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Transcript Page 3
ONE-QUARTER TO ONE-HALF OF ALL UTAHNS LACK A PRIMARY CARE PROVIDER, A DOCTOR OR OTHER HEALTH CARE PROFESSIONAL TO CALL THEIR OWN. AND EVEN FEWER HAVE A PLACE THEY CAN CALL A MEDICAL HOME.
Marc Babitz, M.D.
A medical home is a place where a patient knows that they can go with any question, any concern. And that provider, whether it's the pediatrician or the family doc, or the nurse practitioner, that that provider will be there to listen to their concern and help the patient get on the right path of solving the problem. Voice Over
(anything else that’s going on? As if that wasn’t enough)
Nell Hodo, M.D.
Patients are kind of like family in a way. I love the people I take care of. I love seeing multiple members of the same family, you know, seeing somebody come in and you already know their family history.
NARRATOR: DOCTOR NELL HODO SEES PATIENTS AT THE STEPHEN D. RATCLIFFE COMMUNITY HEALTH CENTER --LOCATED IN ROSE PARK, IN THE HEART OF SALT LAKE CITY’S MOST DIVERSE, AND ECCONOMICALLY CHALLENGED NEIGHBORHOOD.
IT’S COBBLED TOGETHER THROUGH STATE, FEDERAL AND PRIVATE FUNDS. AND HERE THEY SEE A MIX OF PATIENTS—BOTH INSURED AND UNINSURED. THE UNINSURED PAY A SLIDING-SCALE FEE BASED ON THEIR INCOME.
Archival film of President Lyndon Johnson:
And this administration today, declares a war on poverty in America)
NARRATOR: THE FIRST CHC’S WERE CREATED IN NINETEEN-SIXTY-FIVE AS PART OF PRESIDENT LYNDON JOHNSON’S “WAR ON POVERTY”. The goal REMAINS THE SAME--break the cycle of sickness and poverty by SERVING communities beyond the reach of traditional medicine. CHC’S ARE LOCATED IN NEIGHBORHOODS WHERE LANGUAGE, CULTURE, GEOGRAPHY OR EVEN POVERTY CREATE BARRIERS TO CARE.
Nell Hodo, M.D.
And ideally the services that are provided are tailored to the needs of that community, which could be different depending on language, or culture or the age range or the people living there.
NARRATOR: THE CLINIC FOCUSES ON FAMILY AND PREVENTATIVE CARE AND STRESSES THE IMPORTANCE OF DEVELOPING A RELATIONSHIP BETWEEN HEALTHCARE PROVIDERS AND PATIENTS—
Jay Moreland, M.D.
You know you treat the whole person and you really have to take into account their family, their social context, their resources.
(Dr. Moreland: Hello. Good Morning, Good Morning)
Jay Moreland, M.D.
Your patients become more like friends. You take greater joy in hearing what's happening with their kids and watching them grow up. That's a great joy.
Luz Sanamiego
When you work in this type of clinic, of course you develop a relationship with them. You see them at church, you see them outside of the grocery store, you go shopping and you find some of them.
Well, Margarita came as our patient, pregnant. And then when we do the history, she had miscarriages. And after some time, taking medications, taking care of her and everything, she keeps the pregnancy and then finally she has a baby. For the first time she's a mom after miscarriages. For me was something so beautiful that we help her to keep that pregnancy.
NARRATOR: THE RATCLIFFE CLINIC PRACTICES PRIMARY CARE MEDICINE. IN ANOTHER DAY, FAMILY MEDICINE WAS DELIVERED BY THE TOWN DOC. IT WAS CRADLE TO GRAVE CARE, WARM IMAGES FROM A BYGONE ERA. BUT DELIVERING NEW PRIMARY CARE DOCTORS IS BECOMING INCREASINGLY DIFFICULT.
Mark Babitz, M.D.
Within physicians we know that 70% of our doctors are in sub-specialties, and only 30% of our physicians are specializing in primary care fields--primary care being family medicine, pediatrics, internal medicine, and to some degree obstetrics and gynecology. Well national or international studies actually have shown that the ideal mix of physicians is about half and half; half in the sub-specialties, half in primary care, and we know there is a significant barrier to the availability of a primary care physician for those who need that, we call it a medical home or that kind of care.
Nell Hodo, M.D.
It's hard to go into family medicine and it's hard to go into general pediatrics, and it's hard to go into general internal medicine--all of this sort of big primary care fields. If you look at a spectrum of physician income, those are the bottom three, always.
Jay Moreland, M.D.
