In many of the tight-knit farm towns and rural communities sprinkled throughout Washington, it's difficult to find a doctor.
Partly that's because it's hard for clinics to balance a budget when there's a limited population of patients, particularly if many of them are insured by Medicaid or Medicare, which typically reimburse less than private insurance.
With the nearest doctors sometimes an hour or more away, medical professionals say that aging populations and those limited by harvest and work schedules may put off routine visits as they struggle to access the care they need. Places may have primary care physicians, but not specialists such as eye doctors, dentists, pharmacists, cardiologists and psychiatrists.
To assess the needs in some Inland Northwest communities, students from the Washington State University College of Nursing are in the midst of conducting interviews to see if pharmacies or doctors are available (they're usually not), and which types of medical care people would like to see in their town.
On trips to places like Sprague, population 511, a Columbia Basin town little more than a half hour drive southwest of Spokane, they've heard anecdotes of how difficult it is to get to appointments. Some senior citizens say they've faked an injury to call an ambulance so they can get a ride to their doctor.
In Fairfield, a town of 485 people about 40 minutes south of Spokane Valley on the Palouse, the closure of medical services in recent years left residents with no options for a simple doctor's visit. Getting to the Valley or Spokane can require taking a full day off work, or prove difficult for transportation-limited senior citizens who live at an assisted-living facility in town.
But since 2017, WSU's health sciences schools — the Spokane-based colleges of medicine, nursing and pharmacy — have been hard at work building a nonprofit organization that can provide at least one solution: mobile health care.
Known as the Range Community Clinic, the organization already has one mobile doctor's office that can provide checkups, sports physicals, routine vaccinations, small wound care and more. With a doctor present and nursing students getting clinical practice, patients can show up to see if there's walk-in availability or schedule an appointment before the clinic rolls into town, with insurance getting billed just like other doctor's offices.
"Range Community Clinic is trying to fit into those places where those gaps exist and folks remain underserved," says Jim Zimmerman, the chief operating officer for WSU's College of Medicine and treasurer of Range's board. "As we grow, and as we move out into the communities, there'll be more things that the mobile units can provide, hopefully, along the lines of behavioral health and expansions of primary care into more pediatric and women's health as well."
FROM COVID TO SPORTS PHYSICALS
Although Range Community Clinic was founded in 2017, it took a few years to get a board of directors together, credential the medical personnel, build a doctor's office on wheels and ensure electronic health records systems were in place, Zimmerman says.
Just as the first mobile health unit was ready to roll out and start connecting with rural communities, the pandemic hit. So for much of the last two years, the unit was instead used to provide COVID testing and vaccinations in the Spokane area.
But by February 2022, the focus shifted back to providing a broader suite of health care for patients and clinical training for students, with regular dates scheduled in places like Fairfield.
Fairfield's town clerk and treasurer, Cheryl Loeffler, and Mayor Jamie Paden say that the pandemic actually helped them connect with the mobile unit, as city leaders started contacting medical providers throughout the region to see if anyone could help with COVID vaccinations and testing. From there, they brainstormed how to bring more health care to town and partnered with Range.
The need for local care is clear. Paden, who is also a volunteer emergency medical technician (EMT) with the local fire department, says they regularly get 911 calls for issues that could be addressed by having more medical options in town.
"When you transport them, now you're tying up your ambulance or EMTs for maybe a more emergent call that could be a field accident or something," Paden says. "If they just had the basic health care here, they can drive here — we have a lot of elderly that can drive just here, but they can't drive all the way to Spokane."
Some of those options are now getting better, as the Range Community Clinic has been visiting Fairfield roughly every other week since earlier this summer. Patients have appreciated the short walk or drive to the town's community center to see a provider, Paden and Loeffler say. They've both been able to get shingles vaccinations at the mobile unit, and say that many parents in town have been able to bring their kids in after work for physicals to participate in school activities.
"Right now we're at twice a month," Paden says. "In the future there's a lot that can happen: virtual calls that EMTs could help facilitate ... and we've got nurses here that are retired that we've talked about perhaps getting them involved in some way. We're just continuing to try to brainstorm ways to keep health care in the community."
TRUST, TIME AND MONEY
One of the best things the mobile unit can provide is the chance to build trust between patients and their providers, says Dr. Sam Schneider, the medical and program director for Range who was running the mobile unit in Fairfield on a recent Thursday afternoon with students Anna Syverson and Shreya Patel, both in their last semester of nursing school.
"The vision of WSU is to build this network of health care where we are actually a part of the community, and people can rely on us and trust us that we're going to be there," Schneider says.
Still, providing those services through the mobile unit is an expensive way to connect patients and providers, so they're continuing to figure out how to keep things affordable for both sides, Schneider says. Affordability and access will ideally get patients to visit a doctor before their health issues worsen.
"People out here work hard, they work long hours, they don't have time to go see the doctor, so they don't," Schneider says. "That's where you get these chronic disease problems — people who aren't taking care of their blood pressure, their cholesterol, their diabetes, they're just ignoring it, because they don't really have the time or the resources to take care of it."
Syverson says she grew up in a small North Idaho town similar to the size of Fairfield, so getting the chance to help at the rural mobile clinic on top of her other clinical rotations is special.
"Every time you come to a place like this, it's a learning experience," Syverson says. "It's great to see that we're really maximizing health care in different communities around us."
Range addresses a couple of goals for WSU's health schools, says Zimmerman, the COO of WSU's medical school. It provides education to students who need clinical practice, offers improved health care options to people around the state and creates opportunity for more research in rural areas.
On the patient side, the clinic should also be able to offer better access to specialists, either through bringing providers directly to the patients, or providing referrals or even telehealth diagnoses through the mobile unit, with the help of medical school faculty who specialize in different areas.
By next summer, the organization plans to start serving rural communities near WSU's Tri-Cities location as well, he says. Another mobile clinic ordered before the pandemic has been delayed due to supply chain issues but will operate in that area, serving groups such as agricultural workers who may not speak English as their first language, Zimmerman says.
WSU's other major campuses in the state, and the extension offices that exist in every county, provide opportunities to offer more complex health care options from physical office locations, he says.
"It may well be that over time we're able to expand our operations to those campuses," Zimmerman says. "The mobile unit has its place and allows us to get into communities ... but for some things that are more sophisticated in nature, having the bricks-and-mortar facility that's properly outfitted is definitely necessary." ♦
