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, arandshy;range 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.
Email suggestions for future House Calls columns to Beth Liles at
Sutter Coast Hospital, firstname.lastname@example.org