The emergency room at Mercy Hospital in Williston, North Dakota
The Bakken oil boom in western North Dakota has put a tremendous strain on the rural region’s small hospitals. A declining, older population and a rapidly expanding younger, uninsured population; a major overload on emergency facilities, accompanied by skyrocketing bad debt; nurse and staff recruitment has become much more difficult due to high housing prices and high competitive wages in the oil patch; and physician recruitment, always a problem for rural areas, has gotten worse as needs soar.
By John McChesney
I met Randall Pederson, right, in his cramped office. As I start my interview, he yawns. He’s sitting behind a desk piled high with papers surrounded by shelves, and also piled high with papers. Pederson is President and CEO of the Tioga Medical Center, a 25-bed hospital in the town of Tioga, population around 2,000, although Pederson says it’s anybody’s guess how many people live here now. Several towns have more than doubled in size in the last couple of years. Pederson not only runs this hospital; he also serves on the town’s volunteer ambulance squad. Thus, the yawn. The squad is now making a lot more runs in the middle of the night. “They say New York City never sleeps,” Pederson says. “Well, I don’t know if western North Dakota ever sleeps.”
Like many small town hospitals around here, the Tioga Medical Center has seen a dramatic leap in ambulance runs and emergency room patients. “In 2007 we would see 600 patients in ER per year,” Pederson says. “In 2012, we anticipate seeing over 2,000. So in a five-year period, we have more than tripled our emergency room visits. We are seeing a lot more industrial accidents, major trauma, many of those involving car accidents, because there’s a lot more vehicles on the roads these days.”Many of those accidents involve a 40-ton tank truck colliding with a 5,000-pound passenger car. Those can bring several patients with horrible injuries into the small ER at the same time. The one doctor on call has to scramble to get some help. Read more »
Last modified Mon, 1 Oct, 2012 at 10:34
(Photo: Edgar Zuniga, Jr. via Flickr)
By Robin Pam
According to a new report from the Center for Rural Affairs, conditions such as diabetes, heart disease, cancer, and stroke are responsible for 75 percent of all health care spending. Rural Americans experience these diseases and chronic conditions in higher numbers than the general population. This happens for a variety of factors, including heavier tobacco use, physical inactivity, poor diet, and alcohol abuse.
The health challenges facing rural communities are even further exaggerated in the West. Here rural and frontier communities are farther away from urban centers or larger towns with more sophisticated health care facilities. The large distances and extreme isolation place a greater strain on community health providers.
Encouraging healthier behaviors and preventing chronic conditions is critical to controlling costs in the health care system. These goals are a major part of the Affordable Care Act, the health reform law passed in 2010. Residents of rural communities, and especially those in the West, stand to benefit greatly from the increased emphasis on prevention.
Last modified Thu, 8 Sep, 2011 at 8:36
Map of hospitals designated "Critical Access Hospitals" that are eligible for Medicare financing to shore up health care access in underserved communities. (Source: the Flex Monitoring Team, a consortium of university health care research centers) Click to enlarge.
By Robin Pam
It’s not every day that the American Hospital Association calls out researchers for doing a “disservice” to a group of hospitals. Yet that’s just what the president, Rich Umbdenstock, said in response to a recent study in the Journal of the American Medical Association about the quality of care at Critical Access Hospitals, almost all of which are small, rural hospitals that serve as a first point of access to emergency care for the 20 percent of Americans who live in rural areas.
He’s not the only one. The article has been generating heated responses among rural health experts from all corners in the weeks since its publication.
Last modified Mon, 1 Aug, 2011 at 11:28
President Obama and Agriculture Secretary Tom Vilsack tour a Missouri farm, in April 2010.
(Official White House Photo by Pete Souza)
By Robin Pam
Teddy Roosevelt’s Country Life Commission released its report on the state of rural America in 1909, highlighting “deficiencies” in rural life that led to people leaving the country for the city. One hundred and two years later, the Obama administration announced the formation of a new White House Rural Council, on June 9.
When Roosevelt announced his Commission, it was ridiculed as a transparent bid for votes, and rural papers across the country poked fun at the president as “Teddy the Meddler.” There was also some mockery of President Obama’s council as well: http://goo.gl/y47mA. But not everyone was in a mocking mood.
The National Rural Health Association applauded the announcement, saying in a blog post that it was “pleased the White House is focused on improving the lives of the 62 million Americans who call rural home.” When the Country Life Commission conducted its survey, more than 40 percent of Americans lived in rural areas.
Last modified Thu, 23 Jun, 2011 at 15:04
Photo by Flickr user Jeua
With this blog post, we introduce Robin Pam. She is the co-author of our essay on rural health care and will be appearing from time to time with posts on the on-going problems in western rural health care. She is the director of operations at a health data start up in the San Francisco area. She has worked in health policy on a congressional committee, online communications at a think tank, a political campaign in Montana, and historic architecture at Yosemite National Park. Her writing has been published by the Center for American Progress and High Country News. Robin holds a degree in American Studies from Stanford, and is a native of the West.
– John McChesney
By Robin Pam
The House voted last week to eliminate more than $230 million in funding to graduate medical education residency training for primary care providers in community health clinics. The Affordable Care Act, 2009’s landmark health care reform law, mandated the funds for a five-year period, from 2011-2015. The bill under consideration, H.R. 1216, would eliminate the program’s automatic funding and shift the money into an appropriation subject to annual renewal in Congress.
Last modified Thu, 23 Jun, 2011 at 15:02
By Michael De Alessi and Robin Pam
“In general, the rural population is less safe-guarded by boards of health than is the urban population. The physicians are farther apart and are called in later in case of sickness, and in some districts medical attendance is relatively more expensive. The necessity for disease prevention is therefore self-evident and a betterment of these conditions is a nation-wide obligation.”
– Report of the Country Life Commission 
Fearing a loss of agricultural productivity and rural community, Teddy Roosevelt formed the Country Life Commission in 1908 to investigate why the social and intellectual, as well as economic, aspects of country life were not keeping pace with city life. Of the six “deficiencies of country life” highlighted by the commission, “health in the open country” featured prominently. The report emphasized issues such as differential access to doctors, numbers of physicians per capita, and costs of rural health care, and all remain contemporary concerns. The Commission’s call for “increasing the powers of the Federal Government in respect to the supervision and control of the public health” could be pulled straight from today's health care debates.
In spite of a broad increase in the number of doctors per capita in the United States and in the American West over the past century, many rural areas in the West have seen little or no increase. This is a cause for grave concern. The fact that much of the rural West has seen little improvement in this basic measure of health care access is surprising, and it underscores the persistent remoteness of vast stretches of the rural West. But it also underscores the importance of improving physician access in the rural West. And the state of Utah shows a way forward.
Last modified Tue, 5 Jul, 2011 at 6:12