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Attracting Medical Professionals

"It’s very difficult to entice medical professionals to remote communities and health care centers that serve primarily low-income communities," TCWF’s Procello said. "The clinics are often underfunded, underequipped and understaffed, and professional resources and opportunities are limited."

Rural health care centers recruit medical personnel in a variety of ways. For example, foreign-born physicians who complete their medical training in the United States have their government loans waived if the new doctors serve three years in rural facilities.

"Physicians think the desert is the end of the world," said Cathryn Taub, R.N., administrator of Borrego Medical Center, which is located in the Anza-Borrego Desert and a two-hour drive over the mountains to the nearest large medical facility in San Diego. "But when they get over not being in an urban setting, they enjoy it. They have time to provide quality care and education, and they have an opportunity to practice some clinically challenging medicine."

In fact, Taub said, medical personnel at rural health care facilities often encounter a diversity of medical cases that provide extraordinary opportunities for professional growth.

Another staffing technique includes providing medical training to existing personnel and recruiting community volunteers. Registered nurses at Borrego, for instance, trained a clerical employee to become a nursing assistant.

The physician’s assistant at Big Sur Health Center—situated in a coastal community of 2,000 residents—trained volunteers to provide health education for students at the two local schools and to facilitate enrollments in the state’s Healthy Families health insurance program for low-income families.

"We need a system of recruiting and bringing medical providers to rural areas, instead of making each community figure it out for themselves," said Luisa Buada, executive director of the California Institute for Rural Health Management, a nonprofit organization created to help rural communities adapt to the managed care environment.

Buada suggests a community service requirement in rural clinics for medical school graduates, which "may help them make the decision to stay."

Adapting to Funding Cuts

Perhaps the greatest threat to rural health facilities is the effect of changes in government funding precipitated by the Balanced Budget Act of 1997, Buada said.

"We’ve created a reimbursement system in which less sophisticated facilities with the least resources won’t survive. We need to stabilize and support facilities that serve people close to home," she said.

Butte Valley-Tulelake’s Jones agreed. "Sustaining our finances becomes very difficult. We have to rely on state grants to help, and because our area is so sparsely populated—less than seven people per square mile—we have a harder time competing for funding," he said.

In fact, most small rural facilities run an operating deficit and count on their communities to fill the gap with donations, fundraisers and volunteer efforts that supplement staff activities.

The Big Sur Health Center serves a highly diverse population that includes both wealthy landowners and workers who are the backbone of the tourist industry. Because the area is accessible only by the Pacific Coast Highway, it is sometimes isolated for months at a time because of floods and fires, and the health center becomes the only source of emergency treatment and disaster relief for residents and disaster workers. With a newly expanded board composed of dedicated volunteers, the center is holding fundraisers that appeal to business people and wealthy residents to support its activities, said Anne Ashley, Big Sur Health Center’s board president.

The Borrego Health Center is striving to secure funds to increase services for the growing Latino population and to provide physical exams for school children. The center counts on local resources—donations, golf tournament proceeds and a developing endowment fund—to help keep medical care available around the clock and year round. A $40,000 grant from TCWF is being applied toward salaries for nursing staff.