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THE HOSPITAL CLOSED AFTER SHE GOT PREGNANT. She didn't plan to have to drive 2 hours away.
So. She had about 6 weeks to make arrangements. The hospital began calling and making referrals may 3rd. So in what world does an OB doctor not plan for an at risk patient's delivery. Obviously Twin Rivers was not equipped, it seems as though Poplar Bluff was not equipped, so early on realizing there were twins she would have been advised and set to deliver at St. Frances before the hospital closed.
Quote:
Originally Posted by Tinawina
Again, stop being so focused on the woman's income and look at the overall point. What she had to travel for is not some super rare specialty service. Having twins or a high risk pregnancy is not unusual, and any decent natal facility should have what she needed. The nearest good one being 2 hours away is a problem that more and more people will have as this phenomenon gains steam... putting even rural babies born to parents who have good jobs and decent health insurance at risk.
You keep saying that there were hospitals 20 and 30 miles away... but they were bare bones at best and increasingly, those distances are going to get longer and longer for people in rural areas. At some point, people will start dying over this. What you are calling "not uncommon" WILL BECOME MORE AND MORE UNCOMMON. Your dstances will be the good old days.
We KNOW they're closing because rural hospitals are no longer "econmically feasible" in a for-profit healthcare system. The point to debate is, as a society, is that what we want? Because when the consequenses of this really hit it will no longer be an abstraction, and it won't just hit the poor. They'll bear the brunt at first but it won't stop there. Do we want peope dead over profits or not? Do we try to find solutions or not? Or do we just let people die because they were "stupid" enough to live where they live?
May I ask if you live in a rural area? How far is it to a decent neo natal facility?
Honestly I don't know what services other that ER the closer hospitals offer. Maybe bare bones, maybe a decent maternity, I did not research those hospitals. Either way for such emergencies or high risk facilities are available with in 2 hours. This is how it is in my rural area and it is not a problem, inconvenience maybe.
Do you really believe "we" can handle the expense of building and funding state of the art hospitals with top notch NICUs and neo natal doctors and nurses, cardio services, etc. in every rural town in the US so when there is an emergency or high risk those folks don't have to drive 2 hours for services?
As far as bringing up income, I would not if the article had not. They focused on the expense of driving to a larger hospital further away for care and how the gas money is a burden on already poverty stricken mothers. The door was open.
And as far as people living in rural areas being stupid, its not those people getting their nickers in a bunch because they must drive for specialized medical services. Its a choice they made. If being within 5 minutes of a large hospital were a priority, they would relocate.
But I will say that this is a very complicated issue. It has very little to do with "wants".
For example, One issue driving a reduction in the quality of health care available in rural America is the availability of physicians.
The cost of educating a physician has skyrocketed in recent decades. Most physicians leave school and residency with huge debts. They can most easily pay these loans back by moving to a city and/or becoming a specialist. Specialist are in demand in cities.
If we want and adequate number of physicians and the array of expertise in rural America we will have to tackle this problem.
I will say this as a Republican, I don't think my party or any parties have really cared about rural area healthcare issues.
The repeal and replace effort in Congress totally avoids this issue, so we likely have to wait until the political hysteria passes, partisan politics calm down and a bi-partisan effort of rural Congressmen and Senators get together to find solutions.
Again, it depends on these politicians. It is a sad situation.
In my area physicians from the larger hospitals, Vanderbilt, St. Thomas, UT will put time in serving in the smaller surrounding hospitals. Not sure how this "loan" program works but it helps with the lack of more specialized in more rural areas.
Here's where we part company. What do you call a "decent natal facility"? The rate of twins is about 3 in 100 births in the US. It takes a fairly large facility to have sufficient experience with twins. This mom probably should have been planning to go to a larger facility all along. Even the NYT seems to like these tear-jerker stories.
Rural hospitals have been closing for at least the past 50 years. The trend is probably going to continue. We are in need of some creative solutions for people who need immediate care, like heart attacks and childbirth. I'm surprised (and glad) she made it to the hospital in time to deliver there.
Yes but if she hadn't she may well have been fine at Poplar Bluff. And as you said and I have been trying to convey there should have been planning early on for delivery at St. Frances for high risk cases or in case of complications.
And again if she would have gone directly to St. Frances instead of driving first ~17-20 miles to Hayti where the OB ward had closed 4 years prior to wait 25 minutes for an ambulance to come out of Kennett, where she was to begin with, before going on to St. Frances she would have been there an hour or more sooner. I'm at a loss as to why that was the plan or there was no plan.
