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Health Horizons : MEDICINE : Rural Medical Delivery : Lack of a general hospital, shortage of doctors makes it difficult for the poor in redwood country to receive adequate care. One physician goes on the road to treat people.

March 21, 1993|HARRY NELSON | Nelson is a retired Times medical writer now living in Pine Mountain , Calif.

Dr. Wendy Ring spends her days towing a mobile medical clinic around the countryside caring for people marooned in places that doctors don't serve. If she weren't doing that, she would probably be working in an inner-city clinic or treating the sick in some developing country.

Ring's passion is to help people who have little but who need much. Her patients are the homeless who wander the streets of Eureka in California's redwood country and the very young and the very old who live in once-thriving logging communities now drawn into a deep economic recession.

Once Eureka was the busy center of the state's vast timber industry. But today logging is in sharp decline and the economy depends heavily on the thousands of tourists who flock to the North Coast country to hike, fish, hunt and enjoy the natural splendor of the sea and mountain scenery.

But for many of the 150,000 residents of Humboldt and neighboring Del Norte County, life is not so joyful. The forests are quiet. The stream of logging trucks that once flowed along mountain roads has slowed to a trickle. The men and women who worked the woods and the mills still remain, but most of them are out of work, out of money and out of health insurance. According to one estimate, only 20% of the local population has health insurance. Most of the rest are on government programs for the poor and the elderly or have no coverage of any kind.

Like the poor in hundreds of sparsely populated regions across the United States, the poor who live in California's rural counties have extra burdens obtaining medical care, which some experts see as exceeding those faced by the poor who live in cities.

Living 50 miles from the nearest doctor without a car means there are lots of reasons for delaying health care, especially when there is no public transportation.

But perhaps more important are two factors unique to rural areas: the frequent absence of a county hospital--traditionally the last resort for the poverty-stricken and the uninsured--and, compared to cities, the relative shortage of physicians. Recent U.S. statistics show there are 97 physicians per 100,000 rural residents versus 225 physicians per 100,000 in urban areas.

Rural Americans, especially rural poor Americans, are more likely than people in cities to have difficulty finding health care services, reports the Center for Budget and Policy Priorities, a Washington-based independent organization that specializes in policy issues affecting low- and moderate-income people.

The poor in Humboldt and Del Norte, as well as other rural California counties, seem to fit the national pattern outlined in this and similar reports: fewer doctors, less health insurance, poorer health and fewer visits to a doctor than by their urban counterparts.

Nearly all of the 250 physicians in Humboldt and Del Norte counties practice in four cities: Eureka, Arcata, Crescent City and Fortuna. For the residents of numerous other communities, the only choice is to travel as much as 150 miles to get to a doctor and home again.

For the uninsured and those on Medi-Cal, the government medical program for the poor, a major problem is finding a doctor who will accept Medi-Cal payments, which are much less than most physicians' charges.

When Wendy Ring arrived in Eureka three years ago, only a handful of the physicians who practice general medicine accepted Medi-Cal patients and most of them would take only a limited number. As the recession has deepened, the situation worsened, despite numerous recruitment drives conducted by overworked local doctors. Both counties are on the federal government list of medical manpower shortage areas.

Obtaining a specialist's care in Eureka for her patients is a lot easier than finding a generalist to see a Medi-Cal or uninsured person, Ring says. This may be because specialists are more numerous than generalists in the city and consequently not as fearful of being swamped with patients who don't have private insurance. In rural areas, specialists and generalists alike are hard to find.

The problem is evident in Crescent City. "If you include the emergency room physicians, there are only 10 to 12 primary-care doctors for a population of 30,000 to 35,000 spread over an area that covers from 25 miles north of here to 25 miles south," says Dr. Michael Mavris, a Crescent City family practitioner and a member of the board of the county's only hospital. "On some weekends, I'm the only doc to take care of everything.

"Sometimes I wish we had another pediatrician, a urologist, an ear and throat specialist, another orthopedist, and it would be nice to have a psychiatrist. There's a need for them all."

Mavris says he "has more patients than I can take care of." He has not taken new patients--either private or Medi-Cal--for three years.

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