Doctor deserts in the mountains

Posted at 9:31 AM, Jul 30, 2019
and last updated 2019-07-30 11:31:02-04

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    Franklin, NC (WLOS) — One out of four people in rural communities, according to an NPR poll, say they can’t get the health care they need.

In North Carolina, a shortage of health care professionals has created doctor deserts or shortages.

It’s a problem the state’s been working to solve for decades.

The state’s spent more than $4.2 million in the last year addressing one of the biggest health concerns and one solution as News 13 investigated has gaps of its own.

Stroke is time, specialist sensitive

Agnes Cabe was washing laundry in rural Macon County when suddenly her hand went numb. She called her son, but before he got there, her condition worsened.

“I’d loss the use of my leg,” Cabe said. “You think you have time, but it zaps you before you know what’s happened.”

Time ticking, the 85-year-old arrived in the local ER minutes away and was diagnosed with having a stroke.

“Stroke is a neurological emergency, if we didn’t have that neuro-imaging there at Angel Medical Center, we would have to bring a patient over just to do the imaging, and minutes count, time is brain,” said Dr. Alexander Schneider, a neurologist with Mission Health.

Cabe was able to get treatment closer to home because down the hallway is a lifeline and the next best thing to a specialist physically being at the hospital in Franklin.

“Rural communities simply won’t have all the expertise and specialists they need,” said Dr. Marc Westle, FACP, Vice President of Innovation at Mission Health.

Mission Health’s Telestroke, two-way live video, allows a neurologist 70 miles away to make critical decisions.

“I can easily get a really close up shot and get good resolution of your pupils and other features,” Schneider said as he uses the camera to zoom in closer on the patient’s face.

It also provides for follow up care and additional exams before a patient is discharged.

“What do you see happening right here?” Schneider asked as he begins his neurological work up.

“All right, the ladies letting the sink run over, the children are in the cookie jar,” Cabe answered about the images she’s being shown.

Telehealth is considered critical in North Carolina for relieving doctor deserts.

All 16 western mountain counties are primary care shortage areas. In Clay and Graham counties, the doctor to patient ratio of one to 2,000 for family doctors compared to Buncombe’s one to 700 ratio, earning Clay and Graham counties geographic shortage designation for 40 years.

You shouldn’t have to leave your community for health care

“You shouldn’t have to leave your community to have high quality health care,” said Stephanie Nantz, assistant director of operations at the N.C. Office of Rural Health.

Many rural residents, unfortunately, can’t leave their communities in search of a physician because of transportation needs. It’s why the Office of Rural Health searches for funding offering encouragement to health care workers to choose rural areas. Over the last five years, it’s recruited six international medical graduates to stay in-state. Among them, two specialists in Rutherford County and two doctors working in Transylvania County’s hospital.

“If we can offer a provider the opportunity to pay off $100,000 of that debt in four years tax free, that becomes a nice tool for rural communities to have,” Nantz said.

The state however has been short on recruiters, down to one statewide and rural living can be a tough sell.

“They’re thinking where is my spouse or partner going to work, where are my children going to go to school, what kind of recreational resources am I going to have access to,” Nantz said.

“There’s been all kinds of programs to try to incentivize doctors going to rural areas, but they don’t always work that great,” said Rep. John Ager, of Buncombe County.

Making telehealth available

That’s why the legislature is upgrading state law ensuring patients get reimbursement for telehealth in House Bill-555.

“One of our jobs in the General Assembly is to keep pushing to update the legal framework around something like telehealth so it functions well,” Ager said.

The North Carolina Department of Information Technology is working to identify gaps in broadband coverage compared to doctor shortage areas in a $98,000 study with 11 mountain counties.

“We expect the data to show that there are gaps in broadband coverage probably more than what we know right now and that there are plenty of opportunities for expanding telehealth,” said Amy Huffman, NC DIT Research and Policy Expert.

With broadband access scarce, in mountain counties that means telehealth also has limitations. It’s use in the mountains is tied to eight Mission Health rural hospitals and Health-E-Schools programs in McDowell, Yancey and Mitchell counties.

“Maybe at some point having churches set up internet connections, broadband connections so that we can do this. The time is now, the time is now,” Ager said.

Access to telehealth services

Health-E-Schools telehealth is available for any public-school student in Mitchell, Yancey, McDowell and Burke counties.

If you’ve got internet access at home, UNC REX Healthcare in Raleigh has 24 hour/seven days a week Virtual Urgent Care. The visit could cost you $49 or less, depending on your insurance. They handle treatment for yourself or a child 2 years old and older. Here’s the types of conditions they can see you over the phone or computer or just talk to you on the phone with:

Acne Allergies Cold Flu symptoms Constipation Cough Diarrhea Ear problems Fever Headache Insect bites Nausea and vomiting Pink eye Rash Respiratory problems Sore throats Urinary symptoms or infections Vaginitis

Go to the Office of Rural Health Safety Net resources. It can link you to free and charitable clinic sites near you.

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Please note: This content carries a strict local market embargo. If you share the same market as the contributor of this article, you may not use it on any platform.