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A look at frontier medicine in Montana

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Some of you may know that I write for Stanford from my home in Montana's Flathead Valley. I return regularly to campus and, when I do, I'm always struck by the contrast between the landscapes of pavement I see in California and the mountains and rivers of my home. We pay for the natural beauty and lack of congestion here, however, with a lack of diversity and access to amenities like shopping, ethnic restaurants (oh, Indian food, how I miss you!) and cultural events.

An article today in the Wisconsin State Journal points out another, less visible, difference between the Bay Area and the Flathead: access to medical care. The story is part of a series about rural medicine that my colleague Michelle Brandt has written about here before, and which I've read with interest.

I was struck by just how difficult it is for many Montanans to get anything but the most basic of health care, as well as by some of the innovative ideas for improvement:

Rural health challenges are magnified in Montana, where few hospitals deliver babies, no burn unit can be found and the closest level 1 trauma center is in Seattle.

But the sparsely populated state - fourth largest in area but 44th in population, with 975,000 people - has become a testing ground for tackling some of the country's biggest rural health problems. Montana's increasing use of physician assistants, experimental payment methods for small hospitals, proposals for expanding the role of paramedics and efforts to control malpractice insurance rates are ideas being considered by other states, including Wisconsin.

"I always thought I was practicing rural medicine in Wisconsin," said Karyn Thornton, a physician assistant from Brooklyn, south of Madison, who now works at seven small Montana hospitals, including the one in Cut Bank. "But this is really rural medicine. It's frontier medicine."

In contrast to the heartbreaking stories of many of the folks in the article (more than half of Montana's residents live in counties considered frontier, based on density and distance to services, according to the National Center for Frontier Communities), I'm fortunate enough to live in an area with two good hospitals nearby. But some things we take for granted in the Bay Area are lacking here (I experienced this firsthand after moving here shortly before the birth of my third child, only to learn that the hospital at which I would deliver didn't offer epidural anesthesia for childbirth), and it's not at all uncommon to hear of adults and children being airlifted to Spokane or Seattle for urgent or specialized care. So this article resonates with me. I know people in Babb, in Cutbank, in Chester. I've traveled through and love many of these regions. I wholeheartedly agree that it's important to figure out how to improve medical access to care in these and other similarly isolated communities across the country.

The article outlines how a federal study into whether the creation of so-called 'frontier networks' could help small rural hospitals provide basic medical care by relying on a different payment system, perhaps supported in part by federal grants or larger Medicare reimbursements, or by recruiting community members to provide some health care services.

It's an eye-opening read, even if you live in a metropolitan area, and for someone like me, who straddles both worlds, it articulates a problem that hits uncomfortably, and very literally, close to home.

Previously: Dental health a problem for many and Newspaper series examines rural health care challenges
Photo courtesy of the First Best Place

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