Micah Wilkins/Carolina Public Press

Data show 9 percent fewer in 2014 than in 2010

Fifty-year-old Tammy Wines of Columbus, N.C., has developed a lot of medical problems in the last few years. She doesn’t have health insurance, so she’s spent the last 20 years seeking medical care from Saluda Medical Center, whose fees are on a sliding scale for the uninsured.

For Wines, the price is right, but the drive is long.

“You have to think to yourself, ‘Do I have gas? Do I have money to buy more gas? Do I have the money for the doctor?’” said Wines, who drives 30 minutes from her home in Columbus to the center, where she pays $25 per visit. Wines and her husband, who is also uninsured, feel discouraged from moving away from the Saluda Medical Center because, she said, it is the only place they know of that can provide them with inexpensive medical care.

Amy Copeland
Amy Copeland

According to the National Rural Health Association, people in rural areas throughout the country are more likely to be uninsured than their urban counterparts. That makes addressing the needs of the uninsured especially important for rural health care providers, said Amy Copeland, the administrator of Saluda Medical Center.

Rather than pay for office visits patients cannot afford, many people living in rural communities simply forgo visits to the doctor’s office, she said. But Saluda Medical Center, the only health care provider in Saluda, tries to find a way around this. The clinic accepts all types of insurance, and about one-third of their patients are uninsured.

“Many of the locals are hardworking individuals that, for one reason or another, can’t afford the cost of a premium,” Copeland said. “If (patients) don’t have copays, we’ll try to work out a payment plan. I don’t want anybody not to be seen because money is an issue.”

Finding affordable care within close proximity has been a challenge for people like Wines who live in rural communities. And across the country, the number of health care providers in rural areas has been dropping.

According to a study by the George Washington University School of Public Health and Health Services, only 5 percent of new doctors choose to practice in rural areas. Today, nearly a quarter of all people live in rural areas in the United Sates, but only 10 percent of physicians practice in rural communities, according to the National Rural Health Association.

This trend can also be seen in the counties of Western North Carolina, where the number of physicians working in the 18 westernmost counties dropped by 9.2 percent from 2010 to 2014, according to data from the National Center for Health Statistics. Of the 18 westernmost counties of North Carolina, Avery and Graham counties are considered health professional shortage areas, with fewer than one physician per 3,500 people.

The shortage of medical providers in rural areas is not, however, a new trend.

Hospitals, state offices, even President Barack Obama have recognized the problem and have tried to bring more doctors to rural communities. Mission Health announced earlier this year that it is forming a new Rural Health Planning and Development department to “enhance and expand” health care in the communities that need it most. Last year, the Office of Rural Health also recruited 39 physicians, dentists and nurses to rural hospitals in Western North Carolina.

Rural areas are lacking not only in primary care doctors, but also in specialists. According to the NRHA, urban areas on average have over three times the number of specialists than rural areas. This is especially troubling for rural communities, where people tend to be older, as the demand for specialists increases for patients over the age of 65.

Despite being open for more than 40 years, Saluda Medical Center is struggling to stay afloat. Micah Wilkins/Carolina Public Press
Saluda Medical Center has been open for 40 years, but cuts in the clinic’s budget have seriously jeopardized its future, its administrator says. It is one of several rural health care centers located throughout Western North Carolina. Micah Wilkins/Carolina Public Press

Wines has been experiencing pain in her hands, and wants to see a specialist, but, she said: “We just can’t afford the bill of these specialists. They’re so expensive. I’m just waiting, dealing with the pain.”

Even if she had the money, Wines said, there is no specialty practice near Columbus that she could see.

“If you’re in the city, you can find any kind of doctor you want, all the specialists and anything you’re looking for,” she said.

New technology has been developed in the last few years to address problems similar to Wines’s concerns. Rather than sending patients to specialists, Mission Health and Saluda Medical Center have installed computers that bring the specialists right to the patient, but virtually. In some cases, a video conference call is enough for a specialist to diagnose a problem and advise the health care providers at the local clinic.

“We’re remote,” Copeland said. “If you can take care of a specialty problem in your own home area without having to travel to a specialist, especially when it comes at a office visit, there’s no time lost from missed work.”

Physicians by WNC county, 2010-2014

But, Copeland said, the technology is expensive and Saluda Medical Center is still working out the kinks.

Saluda Medical Center is celebrating its 40th anniversary this year, but cuts in the clinic’s budget have seriously jeopardized its future, according to Copeland.

In the past, the Medical Center has received funding from the state’s Office of Rural Health and Community Care to pay its providers, but this funding has been completely cut. In the last year and a half, provider salaries have amounted to $150,000 which Saluda Medical Center is now having to pay for from its general funds.

“It has made paying our bills hard,” said Copeland, who has gotten creative when it comes to cutting costs. “I send people home early if the schedule’s not full. I’m a stickler for turning off lights when you’re not in the room. If I’m here by myself I turn off the heater. I’m doing everything I can to keep us in business.”

The Office of Rural Health and Community Care currently funds Saluda’s medical visits with uninsured patients, which make up about a third of their 3,500 patients each year. But with the Affordable Care Act, Copeland expects to see a decline in the number of uninsured patients that the medical center sees. Indeed, over 200,000 uninsured North Carolinians have already enrolled for coverage provided through the ACA.

But whether patients are insured or not, Copeland said she hopes that the Medical Center will remain an important resource for the people of Saluda and beyond.

“It gives people a sense of security knowing that if they need medical care, we’re here,” she said.

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Micah Wilkins is an editorial intern at Carolina Public Press. Contact her at intern@carolinapublicpress.org.

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