Modoc Country Living-The Country Doctor

When I hear the term country doctor, I almost immediately form a mental picture of a kindly-looking silver-haired gentleman in a suit and tie, stepping out of a model A Ford (or maybe a horse and carriage) and carrying a small black bag. He is walking from his car (carriage) up the walk to the front porch and removing his hat. The country doctor is making a house call on a patient, a practice that was fairly common a generation or two ago. A country doctor could treat most anything, from a common cold to measles to setting a broken bone, and do most all of it without the patient leaving home. The country doctor was not a specialist, as we have grown accustomed to in today's medicine. He was a Medical Doctor (MD) or family practitioner who possibly had some interest in a particular aspect of medicine, but was trained and licensed in the general practice of medicine. Yesterday's country doctor didn't always demand cash for treatment, but often traded medical services for the services or products of his patients. There are still doctors who practice in the country, and some probably still make house calls. But instead of a carriage or a model A Ford, today's country doctor more likely drives a beemer or an SUV. That country doctor probably practices medicine at a small limited-facility rural clinic or an individual office in a small town. The majority of a country doctor's fees are now paid through health care insurance programs or Medicare/Medicaid. The following link proves that a country doctor still exists. This link provides a common-sense approach to medicine and some worthy prescriptions in a series of easy-to-understand essays that deal with a wide variety of subjects dear to one's body, mind, and soul from a real country doctor.

Just as the face and function of the country doctor has changed over the years, so has our national health care system in general. Our entire nation is struggling with healthcare issues such as access to care for the uninsured, an aging population, and financial viability while still providing adequate quality care to patients. In rural areas, geographic isolation and transportation barriers, plus a somewhat older and less affluent population exacerbate these same problems. Rural areas also suffer from a general shortage of medical resources both in care facilities and medical personnel, and your country doctor. Because of limited capabilities at many rural facilities, rural health care systems often directly compete with urban systems for patients. The patients that are most likely to travel greater distances for medical treatment in urban centers are the very patients that provide the most significant revenue source for rural hospitals. Those are the patients who participate in larger group health insurance programs. In order for any hospital, clinic or country doctor to be financially viable, the mix of revenue streams must be slanted toward patients with commercial insurance coverage with a smaller percentage of uninsured and Medicare recipients. As the population in rural areas is generally older and less affluent, the mix of revenue streams for rural hospitals, clinics and country doctors becomes heavily slanted toward Medicare payments with lower reimbursement rates. This situation limits rural facilities in the services they can provide and number of quality health care professionals and physicians they can employ. Because of a greater reliance on discount patients/payers (Medicaid and Medicare), and their small size, rural hospitals are extremely sensitive to changes in public policy. Changes in state or federal public policies regarding medical services reimbursement and facilities requirements (like earthquake survivability retrofits) have a tremendous impact on smaller facilities. The smaller rural hospitals and medical centers cannot adapt or respond as quickly as large urban facilities to changes. Rural hospitals do not have a large patient base over which to spread losses. The smaller volume and bed-size rural facilities are especially vulnerable to changes such as state or federal budget cuts that result in reductions in Medicare/Medicaid reimbursement.

Providing quality emergency medical services (EMS) is another dilemma for rural administrators. Geographic isolation and transportation barriers in most rural areas make EMS a critical part of the rural health safety net. But rural hospitals and EMS providers experience greater difficulty in recruiting qualified Emergency Medical Technicians (EMT). The EMT is possibly today's closest equivilant to a country doctor. It is also more difficult for rural EMT personnel to maintain proficiency and certification in their fields. A rural EMT also usually assumes greater responsibilities than urban counterparts due to greater distances between emergency treatment centers.