Or maybe people who actually EARN their way in life don't like smug, judgemental, condescending comments from silver spooners born on third base who act like they hit the triple themselves. (Shrug)
well, that is too damned bad.
I will give the exact same advice to my little sister (if I had one)
shrug
advice:
well, if you are 21, still lives with your mother, and you have a 2 year old son, maybe it is time to take out some time to re-evaluate your life.
<exactly what I posted you disagree with?> That is smug, judgemental, condescending comments ? ! Did I say if you don't make certain amount of money a year, you shouldn't breed? Please. If you want to argue, at least be fair.
Plus, dont assume something, you don't know me. I EARNED my way in life, thank you!
I want to add some observations based on personal experience about the challenges of recruiting (and more importantly, retaining) physicians to work in rural/small city locations. My husband is a surgeon in a very in-demand specialty and my background is health care as well. Our first location after he completed training was a city of 100K in North Texas where he was in private practice with 2 other guys. Great partners, great clinic, great income due to ownership in ancillaries, but crummy city. After 5 years we left due to the reasons below. Money can only keep you somewhere for so long.
1. If you practice in a surgical or medical specialty field, you need a large referral area to get an adequate clinical volume. A rural or small location is not going to get you that. To compensate for this reality, hospitals will usually subsidize the physician's salary (regardless of whether or not they are directly employed by the hospital). People in any career who are highly driven want to work and produce. After a while, my husband grew unhappy that his skills and abilities were not being utilized. He wanted more work and challenge than our small location provided. When we left the community, he took an academic position in a large metro area, where he stayed for 3 years.
2. The management and quality of care in rural hospitals is not always that great. In depends on the hospital, but my husband was surprised by some of the things he saw come into the regional hospital from the smaller rural facilities. And he was generally unimpressed with the primary care physicians he was dealing with. On the other end of the spectrum, the city itself did have two decent regional hospitals and some very well trained physicians.
3. Well insured patients will often travel to large metro areas for their care, leaving you with uninsured or underinsured patients, including high percentages of Medicare and Medicaid. As several people on this thread have mentioned, you need a much better payor mix to offset the low reimbursement and challenges of this patient population.
4. Rural areas do not offer the quality of life and amenities that appeal to most highly educated professionals. The local economies are usually not strong, schools are often not that good, there is a lack of restaurants and nightlife, less cultural offerings, limited religious communities for non Christians, no large airport etc.
In short, throwing money at a physician in the form of golden handcuffs may get them there, but it probably won't keep them there. Same thing with loan forgiveness programs like the National Health Service Corps (NHSC), which has been around since the Nixon Administration. One thing that really helps is to identify local students who have an interest in the health care field and spend time cultivating those relationships in an effort to get them to come back home, if that makes sense.
Anyway, just my $.02.
Last edited by Texas Ag 93; 07-25-2018 at 10:02 AM..
I keep going back to the issue that did not get much coverage in the story because the young woman with twins was so much more compelling. Another woman in the story is a thirty-something professional who could not find a local OB and ended up in Jonesboro, which is a 108-mile round trip from Kennett, for routine prenatal care. That tells me there is a huge hole in that part of Missouri. I don't really what the solution to that kind of problem might be. Maybe a clinic with one or more nurse practitioner midwives working with an OB who comes to town once every couple of weeks to see high-need patients? I don't really know. I'm just grateful that despite having lived in a small town when I was pregnant with my children, I never struggled to find good care for myself or for them. In fact, it's now that I live in Denver that I find it harder to find the kind of healthcare I want for my family. Large-scale corporate medicine has changed healthcare and not for the better, but that's for another thread.
I want to add some observations based on personal experience about the challenges of recruiting (and more importantly, retaining) physicians to work in rural/small city locations. My husband is a surgeon in a very in-demand specialty and my background is health care as well. Our first location after he completed training was a city of 100K in North Texas where he was in private practice with 2 other guys. Great partners, great clinic, great income due to ownership in ancillaries, but crummy city. After 5 years we left due to the reasons below. Money can only keep you somewhere for so long.
1. If you practice in a surgical or medical specialty field, you need a large referral area to get an adequate clinical volume. A rural or small location is not going to get you that. To compensate for this reality, hospitals will usually subsidize the physician's salary (regardless of whether or not they are directly employed by the hospital). People in any career who are highly driven want to work and produce. After a while, my husband grew unhappy that his skills and abilities were not being utilized. He wanted more work and challenge than our small location provided. When we left the community, he took an academic position in a large metro area, where he stayed for 3 years.
