malpractice insurance for
liability litigation. According to Keyser, medical malpractice insurance
premiums have increased in Illinois dramatically, forcing physicians
to relocate their practices to other states. By relocating, some
physicians are seeing a drop in their malpractice insurance premiums
by as much as $100,000 per year. The remaining Illinois doctors
have been forced to raise their fees to cover the cost of the insurance,
and/or see more patients per hour to make up the difference. Keyser
adds, "When the doctor comes in, he's in a greater hurry, talks
to me less, gives me less personal attention, and is less likely
to ask critical questions." Even Dr. Mitchell
is carrying the burden of rising malpractice insurance costs. He
says he sees only a minimal number of patients per day and pays
the lowest malpractice insurance rates available. "I'm working
part time here, so I get a special rate on my malpractice insurance.
But, it still costs me $14,000 per year. If you consider that, along
with the other expenses I have, I'm not making a dime on the practice
of medicine. In fact, I'm subsidizing it." Dallas says
the malpractice insurance issue is being argued at the federal level,
and she believes it's the only way it will ever be settled. According
to her, Illinois is at the top of a list of states where malpractice
insurance rates are out of control. So, how do we
solve the problem of reduced medical services for whatever reason?
One answer is telemedicine. Through telemedicine, fewer doctors
and nurses will be necessary, we'll need fewer healthcare facilities,
and medical costs on the whole should decrease. Soon all telephone
lines will be able to accommodate high-speed data transfer, enabling
patients to receive services such as medical consultations, follow-ups
and surgical procedures thus allowing anyone, regardless of where
they live, to receive superior health care. And some patients
with high speed Internet access are already able to receive the
benefits of telemedicine without leaving their homes. For example,
a patient who is recovering from heart surgery could forego driving
to the healthcare facility for a check-up. A remote blood pressure
cuff and heart monitor hooked into a computer modem at his home
could send instantaneous reports to a doctor in an office many miles
away, who could evaluate the reports and ask the patient questions
accordingly. Dr. Mitchell
is a strong advocate of telemedicine. For one thing, the idea of
elderly patients getting out on the highway and traveling sometimes
a long distance to the nearest healthcare facility concerns him.
He says, "I've envisioned having telecommunication between
our local clinics in Marshall and Casey, and Union Hospital and
all the specialists in Terre Haute. We'd be connected to the specialists,
so if we have a patient here with a problem, instead of sending
them over there, we could instantaneously treat them by telemedicine.
The more isolated the place is, the more important that you'd need
technology like that." And, even surgery is being performed
remotely using robotics, and virtual instruction for procedures
can occur between a medical facility here and one overseas. The
possibilities are endless. Although there
may be a shadow over the healthcare industry now, Mitchell, Dallas
and Keyser look to the future somewhat optimistically. They believe
that if a community is willing to work cooperatively, look at the
necessary technology and be open to innovative ideas, rural healthcare
can be resuscitated. They also agree that rural healthcare is simply
"neighbors helping neighbors." Maybe rural healthcare
isn't exactly what it was in the past; but somehow, some way, a
doctor will always be in the house, and through technology, maybe
even on a computer screen in your house. |
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For more information about rural health issues |
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To contact Barbara
Bock Dallas, write: And finally,
Dr. George Mitchell has written a book, which outlines the story
of his many years of practice, and about his many contributions
to rural America. |
