As rural communities lose physicians, a creative "patchwork" of care can emerge

An OnMed health kiosk uses high tech, remote care.
(Photo by Arielle Zionts, KFF Health News)

Rural patients are more likely to face medical provider shortages, and these communities have to find new ways to provide care. In LaFayette, Alabama, "Terry Vester and her husband, Al, are the only primary care doctors in the town of 2,700 residents, surrounded by farms and other small communities," reports Arielle Zionts of KFF Health News. "The Vesters are in their late 60s and would like to retire soon. Terry Vester wants to spend more time with her grandson and aging parents. But she can't imagine abandoning her patients, some of whom she has cared for since they were born."

Attracting new physicians is challenging for LaFayette, which is not a wealthy town with the amenities many doctors seek. Residents have a median income of $39,077, compared to the state's $59,910. "Black residents — who make up 70% of the population — are much more likely to live in poverty than white residents," Zionts writes. "The Vesters have worked in LaFayette since the early 1980s and saw the local hospital close in 1988. The nearest emergency room is now in another town 20 minutes away along a rolling road. So are the nearest urgent care clinic and pediatrician's office."

With those barriers in mind, town residents who need medical advice have turned to "the city fire department, staffed with full-time firefighters and emergency medics," Zionts reports. "People from LaFayette regularly walk or drive themselves to the fire station to ask for help, said Fire Chief Jim Doody. He added that the station has a makeshift exam area within its small entryway, containing a bench, defibrillator machine, and cabinet filled with medical supplies. . . .This de facto walk-in clinic option isn't available in most other rural areas, where emergency medical services are often run by volunteers who aren't posted at a station all day, Doody said. But he's noticed fewer LaFayette residents relying on the fire department since a new telehealth service arrived in town."

OnMed telehealth kiosk service opened in LaFayette to meet basic medical needs. Patients can head into a computerized booth, press a button and see "a nurse practitioner appear on a large vertical video screen positioned at eye level," Zionts explains. "OnMed patients use an automated blood pressure cuff and other devices to collect their vital signs, and the data is sent to the provider treating them from a distance. Patients can also hold a stethoscope to their chest to transmit the sounds of their heart and lungs. A special camera captures internal temperatures, which can be used to diagnose infections. A hand-held camera lets providers examine problems such as rashes, irritated eyes, and swollen throats. In some states, the stations can dispense medications."

While Vester spoke positively about OnMed services, she feels "It's still important to have doctors in town," Zionts reports. "Vester plans to reach out to Alabama medical schools to let them know she's looking for doctors to take over for her and her husband."