Wednesday, June 13, 2012

Sustainable rural healthcare

I've been thinking a lot about rural healthcare and how we make it work.  Rural parts of the country have few primary care providers.  Near me a critical access hospital just stopped delivering babies because they couldn't find a second OB to join the practice and the one doc can't be on call all of the time.  (why on earth they aren't hiring another non-OB provider who could deliver babies is beyond my pay grade. I'm just a future pharmacist and a potential pregnant person who would far prefer NOT to see an OB but that's a post for another time.)

Anyway, I read an interesting article at this Washington Post blog about one rural, solo practice doctor, who's giving it up in favor of a city job with humane hours.  It makes me wonder if this solo practice model would be sustainable if it were combined with a pharmacist in the practice.  If the doctor is stuck doing prior authorization paperwork, maybe a pharmacist in a collaborative practice could speed that along or suggest something else that might cost less or be covered from the get-go.

I'll have to see if anyone is doing that and if it's sustainable.  A pharmacist doesn't really fix the "on call all the time" problem of the rural doctor, but the doc in that blog post was actually fed up with 4 hours a night of paperwork with a weekend on call at the hospital once a month (which i don't think is unreasonable myself, the weekend on call).  But a pharmacist could help manage medications, do some chronic med education, help with billing and paperwork for prescriptions, save the doctor spending so much time hearing about medication regimes and let the doc focus on diagnosing.

The other big chunk is that specialists get reimbursed more than primary care docs from Medicare and a huge swath of rural dwellers are on Medicare.  We have to fix this or there will be no doctors left in rural places and people will have to travel more than 40 miles to find a doctor, and will have to schedule appointments weeks ahead because of a shortage.

We're moving to a rural area, so I've been looking at new doctors, and over half aren't taking new patients.  Plus although we're moving somewhere with a higher population than our current town, there are fewer doctors on staff, so it's going to be a struggle to find a doctor we like because there are just fewer doctors available.

1 comment:

  1. We don't take on new Medicare pts unless they live in our county (pop: 4,000). They take up a ton of time for very little pay, and it just doesn't keep the doors open. It's sad. :(