So as a medical student you have a choice, let's see you can become an orthopedist and make lots and lots and lots or a family doc and have really long hours and not get paid so much, hmm.
Nell Hodo, M.D.
I knew since I was very little that I wanted to be a physician, and when I was growing up my grandfather was a general surgeon in small town in Alabama. He still did house calls, people paid him in bushels of tomatoes and watermelons and stuff when they couldn't pay. And to me that was what medicine was about. It wasn't about just seeing the people who could pay the bills, it was about seeing Mr. Johnson who said, “well Doc I can give you a watermelon for my visit, that's all I got”, and that was o.k. with my grandfather. Of course medicine was different then.
NARRATOR: BACK WHEN DR. HODO’S GRANDFATHER WAS PRACTICING MEDICINE, SAY In NINETEEN-FIFTY, YEARLY MEDICAL COSTS AVERAGED ABOUT ONE HUNDRED DOLLARS PER PERSON. WITH INFLATION that TRANSLATE TO ABOUT FIVE HUNDRED DOLLARS NOW.
But in TWO-THOUSAND SEVEN, NEARLY SEVEN THOUSAND DOLLARS IS SPENT PER YEAR ON THE AVERAGE AMERICAN FOR MEDICAL CARE. TODAY, OUR LIFE expectancy is a decade longer THAN IT WAS IN NINETEEN-FIFTY. SO EACH OF US WILL SPEND THAT MUCH MORE, THAT MUCH LONGER.
HOW DID IT HAPPEN?
Well broadly stated, after World War Two, there was an explosion of medical advances and NEW TECHNOLOGY increased OUR life expectancy. MEDICAL ADVANCEMENTS REQUIRED GREATER SPECIALIZATION AMONG DOCTORS, AND GREATER USE OF HOSPITALS. DOCTORS AND CARE BOTH BECAME MORE EXPENSIVE. NOW ADD IN HEALTH INSURANCE, WHICH REALLY DID NOT EXIST AS A SIGNIFICANT FACTOR BEFORE WORLD WAR TWO. ADD IN NEW DRUGS, ADD IN EXPENSIVE MEDICAL TESTS, ADD IN GREATER LIABILITY. THESE coupled with the fact that most people are STILL unaware of how much their healthcare is really costing, contributed to healthcare costs spiraling out of control. IT CAN ALL SEEM SO CONFUSING.
Nell Hodo, M.D.
So that was why I picked family medicine, because I wanted to take care of families and I wanted to take care of communities, and I wanted to do something where there was at least a possibility that I would be able to take care of people regardless of their ability to pay.
NARRATOR: BUT EVEN THE BEST OF INTENTIONS ENCOUNTERS THE BOTTOM LINE.
Jay Moreland, M.D.
Well I've been there twelve years and this is the third financial crisis that we've been through where we've either had to lay off people or weren't going to make payroll.
NARRATOR: AS WE VISIT, THE RATCLIFFE CLINIC IS DESPERATELY HANGING ON.
Nell Hodo, M.D.
It's hard for me to say wow you know, I need to see more insured patients for the financial well-being of the clinic, but that's not really what I went into medicine to do per se, and that's not the overall mission of the clinic. So I think we all have a little bit of a struggle there saying you know, this is what we need to do to survive, and if we don't survive we can't provide anybody with any services.
Jay Moreland, M.D.
We're at the whim of some political winds that blow so sometimes we do a little better and sometimes not so well. It’s a real struggle to do the right thing, and to do the right thing for as many people as we can.
Nell Hodo, M.D.
All of the community health centers in the country get money from the federal government, but they have to vote to increase the funding on the federal level for us to see the difference here, and then the other part is the state legislature, which historically does not fund community health centers at all well compared with other states in the country.
NARRATOR: UTAH SPENDS APPROXIMATELY TWENTY-SEVEN PERCENT OF THE NATIONAL AVERAGE IN SUPPORT OF COMMUNITY HEALTH CENTERS.
David Sundwall, M.D.
I think the state acknowledges the legislature mostly, that these public or community health centers are filling a very important need. By the way, they get a lot more Federal money than they get State money, it's just been recently that we've kind of stepped up and decided that we need to give some state money. We could do much better.
NARRATOR: FOR NOW, THE RATCLIFFE CLINIC HANGS ON. BUT ACCESS IS LIMITED. THEY’RE NOT SEEING NEW PATIENTS.
THE CHALLENGE OF PROVIDING ADEQUATE HEALTH CARE IS NOT MERELY AN “INNER CITY ISSUE”. IN SMALL TOWNS, PROBLEMS ARE COMPOUNDED BY GEOGRAPHIC ISOLATION.
