Is There a Doctor in the County?

Many people dream of getting away from it all and moving to a small town. But in rural California, many people leave not only traffic and crime behind, but they also leave behind convenient access to healthcare.

Quite simply, there are not enough practicing doctors in many parts of rural California. Nearly half of all rural Californians–two million people–live in a federally designated “health profession shortage area,” meaning there is less than one primary care doctor for every 3,000 people. By comparison, metropolitan regions like Los Angeles and the Bay Area have more than two primary care doctors for every 3,000 people.

In the Gold Country town of Downieville, 100 miles northeast of Sacramento, a 900 square mile area is served by one clinic, the Western Sierra Medical Clinic, staffed by nurse practitioners. While NP’s can do almost as much as a physician can, including writing prescriptions and stabilizing people in an emergency, seriously ill patients must travel 50 miles on a windy two-lane highway to get to the nearest hospital.

Recruiting additional doctors and nurses to remote areas is a challenge because many providers don’t want to work in an area where their nearest colleague may be far away. Foreign doctors finishing their residencies in the U.S. were a good source of practitioners until earlier this year. These foreign doctors were eligible for special Visa waivers if they elected to enter practice in under-served areas, especially rural areas. But the federal sponsor for this rural program pulled out earlier this year, leaving rural areas across the country with one less tool to recruit doctors.

Perhaps the biggest challenge facing rural providers, hospitals and clinics is financial. Patient fees alone cannot keep hospitals and clinics afloat; there simply aren’t enough patients. Grants and state subsidies are essential. But with the State of California staring down a 20 billion dollar budget deficit, and significant cuts proposed in healthcare, rural clinics and hospitals are waiting to see how hard hit they will be in the final budget.

This week, “California Connected” takes you to waiting rooms of rural healthcare facilities where geographic isolation can often mean scant medical attention.