Behind Oklahoma’s nation-leading access-to-care problems
Filed under: Government, Health care reform, Health data, Health journalism, Hot Health Headline, Nursing, Public health, Public records
In February, the New England Journal of Medicine ranked Oklahoma as the worst when it came to access to medical care. With help from a California Endowment Health Journalism Fellowship, Tulsa World reporter Shannon Muchmore sifted through reams of data to emerge with a three-part series helping readers better understand the state’s unique health care delivery challenges.
Fans of data analysis and numbers will want to dive straight into the first installment. According to Muchmore, 66 of Oklahoma’s 77 counties contain “Health Professional Shortage Areas, which means “they don’t meet the national standard of one physician for every 3,500 people.” And those doctor-patient ratios aren’t improving.
The state is facing a severe shortage of doctors as the population ages. Adding to that, as many as 180,000 people are poised to receive insurance when provisions of federal health-care reform kick in 2 1/2 years from now.
What’s behind that shortage? Muchmore enumerates the key drivers.
Medical schools are not increasing their class sizes, residency slots are hard to come by, and doctors are choosing to locate in other states.
The last two factors go hand-in-hand, as doctors often practice where they have their residencies. Without a connection, they have little reason to locate in a rural area.
The state is not well-positioned to handle a further deterioration in its health-care system. Oklahoma consistently ranks among the worst states for obesity, diabetes, smoking, heart disease and overall health. It has the least improvement in the country in age-adjusted death rate since 1990.
In the second installment, she examines the link between disparities in access to medical care and disparities in life expectancy and other indicators throughout the state, with a special focus on Oklahoma’s most rural counties.
In the final piece, Muchmore looks at the future of health care provision in Oklahoma and the key role that physician extenders, such as nurse practitioners and physician assistants, are poised to play.
Keep an eye on the AHCJ website for an upcoming “How I did it” article from Muchmore in which she shares how she did the reporting on this project.
In China, pharma hires thousands of doctors to sell drugs
Filed under: Government, Hot Health Headline, Public health
Bloomberg News reports that pharmaceutical companies in China are poaching thousands of trained physicians, many of them recent grads, to become sales representatives in the massive push to take advantage of China’s exploding drug market. The companies can offer salaries that are two to three times those the physicians would earn otherwise, and Bloomberg’s sources estimate that as many as 14,000 more Chinese doctors will become marketers in the coming five years.
The hiring boom is hampering China’s three-year, $131 billion effort to stem a massive shortage of doctors in rural and peripheral areas and provide basic health insurance to at least 90 percent of the population. Paradoxically, it’s that same push, and the demand for drugs that it has created, that’s providing the incentive for big pharma’s Chinese campaigns. One pharmaceutical representative told Bloomberg that China is expected to overtake the United States as his company’s largest market within the decade, and companies have been budgeting accordingly.
Foreign drugmakers like Sanofi and their local affiliates will hire at least 35,000 sales staff by the end of 2014, Aon Hewitt China estimates, based on a survey of 24 companies. The same employers had 33,000 on staff at the end of 2010. About 30 to 40 percent of people recruited for sales jobs will have a medical degree, said Jarroad Zhang, a consulting director with Aon Hewitt in Shanghai.
Reporter’s narrative illuminates little-researched birth defect
When Wisconsin State Journal reporter David Wahlberg investigated what appeared to be rural Wisconsin’s increase in gastroschisis, a rare birth defect in which the intestines grow outside of an infant’s body and must be replaced after delivery, the lack of institutional research, statistics or easy answers seemed to raise far more questions than it answered, particularly in relation to rural incidence and pesticide use.
Wahlberg’s solution to this roadblock is to dive headlong into the human component of the story. In a two-part narrative (Part 1, Part 2), he puts these larger questions on the back burner and instead follows a family, in real time, as they deliver an infant boy who had been diagnosed with the condition during an ultrasound. No amount of summary would do Wahlberg’s piece justice, so I encourage you to simply invest a few minutes and bury yourself in the details. You’ll exit with an understanding of the condition and the toll it takes that no amount of statistical analysis could match.
Troubled Mont. nursing home illustrates special federal status
Filed under: Government, Health data, Hot Health Headline, Public records
Reporters looking to implement the tricks they picked up at AHCJ 2011 or one of our workshops can look to Billings (Mont.) Gazette reporter Cindy Uken, whose story about a dangerously deficient local nursing home was carried by inspection reports and her understanding of federal programs and regulation.