2. The management and quality of care in rural hospitals is not always that great. In depends on the hospital, but my husband was surprised by some of the things he saw come into the regional hospital from the smaller rural facilities. And he was generally unimpressed with the primary care physicians he was dealing with. On the other end of the spectrum, the city itself did have two decent regional hospitals and some very well trained physicians.
3. Well insured patients will often travel to large metro areas for their care, leaving you with uninsured or underinsured patients, including high percentages of Medicare and Medicaid. As several people on this thread have mentioned, you need a much better payor mix to offset the low reimbursement and challenges of this patient population.
4. Rural areas do not offer the quality of life and amenities that appeal to most highly educated professionals. The local economies are usually not strong, schools are often not that good, there is a lack of restaurants and nightlife, less cultural offerings, limited religious communities for non Christians, no large airport etc.
In short, throwing money at a physician in the form of golden handcuffs may get them there, but it probably won't keep them there. Same thing with loan forgiveness programs like the National Health Service Corps (NHSC), which has been around since the Nixon Administration. One thing that really helps is to identify local students who have an interest in the health care field and spend time cultivating those relationships in an effort to get them to come back home, if that makes sense.
If I ever gave you the impression I was coming at you I truly apologize. I defer to your first hand knowledge of the topic!
Everything you said above make a lot of sense.
ETA: I just processed what you said about the conversation seeming too imply all hospitals are for profit. Maybe I contributed to that perception? I was talking about the whole health care industry being built around a profit model, not that all hospitals are for profit, if that makes sense. A lot of what happens in healthcare gets decided based around what/how much much can be billed, not what is actually needed to serve the patients. That’s what I meant by profit model. Does that make more sense?
Thank you. Re: your last paragraph, which really gets at the heart of the matter, as I said, some of my comments were for all readers. People do seem to have misconceptions about a "for profit" health care system. You read here on P&OC and even more on Health and Wellness that doctors are either treating people who aren't sick to make money, or withholding some treatment to keep people sick (and coming to them) to make money, stuff like that. What is really "for profit" is the financing system. The insurance companies make money by charging for the premiums that pay for the care.
I post on a number of forums, not just CD, and I've found that the standards of care for most conditions are the same in the US as in other first-world countries. That's why I say single payer, or some other form of UHC is not going to be the panacea some think it will be (though I support UHC for equity reasons).
The main difference between a for-profit hospital and a private non-profit is that the NP has to reinvest its profits in the hospital; the FP gives its profits to its shareholders. This may guide some decisions as to what services will be provided. I've never worked in a for-profit hospital, but I'd guess that again, the standards of care are the same as the non-profits. The insurers, including Medicare/Medicaid which are single payer, decide how much they'll pay for services.
I keep going back to the issue that did not get much coverage in the story because the young woman with twins was so much more compelling. Another woman in the story is a thirty-something professional who could not find a local OB and ended up in Jonesboro, which is a 108-mile round trip from Kennett, for routine prenatal care. That tells me there is a huge hole in that part of Missouri. I don't really what the solution to that kind of problem might be. Maybe a clinic with one or more nurse practitioner midwives working with an OB who comes to town once every couple of weeks to see high-need patients? I don't really know. I'm just grateful that despite having lived in a small town when I was pregnant with my children, I never struggled to find good care for myself or for them. In fact, it's now that I live in Denver that I find it harder to find the kind of healthcare I want for my family. Large-scale corporate medicine has changed healthcare and not for the better, but that's for another thread.
I would like to know the story behind that person's problem. The town's OB was working out of the hospital. It's not at all clear whether he was an employee of the hospital or renting office space in the hospital. In any case, it's not reported what happened to him. Did he move on to the facility in Pine Bluff, set up an office somewhere else or retire or just disappear?
I do not think the NYT reporter is aware of the difference between "hospital" and "doctor's office".
I would like to know the story behind that person's problem. The town's OB was working out of the hospital. It's not at all clear whether he was an employee of the hospital or renting office space in the hospital. In any case, it's not reported what happened to him. Did he move on to the facility in Pine Bluff, set up an office somewhere else or retire or just disappear?
I do not think the NYT reporter is aware of the difference between "hospital" and "doctor's office".
I haven't read through all the comments associated with the story, but I will now in the hopes that a local has chimed in and shed light on what was not well-covered.
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