Medicine in a Small, Small Town

When 86-year-old Dallas Gaines of Scobey, Mont., woke up with the classic symptoms of stroke last October, the only doctor in the county was out hunting whitetail bucks on a sea of prairie stretching from one horizon to the other. Donald Sawdey, M.D., had just lined up his shot when the emergency call arrived from the clinic. Even out in the great beyond, deer know to run when they hear a ringing cellphone. “Next time I’ll keep it on vibrate,” the doctor says.

Sawdey hustled back into town and treated Gaines within 20 minutes. An hour after that, Gaines was on a 50-minute medevac flight to Billings, the closest town with a fully equipped hospital. He’s lucky the plane was available; it’s about 360 miles to Billings by car, a trip that few critically ill people could survive. Fortunately, Gaines got to the hospital in time. Within days, he was on his way to a full recovery in his hometown, a place that puts the “rural” in rural health care.

Health care access has become a vexing problem all over the country. But the challenge of connecting patients with the right medicines, tests and procedures becomes even more complicated the farther you get from the medical hubs of big cities. A 2008 study published in the journal PLoS Medicine found that life expectancies are actually declining in large swaths of rural America, a trend largely fueled by upswings in diabetes, cancer and chronic obstructive pulmonary disease.

Many of these illnesses could be managed or prevented with proper medical care, but the 77 million Americans who live in rural areas have just 10 percent of the country’s doctors. As much as we idealize the country—clean air, hard-working people—there’s no doubt it can be hazardous to health.

Sitting in the northeast corner of Montana, 15 miles south of the Canadian border, Scobey (population about 1,200) is surrounded by land that’s too dry and windy for trees but marginally suitable for wheat fields, cattle, horses, deer and coyotes. The local radio station runs individual funeral announcements alongside ads for good-tempered bulls. You can drive through town in about two minutes, a trip that takes you past a single flashing traffic light, the Daniels County Courthouse and the medical clinic, a nondescript two-story brick building that makes the rest of Scobey possible. “Without the clinic, this town would disappear,” Sawdey says.

The Scobey clinic—which draws patients from a 200-square-mile area—has 24 hospital beds, 30 nursing home beds and about 90 employees. Everyone in town knows someone either staying or working there. They all know Sawdey, a tall, talkative native Californian who settled in Scobey three years ago with his wife and two sons. He set up shop here partly for the challenge, but mostly because he wanted to raise his kids in a quiet, safe town populated by trustworthy people. By the clinic’s standard, he’s almost an old-timer. “They’ve had a new doc here every year or year and a half,” Sawdey says. That kind of turnover, he says, “destroys the health care system.”

The shortage of physicians in rural areas certainly hasn’t gone unnoticed by the federal government. In 2009 Congress earmarked $500 million for the National Health Service Corps, a program that helps pay the student loans of doctors who spend at least two years in “underserved” areas, most of which are rural. In March, federal officials estimated that it would take nearly 17,000 more physicians to fill the gaps nationwide, including 87 in Montana.

The new health care reform law takes aim at the problem with measures that include a 10 percent bonus to doctors who treat Medicare patients in rural areas, and more money for rural hospitals.