Where you live determines whether the doctor is in: Medicine beyond the burbs in Chicago

by Satta Sarmah
http://news.medill.northwestern.edu

Dr. Kari Cataldo practices primary care in Sullivan, population 4,326. She said she grew up in a small town and likes that environment despite some of the professional concerns.

“One of the challenges is that I don’t have other colleagues in the office with me,� Cataldo said. “It’s also challenging to find specialists in the area, but our patients get very good care here.�

The air may be cleaner and the traffic less stressful in many parts of rural Illinois compared to the big city.

But rural residents deal with the same diseases as metropolitan residents and many have a difficult time finding specialized treatment, said Alice Foss, executive director of the Illinois Rural Health Association.

“There are a limited number of practitioners in the rural areas of Illinois and that in turn limits access to care,� Foss said.

A study published this month in the Journal of the American Medical Association showed people living in rural areas were less likely to get organ transplants than their urban counterparts. Foss agrees that is one of many issues confronting rural health treatment.

Nearly 2 million Illinois residents live in rural areas, according to the U.S. census. More than 40 of the 102 counties in Illinois have physician shortages and many of those are in rural areas, according to the federal Health Resources and Services Administration . For mental health care, all but 15 counties had shortages as of December 2007. Overall, 64 of the 186 hospitals in Illinois are in rural areas and there are 197 rural health clinics.

Attracting new doctors can be tough. The Illinois Department of Public Health has offered incentives for medical and nursing students willing to work in designated shortage areas. The department offers scholarships to students and gives a 5 percent bonus payment to doctors working in shortage areas.

More basic educational resources are needed to deal with the shortage of doctors, said Dr. Michael Gassler, associate dean for Rural Health Professions at the University of Illinois College of Medicine at Rockford.

“Public policy-wise, we need to put more resources into [al] schools in rural areas,� Gassler said. “Often what we find is students are denied very prime types of science and math. They don’t get the best.�

The University of Illinois medical school established the Rural Medical Education Program (RMED) in 1993 to address dwindling numbers of doctors in rural Illinois counties. About 20 students enroll in the program each year, many of whom come from rural communities.

In addition to a traditional medical education, students undergo a 16-week residency in rural areas. A total of 177 students have enrolled in the program, most of them choosing to work in a rural community after graduation, Gassler said. Cataldo graduated from the program in 2001.

Betsey McGee, 32, a fourth-year student in the RMED program, said rural health issues aren’t discussed as much as urban health issues because of misconceptions about rural life.

“People think of rural areas as serene,� McGee said. “[People say] how can people in a rural area be stressed out? But they deal with substance abuse, depression and complex chronic diseases.�

McGee, who completed a 16-week residency at a hospital in Watseka, said many rural doctors confront heavy work loads.

“Because the patient- to-physician ratio is really large, the rural physician struggles to find enough time to manage everything.� McGee said. “It’s really due to a structural problem. You have people who are very dedicated, but they’re overworked.�

It’s something familiar to Sherry Mifkowiec, an X-ray technician at St. Margaret’s Hennepin Clinic in Hennepin.

The clinic used to be open five days a week, but is now only open two days. A physician’s assistant treats patients on Tuesday mornings and a primary care doctor is in the office on Wednesdays.

“Patients want more coverage and better hours, but patients are happy with the care,� Mifkowiec said.

Foss said rising malpractice insurance is one reason many doctors have left Illinois, however. And simply getting to the doctor can be daunting.

“The other big issue that impacts us is lack of transportation,� Foss said. “There aren’t major bus systems, so people have to drive. People make choices about how far they’re going to go; how bad does it have to hurt before they get themselves checked out. By the time they do that, they’ve put themselves further and further at risk.�
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