House Calls runs every other Thursday. Today’s column is written by Christopher B. Cutter, a physician at Sutter Coast Community Clinic.
Rural areas such as Del Norte County present many complex challenges to the delivery of high-quality health care.
They tend to have many people who are elderly, disabled, unemployed and often with limited resources. When this is combined with a limited number of primary care physicians and specialists, the difficulty is obvious.
Without ready access to qualified primary care, it is very difficult to keep a population well while attending to day-to-day needs. People need competent providers to manage their medications, arrange for appropriate monitoring, and take care of their urgent medical concerns. Without a primary care base serving the population, all of the specialists in the surrounding areas could never accomplish much lasting good. People need family doctors. Period.
So what happens when we have a shortage of the type of physicians we need the most? Well for one thing, we can end up frightening off the few who are here by overwhelming them or urging them into early retirement. That would not turn out well. Sutter Coast Hospital, as well as the neighborhood clinics and private offices, are constantly trying to bring in new doctors and retain them. So why the shortage?
For one thing, we are not training enough docs in our medical schools for primary care. Furthermore, doctors are becoming an increasingly mobile group. This particularly applies to doctors newly out of training. Lastly, doctors are usually accompanied by spouses and kids, and they have to be as happy as the doctor with the idea of living in the new area. Sometimes it works out. Sometimes it doesn’t.
Our situation, therefore, lends itself well to the use of practitioners who are referred to as “mid-levels.” This is a diverse group of trained medical professionals that includes physician assistants (PAs), nurse practitioners (NPs), and even mid-wives. Some of you might be asking, “Who are these people, where do they come from, and why should I go to them?”
PAs are men and women who, after completing a bachelor’s degree, attend a certified PA training school for a little over two years. They were more or less invented by an MD at Duke University who saw medics from Viet Nam returning to the states in the 1960s and realized that they had a wealth of experience. The doctor assumed that with some additional training these men could be a very valuable asset to physicians — as their assistants.
Now, over 50 years later, this training has become so broad and effective that these practitioners are allowed to function as independent providers, usually under some sort of supervision from a physician. They are used extensively in the SCH Emergency Department and Walk-In Clinic, Sutter Coast Community Clinic and at the Del Norte Community Health Center. Many of these providers complete further specialty training to fit certain niches such as surgery.
Nurse practitioners came into being about the same time, but the pool of talent came from experienced registered nurses. These were often the best and the brightest nurses who, after mastering their craft in the hospital, aspired to diagnose and treat patients under collaborative agreements with physicians. Nowadays, these practitioners can, like the PAs, practice pretty much independently, or with minimum supervision. They also can specialize in family medicine, pediatrics or geriatrics to name a few.
So how is this working out for us? Well, in my opinion after having practiced in rural Louisiana, and now Del Norte County, these people are a true answer to prayer. They have provided care in this county for decades and have treated many thousands of people of all ages.
They continue to staff our clinics and provide valuable support to our emergency doctors. They have an impressive record of safety and patient satisfaction, and have helped to lighten the load for the physicians who dedicated their lives to our community. They do all this with the kindness, competence, and compassion that we have come to expect from all of our providers. Personally, I enjoy working with them and welcome their partnership in taking care of you — our patients.