The program in question, known as the Centers for Medicare and Medicaid Services Special Focus Facility Initiative, has singled out 49 of the nation’s 16,100 nursing homes based on what it calls “a history of serious quality issues.” In the case of the Montana nursing home, these problems included serious bed sore issues, possible abuse and a failure to get to the bottom of patient injuries of “unknown origin.” Homes in the federal initiative are treated to about two inspections a year – twice the regular rate.
The Centers for Medicare and Medicaid Services (CMS) selects facilities for the improvement program after receiving reports from state agencies. More nursing homes could be candidates for the improvement program, but a lack of funding restricts how many participate, said Mike Fierberg, public-affairs officer for the CMS Region 8 office in Denver.
After 18 to 24 months in the program, officials aim to have the problem facilities either improve their quality, lose Medicare and Medicaid funding or, if they’ve shown progress, to keep improving apace.
When CMS released the most recent list of homes in the SFFI, it released them in a PDF. AHCJ has converted and posted the list as Excel and HTML files to make searching the list easier for reporters. More information about nursing home quality is available from CMS and in AHCJ’s slim guide, “Covering the Health of Local Nursing Homes.”
Montana student documents frontier hospital
Every year, as part of the Montana Town Project, University of Montana School of Journalism students pick one little rural town in Montana and descend upon it to discover what unique stories it might hold. 
In this year’s target, a town surrounded by mountains with the incongruous name of Plains, Mont., (population 1,126), student Amy Fox stumbled upon the Clark Fork Valley Hospital.
By definition, CFVH is considered “frontier medicine” rather than rural medicine because of its size. The hospital only has 16 beds. To be considered rural, a hospital must have over 100 beds. The number of beds in a hospital typically represents the kinds and number of services the hospital can offer. With its own cardiologist, surgeon, anesthetists, and a full nursing staff, Clark Fork Valley Hospital is far from what one may think of as “frontier”.
In what I assume is a tribute to both the hospital’s size and small-town Montana accessibility, Fox was able to get an unusually candid portrait of the difficulties of administering a hospital on the edge of sustainability. I can’t embed her photographs here, but be sure to take a look. The hospital has trouble recruiting doctors, not because of their location, which is actually quite desirable, but because it’s difficult for doctors’ spouses and families to find work in the tiny community where the hospital is the largest employer. And those employees they do retain have to do more with less.
“We have found ways to be more resourceful,” says Tanya Revier- Marketing Director. “We just switched propane companies and saved over $25,000 that way. Or if someone leaves the hospital to retire or take a different job, we spread the staff we have to cover the vacant position, rather than hire someone new.” Another way they have been able to sustain is by offering more services in order to keep people from travelling elsewhere for their care.
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Dr. Damschen says that often, people feel that frontier medicine is often thought of as a lesser practice, as compared to urban medicine. It does not take a person long to understand that, in fact, the opposite is true. Physicians and nurses alike are required to have skills that excel far outside the reaches of what is normal in large hospital settings. It is all about which hat to put on.
Veteran journalists speak from front lines of prescription drug epidemic
Filed under: Health journalism, Hot Health Headline, Member news, Pharmaceuticals, Public health
In a subject area increasingly defined by its steady drumbeat of alarming numbers and increasingly dire statistics, the opening to a recent episode of WBUR’s On Point with Tom Ashbrook still manages to make even the most jaded readers sit up and take notice.
Prescription drug abuse is sky-rocketing in the United States as accidental overdose deaths now exceed crack deaths in the 1980s. Overdose from prescription painkillers like Oxycontin and Xanax is now the leading cause of accidental death in 17 states.
The show touches upon every point of the prescription drug epidemic, from the pill mills of Florida to the devastated counties of rural Appalachia, where entire generations have been lost. The show is driven by the expertise of guests like Louisville Courier Journal reporter Laura Ungar and The Charleston Gazette’s Alison Knezevich, both of whom will be speaking at the June 3 lunch session of AHCJ’s upcoming Rural Health Journalism Workshop in St. Louis. The thoughts of these veteran journalists are also supplemented by a unique interactive element, thanks to On Point’s national reach and call-in format. One example:
On Point caller Michelle in Carter County, Ky., grew up with her mother addicted to prescription medications.
“We would wake up in middle night and have to put her to bed because she was like a zombie,” Michelle said. “It was like no one was there.” Michelle is now going to school to be a drug abuse therapist.
A summary of the show is available online, as is an MP3 of the entire broadcast.
Nun talks about practicing medicine in rural Miss.
Filed under: Health policy, Hot Health Headline, Public health
In today’s episode of The Story, from American Public Media, listeners hear from Sister Anne Brooks, a physician who has been running a clinic in Mississippi for almost 30 years.
She talks about the challenges of treating patients in a rural area, the effect the lack of care has on people and how she makes ends meet in a poor community. Brooks sometimes takes things in trade for her medical services - her payments have included catfish, crookneck squash and chainsaw services.
