By OMA President Carla McKelvey, MD
I attended the Oregon Rural Health Association Conference. Though I was unable to attend the whole conference, the topics looked good and timely. It is a great networking event which gets different folks not only from different parts of the state together but also from different areas of health care, including clinics, hospitals, health departments and private practitioners.
I also wanted to let everyone know about the upcoming First National Rural Health Day – November 17. You can go to http://celebratepowerofrural.org for more information. The ORHA would be happy to help you publicize this in your community. You can contact them at www.orha.org.
It was an honor to speak at the conference. The following are some excerpts from my speech:
There is a lot of anxiety out there about what is occurring with health care transformation, and some physicians believe they may lose even more of their autonomy and their ability to care for patients effectively. I believe strongly that rural physicians do and can have a powerful voice in this discussion.
Approximately 37 percent of Oregonians live in a rural area and are cared for by 19 percent of the physicians in Oregon. Yes, our patient to physician ratio is higher than in the urban areas, but that is what makes our voice even more important. Our biggest weakness is that too often we are too busy and so do not take the time to make our voices heard.
The rural population is an aging one with high rates of chronic disease. It would be easy for the state to forget about this population outside the boundaries of the I-5 cities.
What distresses me the most is probably what distresses you the most – the level of poverty and need, the lack of resources medically, economically and socially. When spending cuts are made the impact is felt greater in rural areas because there is little room to absorb cuts. I admit that at times I wonder if it is worth it and that maybe I should move to a bigger area where I can be more distanced from my community and its problems. But I know that my life would be less satisfying if I did.
I have come to realize that my role as a rural physician is not just to be a voice in health care issues but to also recognize the importance of the social determinants of health. I believe the most important of these is education. As we go through the current economic hard times, it is clear that the more education that one has, the better one is doing.
A well-educated person with a good job is going to be healthier and thus decrease our state’s health care costs. More research also seems to show that the stress of being poor sets off a physiological response which has a negative impact on one’s health.
Our current healthcare system though only focuses on health and not the social factors that contribute to it.
A physician from Corvallis said to me that he was tired of legislators not facing the reality of health care – that it was time for some to use the “R” word – rationing. I think we are privileged to live in a state that is willing to have those conversations. We have tackled the “R” word and have the Prioritized List as proof. We have dealt with End of Life issues. Our citizens and our legislators are willing to have those tough conversations.
Over the next several years, we as physicians have a tremendous opportunity to develop a health care system that works for us and our patients. We have taken the step of acknowledging that separating physical and mental health did not make sense and so will be rejoining them with this next step. We have an opportunity to say to our legislators and patients that social determinants of health may be just as important if not more important in addressing health care costs.
We may not agree on the solutions, but none of this will happen if we do not stand up and make our voices heard. That may be just a phone call or email to a legislator. I know the powers that be will listen if you will just take the time to make it happen.
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