Sunday, December 14, 2008

Mountain West still a frontier for doctors

Joan McCarter blogs from Boise about issues in the Rocky Mountain West. Her posts appear regularly in New West and (as mcjoan) on Daily Kos. Leading up to the election, she was guest blogger on the Denver Post’s election site.

She’s written widely about health care issues in the rural West. A year ago in New West, she rolled out some shocking statistics. They won’t be a shock for residents of Lusk, Wyo., Montpelier, Idaho, or Glasgow, Mont. These small rural towns are hours from any major medical facility and sometimes have no doctor of their own.

The situation isn’t much better in the West’s small cities, such as my town of Cheyenne and Pocatello and Bozeman and so on. Here’s info that McCarter detailed in a 2007 New West post:

Yup, Idaho is dead last when it comes to the doctor to patient ratio, around 140 for every 100,000 residents.

It’s actually not much better for the rest of the region. None is in the top half of states when it comes provider access: Nevada comes in at number 48 (not counting D.C.), Wyoming at 47, Utah at 44, Arizona at 37, Montana at 35, New Mexico at 32.

The health care debate in the country and the region has largely been focused around insurance--a valid concern, since some 47 million Americans are uninsured, about 16 percent of the total U.S. population....

Of course, having health insurance is small comfort if it takes you four or five or even six months to get an appointment with a regular family doctor.

In a Friday, Dec. 12, post on New West, she goes on to write about hoped-for changes with Obama at the helm and former S.D. Sen. Tom Daschle as new chief of Health and Human Services. Read the entire article at

According to McCarter’s above figures, each doctor has 700-some patients. No wonder it’s tough to find someone to look after your infected toe or broken arm. Not sure how many nurse practitioners or physician’s assistants there are in the West. It’s possible they take up some of the slack, but they’re obligated to practice under physician supervision. So, no doctor, no physician’s assistant or nurse practitioner.

During my 17 years in Cheyenne, I’ve been relatively healthy. Only a few visits to Dr. B’s office during that time. Once for bronchitis, once for a sinus infection and once for gastroenteritis caused by drinking some bad water up in the Snowy Range. Also, two complete physicals. Each of those times, I saw a C.N.P. or physician’s assistant. They were good, they fixed me up but they were extensions of Dr. B. They wouldn't have been there without his credentials.

McCarter's focus is on general practitioner, docs who can serve an entire small community. We use to call them family doctors. Small- to mid-sized towns are lucky if they have one. Specialists are rare to nonexistent. That's why people in Goshen County have to travel to Cheyenne or Scottsbluff or Casper. Or, in some cases, have to go all the way to Denver or Billings. There are allergists and orthopedic doctors in Cheyenne who dedicate some of their work days to satellite offices in Wheatland and Scottsbluff. A well-known orthopedic clinic even has a plane for its physicians, allowing them to see patients all around the state.

But, as with all things in Wyoming, some specialists are nonexistent. Pediatric psychiatrists and neurologists, to name two. You have to travel across borders for that level of care. We have made the trip to Fort Collins and Denver many times to see specialists. Neurologists in Denver; psychiatruists in Fort Collins and Denver; my wife's endocrinologist in Fort Collins.

Yes, as McCarter says, it's great to have health insurance. Without it, we never could have afforded the right kind of health care. It also would make a big difference if there were more general practitioners to serve this high, wide and lonesome (and rapidly aging) state. Perhaps Mr. Daschle can help us get there.

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