Her efforts go beyond running the clinic. She is a member of the community and talks about building community spirit. There was no emergency room in the area so her home has often served as the ER; once she even delivered twins in her backyard.
She also discusses the cultural realities of being a white woman who came to treat a largely African-American community. When she arrived at the clinic, there were separate waiting rooms for white patients and African American patients - something she put a stop to. She describes how she adjusted her behavior to gain her patients’ acceptance and trust.
Brooks says modern health care relies too much on MRIs and CT scans and too little on clinical exams. She says young doctors and nurse practitioners who rotate through her clinic don’t know how to give a good physical.
Stories about rural health impact all communities; learn to find them
From a shrinking physician workforce to disparities in health care, important stories about rural health abound. Even if your newsroom is in a bustling city, there are untold rural health stories down the road.
So join us in St. Louis on June 3 for this special free workshop to help you find and cover health stories in rural America. Just join AHCJ – or make sure your membership is up to date – to attend. The workshop includes breakfast and lunch.
Rural health care in Calif. nearing ‘crisis’
In a collaboration between the California HealthCare Foundation Center for Health Reporting and the San Francisco Chronicle, the center’s David Freed ventures into rural Mendocino County in northern California to explain and examine the ongoing (and worsening) shortage of physicians in American rural areas.
Ukiah emergency room physician Marvin Trotter says that within the next five to seven years, the shortages will grow into a “full-blown health care crisis.” It’s a crisis about which the 58-year-old doctor speaks with eloquence and force.
“You’re going to see more complications and a lesser quality of life,” said Trotter, who puts in 12-hour days three days a week in the emergency room at Ukiah Valley Medical Center, the town’s only hospital. “You’re going to have your foot cut off more as a diabetic. You’re going to have more heart attacks because nobody’s taking care of your cholesterol. You’re going to have more people lose their vision because they can’t get in to see an ophthalmologist. That’s all a function of physician accessibility, and accessibility’s going away.”
Trotter’s quote is a reminder that, for rural America, “doctor shortage” means far more than just primary care. For a broad overview of the growing rural physician shortage, I recommend the “Older doctors, fewer hours” subheading on the story’s first page. The following subhead, “Scarcity at critical levels,” offers a deeper look.
In the second story in the package, Freed looks at how rural communities are working to solve the shortage, and why their efforts keep falling flat.
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Rural health on the frontier
A defining feature of reporter David Wahlberg’s ongoing look at rural health care for the Wisconsin State Journal has been his willingness to look beyond the state’s borders, as with his recent piece on health care navigators in Kentucky.
In his latest installment, he looks to Montana, not just for a model, but for perspective. In Montana, he finds that all rural health challenges are created equally, and that the rural areas of the Mountain West and western Great Plains are so remote that the term “rural health” just doesn’t do their situation justice. Instead, they deal with “frontier health,” where the only hospital in driving distance can’t afford to deliver babies, and hospitals have to fly patients hundreds of miles just so they can have access to adequate blood supplies.
Only 4 percent of Wisconsin residents live in frontier counties. In Montana, that number is 54 percent. Wyoming is even higher. “Frontier” counties are generally considered to be those with a population density of fewer than seven people per square mile. For those interested, the State Journal included a map of such counties alongside the story.
Ky. program a model for improving rural access
Filed under: Health care reform, Hot Health Headline, Public health
As part of his series on rural health, the Wisconsin State Journal’s David Wahlberg traveled down to Appalachian Kentucky to see how state-funded “navigators” had helped improve access to health care in the region with the lowest life expectancy in the nation. There, they help guide the rural poor through the byzantine system and toward free or low-cost care. They’re part of a program called Kentucky Homeplace.
…lay workers live in the communities they serve, which includes most of Appalachian Kentucky. The workers, who receive basic medical training and earn about $25,000 a year, make home visits and address a variety of needs, such as finding low-cost prescription drugs, arranging transportation to doctor’s offices and helping patients follow up on medical tests.
They also make sure homes have heat and running water — and people have food and clothing.
The lay workers get 40 hours of training, and specialize in navigating the local culture and translating medical terminology into words and concepts the locals find more familiar. Their primary role is helping residents find more affordable prescription drugs. According to one of Wahlberg’s sources, “The program, which operates on $2 million in state money a year, helped clients get $28 million worth of free or discounted medications last year.”
The program, started in 1994, “has linked tens of thousands of rural Kentuckians with medical, social and environmental services they otherwise might have done without,” according to the National Rural Health Association, which named Kentucky Homeplace its outstanding rural health program of the year in 2008.
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