Back to the Boondocks

U.S. doctors have been increasingly reluctant to practice in rural areas. Besides making less money than their urban colleagues, rural doctors must always be on call. When emergencies occur, they often travel great distances.

Though isolated from medical centers and their special equipment and expertise, they must provide a variety of services--from obstetrics to treating snake bites. Still, they must cope with all of medicine's red tape: keeping records, collecting fees, filling out endless forms.

As a result many rural communities are often without the services of a doctor and are eager to accept anyone who is remotely qualified. That sometimes leaves them with a doctor who, as one critical observer says, is "a bum, an alcoholic or a drug addict--somebody on the run."

To help entice qualified physicians into the boondocks, a group that included doctors from the University of Utah's College of Medicine independently established a nonprofit corporation called the Health Systems Research Institute (H.S.R.I.). The idea has been successful from the start. H.S.R.I. has already supplied badly needed medical help to sparsely populated areas of five Western states, where it now operates eleven clinics and three hospitals. As one doctor recruited by the institute says, "It gives me an opportunity to practice medicine as it was meant to be practiced without all the garbage of fighting with insurance companies and the Government."

Providing the Know-How. H.S.R.I.

accomplishes its goal by making a deal with a rural county to take over its medical services. Under the pact, the county provides plant, equipment and finances, while the institute offers the know-how. It recruits doctors, nurses, clerks and other personnel, all of whom are paid directly by H.S.R.I. Though the doctors' salaries--$40,000 to $60,000 a year --may be lower than those of some city practitioners, the rural doctor gets other benefits: four weeks of vacation by his third year, another two weeks a year to continue his education and, perhaps most important of all, a variety of personal insurance policies, including costly malpractice coverage.

Typical of the new generation of country doctors recruited by H.S.R.I. is Dr. Minthorne D. Norton, 38, a graduate of the University of Miami's medical school who quit a family practice in Kentucky to run a clinic in Battle Mountain, Nev. Helped by a physician's assistant, a licensed practical nurse and three clerks, Norton sees about 200 patients a week, including many travelers (he is the only doctor along 120 miles of Interstate 80). In difficult cases, he can call upon advice from specialists at the University of Utah. He also has available the services of an ambulance plane. Best of all, says Norton, he doesn't have to take a "pay cut or suddenly pull a kid out of college" whenever insurance companies hike malpractice rates.

The prognosis for H.S.R.I. seems good. Norton's Battle Mountain clinic, for example, collected, and paid to the county, some $17,000 in patient fees last November--$4,500 more than the county's cost of maintaining the program that month. In fact, H.S.R.I. officials say, they need contracts with only four more communities before the outfit becomes completely self-sufficient. Those contracts may soon be in hand. Inquiries have already been received from dozens of other rural counties in Western states eager to establish their own clinics with H.S.R.I.'s help.

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