Practicing medicine in rural America

NICK EICHER, HOST: Today is Wednesday, July 17th. Thank you for turning to WORLD Radio to help start your day. Good morning. I’m Nick Eicher.

MARY REICHARD, HOST: And I’m Mary Reichard. Coming next on The World and Everything in It: rural doctors. 

We told you yesterday about how difficult it is to deliver quality healthcare to rural populations. One big problem is that the doctors just get burned out.

EICHER: So today you’ll meet one who did suffer burnout. But he discovered an old approach that gave him a new passion for serving small-town patients.

WORLD Radio’s Sarah Schweinsberg spent the day with a doctor in Wyoming whose approach to the practice of medicine allowed him to return to what he wanted to do all along.

SARAH SCHWEINSBERG, REPORTER: Dr. Dean Bartholomew’s day helping patients doesn’t start in an exam room. It starts on his cell phone. 

BARTHOLOMEW: I did get a text back from the kiddo with the bug bite rash from last night and mom says her leg is much better and sent me a picture. And then this morning see. Yup. Yeah, it looks much better.

Dr. Bartholomew is a primary care doctor at 307 Health in Powell, Wyoming. Powell is a small town of 7,000 people near Yellowstone National Park.

307 Health is a direct primary care clinic or a DPC. Over the past five years, more than 1,100 DPCs have opened across the country. 

These are clinics that don’t accept insurance. Instead, patients pay a flat, monthly membership fee and they can see their doctor as many times as they need. 

Most patient consultations don’t happen in the office. Dr. Bartholomew says patients usually call or text him with issues. The clinic’s charting system automatically documents the texts. 

BARTHOLOMEW: When you literally have your doctor’s cell phone number and that’s 24 hours a day, seven days a week, that’s a big deal.

A mom texted Dr. Bartholomew last night. She said her son had a bad cough. This morning, the mom texted again saying the cough hasn’t gotten better. 

BARTHOLOMEW: So we’ll see him here in a little bit and see what we need to do. 

AUDIO: [Sound of knock, meeting little boy] 

After a short examination, Dr. Bartholomew prescribes an inhaler that he can give the little boy right here in the office. He shows him how to use it.

BARTHOLOMEW: You’re going to breathe out and just as you start to breath in you’re going to puff it and suck it in. 

After the 20-minute appointment, Dr. Bartholomew updates the boy’s chart in the clinic’s system. That takes less than five minutes. 

Dr. Bartholomew says that’s one of the biggest reasons he loves working at a DPC. Because the clinic doesn’t accept insurance, he doesn’t have to submit claims to insurance companies to get paid. That means minimal paperwork and more time with patients. 

BARTHOLOMEW: So he’s getting ready to leave on a trip to Florida on Thursday. So we’re trying to get him feeling better. 

Dr. Bartholomew can spend up to an hour with each patient. 

BARTHOLOMEW: When you have hour-long appointments, you can get into some pretty personal issues and get to know people really, really well.

Before coming to 307 Health two years ago, Dr. Bartholomew worked in an even smaller town, his hometown. There he was the only doctor in a 40-mile radius. 

BARTHOLOMEW: There was that expectation that there’s always going to be somebody on call. When you’re a doctor in a small town, you’re doc. No matter where you go.

Dr. Bartholomew says that responsibility weighed heavily enough on him. But what pushed him to burnout wasn’t the patients. It was the paperwork. 

Because the clinic couldn’t support an administrative staff, Dr. Bartholomew and his wife filled out the insurance and Medicare claims themselves. 

BARTHOLOMEW: I loved patient care from 8:00 a.m. to 5:00 p.m. It was hours and hours of charting and work to get paid every evening. Preauthorization paperwork, dealing with insurance companies, um, dealing with billing. 

After eight years of that, Dr. Bartholomew reached the end of his rope. 

BARTHOLOMEW: It was just like anybody else in burnout, in any other job, I didn’t want to do it anymore. 

Dr. Bartholomew says his experience is all too common in rural settings. That’s where a doctor shortage coupled with too much paperwork often pushes doctors to burnout.

BARTHOLOMEW: I think most people went to medical school or became a PA or nurse practitioner or even a nurse, you know, they did that because they want it to take care of patients, not sitting in front of a computer producing reams of paperwork. 

Dr. Bartholomew sees nearly 600 patients, so he’s plenty busy. But it’s the kind of busy he wants to be.

AUDIO: [Sound of greeting patient]

For instance, instead of having a new patient fill out her own medical history, he has time to interview her himself. 

BARTHOLOMEW: Start with some kind of head to toe questions. Any problems on the top? Any problems with recurrent headaches migraines? 

Besides being a better fit for rural doctors like him, Dr. Bartholomew says the direct primary care model also fits rural populations. Being able to text or call doctors, saves patients long drives to the clinic. 

And being a DPC member is a good alternative for people who are self-employed, like farmers and ranchers, or who can’t afford insurance. The model also works for young families with high insurance deductibles. 

But it isn’t a complete answer to rural doctor and patient woes.  

BARTHOLOMEW: Hi, how are you? PATIENT: Ticker is doing good. [Laughs]

Later in the day, Dr. Bartholomew sees a patient who doesn’t have insurance. The patient needs a colonoscopy—a procedure that costs at least $2,000. The patient will have to pay that out of pocket. 

BARTHOLOMEW: So the state of Wyoming does have a cancer program that does help cover the costs of mammograms and colonoscopies. 

Dr. Bartholomew says even though he’s working in a different type of clinic now. He’s still a small town doctor, which means he’s still never really off the clock. But now he likes his boss. 

BARTHOLOMEW: I work for the patient. I don’t work for anybody else. I don’t answer to anybody else but to the patient. So really it has brought back that relationship, and that’s really the focus of our practices. It’s relationship-based.

For WORLD Radio, I’m Sarah Schweinsberg reporting from Powell, Wyoming.

(Photo/Creative Commons)

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One comment on “Practicing medicine in rural America

  1. Kate says:

    Thank you for this great article! One comment, you say that’s this model works great for young families with high deductible health plans (HDHP), but HDHPs are often associated with health savings accounts (HSA). Based on my understanding of current IRS laws, anyone contributing to an HSA is not able to participate in a direct primary care practice membership, meaning the young families who have a HDHP with HSA may not eligible to use this model as you suggest in the article.

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