All is not doom and gloom for rural medicine, however, as the survivability and viability of rural medical centers and the country doctor are subjects of great concern and study at all levels of government. Although rural medical administrators and doctors must be extremely diligent in finding it, help in the form of funding and management assistance is available. Initiatives and new ways of doing business are being tried with regular success at facilities all over the country. Some rural hospitals are improving the supply and distribution of health professionals by guaranteeing education loan repayments and offering mandatory service payback scholarships. Rural administrators are also having some success with enhanced recruitment and retention of medical professionals, and some medical schools are offering rural practice as a country doctor as a sub-specialty in physician training. Rural medical infrastructure is also being improved through telemedicine and grants for EMS. Some rural hospitals are integrating EMS with other local health services, including public health and disease prevention. Integration of EMS with other components of the health care system involves expanding the role of EMS in public health by including EMS in community health monitoring. Also, some success has been achieved by sharing EMS with other health care providers and provider networks. Networking and converting to managed-care facilities are other initiatives being tried with success by many rural hospitals and medical centers around the country. Improvements for rural medicine is explained more fully and in more detail at the United States Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) website.

As a rural area, Modoc County, California medical facilities suffer the same difficulties and experience the same successes that any rural area does. A number of years ago, the medical facility in Surprise Valley experienced catastrophic business failure and closed its doors. This forced the residents of Cedarville and the rest of Surprise Valley to travel a minimum of 20 miles for routine medical care, often through harsh winter storm conditions. Local community leaders and concerned citizens rallied and organized, and formed the Surprise Valley Health Care District. The reorganized District opened a clinic in Cedarville, and today provides quality medical care to the residents of the Surprise Valley area. The Surprise Valley Health Care District is funded by property tax money from residents of the Surprise Valley special district. The Surprise Valley clinic is an independent 26 bed general medical and surgical hospital with emergency services. The hospital, with one resident physician and a full nursing staff, also offers long-term care and a Skilled Nursing Facility (SNF). With the exception of the larger Modoc Medical Center in Alturas, the only other medical center in Modoc County is the Canby Family Practice Clinic in the western part of the county. The Canby clinic is a small privately funded independent medical facility with no in-patient services. The clinic has one highly qualified and experienced resident Physician Assistant (PA), and a nursing and administrative staff. The clinic in Canby, although small with limited facilities, is a very clean and efficiently run facility.

As is the case with a lot of rural medical facilities, Modoc's centers make extensive use of medical registry and contract doctors and health care professionals. A medical registry is a referral system for doctors, nurses and other health care professionals operated by both for-profit and not-for-profit organizations. Some of the health care professionals listed by the registries are retired or semi-retired, and still want to keep their hand in their respective professions. Their services are offered to hospitals and medical centers by the registry on a set time period contract, often short-term. The medical registries can be used by medical facilities to fill gaps in resident staffing whether short-term or long, planned or unplanned. In the case of many rural facilities who have difficulty employing permanent full-time resident staff, Modoc facilities included, a medical registry can fill key staff vacancies immediately. The negatives to using a medical registry are that they are of a temporary nature, professionals' unfamiliar with patients' histories and relatively high cost. These negatives are especially felt by small town hospitals and clinics. A good country doctor builds his or her patient list slowly, building trust, confidence and rapport with each patient. A doctor (or nurse) from 100's or 1000's of miles away on a six-month contract must assume an existing patient load immediately and usually only hope that trust and confidence follows; sometimes it does not, resulting in an unhappy paying customer. The cost involved in hiring contract medical professionals is also considerably higher than hiring a permanent resident. In addition to a sometimes-lucrative base salary, rural medical facilities usually must pay travel and a per diem allowance for the length of the contract, and provide housing while paying a percentage to the registry. Because contract hiring is often the only way a small rural hospital can continue to provide community health care, the higher personnel cost further exacerbates the hospital's already bleak financial picture. On the positive side, some contract medical professionals decide they love the area they are temporarily in, build solid patient relationships and become permanent full-time residents. This results in a win-win situation for all concerned; the doctor or nurse is working in a comfortable niche, patients and customers are happy and satisfied, and the hospital improves its business situation by reducing personnel costs.

