Everyone from the largest cities to the smallest towns should be concerned about the rural healthcare crisis in Texas. The Texas Tribune hosted a panel discussion on the crisis to raise awareness and work towards a solution.
From 2010 to 2018, 84 hospitals in rural America have closed, 26 of those in Texas. When the local hospital closes, employers who need to provide healthcare and emergency care for employees move to a city with a hospital. As the employers leave, the tax base dries up and the schools die. Closing the local hospital is often a death knell for rural communities.
Dr. Mike Henderson, a family doctor in Childress, pointed out that his hospital is the only one providing obstetrics in a 100-mile radius. There are 35 counties in Texas with no physicians. In the panhandle, 24 of the 26 counties don’t have county health departments but depend on the state to provide services like restaurant inspections, food handler’s certificates and other vital preventative health services.
Texas ranks last among the states in healthcare availability and cost, according to Dr. Holly Jeffreys, the founder of Panhandle Family Care, a chain of five health care clinics operated by Nurse Practitioners.
When asked what the solution is to the rural health crisis in Texas, Dr. Henderson said effective use of Nurse Practitioners and Physician’s Assistants, if they practice within the scope of their training.
Dr. Jeffreys pointed out that Texas is one of only a few states that do not allow Nurse Practitioners to operate without direct supervision of a Physician. In states with unsupervised practice, there are more Nurse Practitioners. She told the story of a Nurse Practitioner leaving the Army and choosing New Mexico over Texas because it would take a year for her to begin practice in Texas. Currently, Governor Abbott is exploring ways to simplify the licensing process in all areas requiring occupational licenses in Texas.
Technology is exploding in medical practice according to Billy Philips, VP of the Texas Tech University Health Science Center. Telepsychology has been particularly successful. It is essentially a diagnosis and treatment without being in the same room. Telemedicine works very well for some conditions. The limitations come when the physician needs to actually touch the patient.
EMS trucks have sonograms and EKG’s that can be read by a remote physician on a smartphone. In rural communities, this allows triage or the assignment of degrees of urgency. The patient may not need a level one trauma center and can be diverted to a closer facility with appropriate care. This technology allows the team preparing to receive the patient to know what to expect on arrival.
EMS trucks are parked more often parked. We need to figure out how to make them family health centers when they are stationary.
Representative Ken King R-Canadian said the turf wars are political battles. No group wants to give up the control they have over their practice. He said policies have to win over politics at some point.
Philips observed that it does not matter how many health insurance cards you have. They are useless without someplace to get care.