Melissa Robins
We know everybody. We know everybody here in the community, we know our doctors and they know us.
Jeffrey Chappell, M.D.
People look out for each other, they're very friendly, they're very open. And for a lot of people, this is where they grew up. This is where their parents grew up and this is where their grandparents grew up.
NARRATOR: Over half a million people live in rural Utah. it is estimated that NINETY THOUSAND of them are uninsured. MANY work dangerous jobs, yet WE COUNT ON THEM FOR FOOD AND RAW MATERIALS THAT WE often TAKE FOR GRANTED. BUT just like THEIR CITY COUSINS, they are increasingly unable to afford the high premiums of healthcare.
Todd Jensen
Because we're out here working hard and we have a lot of risks in our profession with heavy equipment and the livestock and we just can't all afford it. Yeah it worries me. It worries everybody. If something happens a hospital bill could put you at bankrupt. The cost of living and hospital bills and if you ain’t working you ain’t producing nothing.
Narrator: IN SMALL-TOWN UTAH, THE WORRY IS MORE THAN DOLLARS, ITS DISTANCE.
Marc Babitz, M.D.
Now the classic geographic barrier, which is very prominent in Utah is the issue of being in a rural area--literally living somewhere where there aren't health professionals.
(Margaret Wells: Good girl)
NARRATOR: Margaret Wells and her family live in Price, Utah. Her daughter Ashland suffers from Spina Bifida and a rare chromosome abnormality that can cause developmental problems.
Margaret Wells
Ashland basically is total care. We have to do everything for her. She has to...she's non-verbal so she doesn't talk, she doesn't walk, so we either have to get her in a wheelchair or we have to carry her. She can't feed herself so we have to feed her. We bathe her, we basically just do everything that you would do like for a baby to take care of her.
NARRATOR: due to ashland’s condition, the family relies on a number of specialized doctors over two hours away in salt lake city.
Margaret Wells
There are a few doctors that come here to town now that we can go and see. But most of what we see is at Primary Children’s so we can go there. One time our doctor here in town said to me "they want you to come and they want you to come right now. You need to leave right now". Well I couldn't leave right now because I had another little boy at home and so I said, "You know what, I can't, I have to go home and make sure he's taken care of". So then I said, "Is she going to be okay?" Because the message they sent to me was that "you need to leave right now and you need to come straight here and if she has problems you need to stop somewhere on the way". So it is scary. A lot of things that happen to her I know what to do but when it's something like that maybe I'm not going to know what to do. So if I'm in the canyon and something happens, I can't call for help.
Marc Babitz, M.D.
We actually know when we look at physicians the vast majority of physicians choose to practice in urban or suburban communities, and only a very small proportion, I believe it's about 5% of the total are practicing in rural America, and yet 20% of our population lives in rural America.
NARRATOR: with A population of THREE HUNDRED THIRTY-FIVE, bicknell is classified as one of utah’s LAST remaining frontier towns. the closest major hospital is three full hours away. people in this region rely on the wayne community health center for their BASIC health care needs.
Melissa Robins
You know we live at such a great distance from a hospital and it's such an issue to have really good healthcare. It's a necessity. People out here have to drive for several hours, some of them on the other side of the county, to get to anywhere where there's a hospital.
Jeffrey Chappell, M.D.
We have probably about, again about 2200 patients who this would be their medical home and that's a diverse population.
Melissa Robins
You're taking your life in your own hands sometimes living here at on these communities. You have ranchers and you have farmers and people traveling through and there are accidents all the time.
Jeffrey Chappell, M.D.
You see and at least treat initially every infirmity known to man, truly. We may not sense it very often but we will see major trauma that we have to try to stabilize as best we can and move on to the bigger facilities.
(I think it would probably be better to have a hand specialist work on this. Now that’s a bit of a challenge because the closest one is in Provo).
Jeffrey Chappell, M.D.
I think we're very good in this clinic to providing primary care and urgent care. Specialty care is a challenge for these people. A lot of these communities have enough work to keep one specialist very busy. But not quite enough for two and it's very hard for these lone specialists to thrive, if you will, in these small communities because they're on call all the time and sometimes...well there isn't anyone else that can cover for them.
I think the big issues in practicing rural medicine are getting physicians that will stay. I think that's important. I think a lot of these rural areas have had a fair amount of turnover.
Melissa Robins
And it's a necessity to have these clinics here. They are a must. We have to have them. There would be so many more people who are injured that would be killed or otherwise be really seriously injured if we didn't have this here.
(Dr. Chappell: Be careful alright? Okay. I like your boots.)