The Modoc Medical Center in Alturas operates as the County Hospital for Modoc County. The Medical Center is an independent facility subsidized by Modoc County government. The center is a county health care facility providing a full complement of services ranging from general acute care to skilled nursing to outpatient diagnostic services. As an acute care facility and skilled nursing facility, the center provides 87 licensed beds. It is comprised of three components, the Medical Center Hospital, Warnerview long term care facility and the Modoc Medical Center Family Practice Clinic. The hospital offers 24/7 emergency room service, an acute care facility and basic diagnostic services required of health care facilities. The hospital also provides several supplemental services consisting of a general surgical unit that provides outpatient and limited general surgeries, diagnostic imaging, a clinical laboratory, physical therapy, respiratory therapy and social services. A dental office is located nearby. Warnerview is a long term care facility and

Like so many other rural medical facilities, Modoc Medical Center has suffered financial and business hardship, recruiting and retention difficulties and poor customer satisfaction. Most recently, the center nearly lost licensing and certification and came dangerously close to closing its doors. In late 2005, after a year or more of failed federal and state inspections and grand jury investigation, Modoc Medical Center management was drastically overhauled. In a testament to community involvement and local government cooperation (possibly found only in small town America) the county Board of Supervisors replaced top management and took charge of operations. Modoc Medical Center is still not perfect and still suffers from normal rural health care woes, but the new management team with support from the Board of Supervisors is making progress. Federal and state inspection discrepancies and licensing issues are steadily being corrected, the financial picture is slowly improving and community customer satisfaction is on the rise.

One of the more sobering facts about living in a remote rural area is that having air-ambulance service available is a must; the country doctor probably won't arrive in time! In the event of heart attack, stroke or serious accident trauma that requires the services of a major full-service hospital, the only viable access is by air. Modoc County is a somewhat remote and rural area. The closest major hospitals are in Redding or Sacramento, Reno, Nevada or Klamath Falls, Oregon, all 2-5 hours driving distance. In 2005, Mercy Medical Center in Redding, California, one of the full-service hospitals nearest Modoc County, reached agreement with PHI Air Medical Group to provide air ambulance service to 12 northern California counties. The 12 counties are: Del Norte, Siskiyou, Modoc, Humbolt, Trinity, Shasta, Lassen, Mendocino, Tehama, Plumas, Glenn and Colusa. PHI Air Medical Group operates as Mercy Air Medical and provides rapid fixed-wing and helicopter air ambulance services for Modoc residents. This service currently costs approximately $40-$50 per year per family. The air ambulance initially transports patients to Mercy Medical Center in Redding. In the event Mercy can't treat, the aircraft will be diverted to another trauma center in the California-Oregon-Nevada area for treatment within minutes instead of hours. This service is not mandatory, but should you experience life-threatening trauma that requires the services of a major trauma center, you will be evacuated by air. Many health insurance programs don't fully cover air ambulance service, so you can either trust that your health insurance carrier will cover your transport, or sign-up with Mercy Air/PHI.

Is just being in the country healthy living? There are many who would say that it is. Cleaner country air makes it easier to breath and less congestion reduces stress, so those things alone make things a little healthier. Some feel that simply living a healthier lifestyle defeats most diseases, and I find it hard to argue against country living being a healthier lifestyle than living in the city. The peace and quiet of country living also lends itself well to holistic style healing and health, practices that a traditional country doctor would probably prescribe. Modoc's Saving Health Ministry combines spiritual guidance and healthy diet in a peaceful country atmosphere to effect lifestyle change and overcome many common and serious illnesses.

There are three dentist offices in Alturas and one in Cedarville. Dental appointments can also be arranged at the Canby Family Practice Clinic. Of course, dentist services are also available at many small towns close by in neighboring counties and in southern Oregon.

Naturally, because ranching and farming are Modoc's main industries, veterinary services are readily available. In addition to numerous veterinarians in towns in neighboring counties and southern Oregon, veterinary services are available in Lookout, Alturas and Cedarville. Alturas and Cedarville are home to the county's largest veterinary hospitals and clinics, catering to both large and small animals.

So, yes, there is still a country doctor in rural America. Today's country doctor is probably not driving the model A Ford with a small black bag making house-calls, but the country doctor mentality and ethic still exist. One should not come to rural Modoc County, California expecting to find a doctor's office complex in every mall (there are no malls, anyway!). Don't expect to drive a few short miles to a major hospital for treatment. But if you live here and experience a serious illness or accident, emergency treatment is minutes away from anywhere in Modoc County by air. Quality medical care for routine office visits, physicals, diagnostic services and some emergency care is available for country living, locally, in Modoc County (with a country doctor attitude!).

More Modoc Country Living...

Modoc Country Living-The Country School

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