Changes could help Fla. improve rural health care


Published: Sunday, March 24, 2013 at 5:06 p.m.
Last Modified: Sunday, March 24, 2013 at 5:06 p.m.

McClusky, North Dakota: population 380. "We count all the dogs and cats," said Sarah Baker, the only health care professional for miles around.

Baker is the lone nurse practitioner at the Northland Community Health Center, and she makes the daily hour-long drive back and forth between her home in Bismarck and McClusky so the residents of McClusky don't have to make that journey every time they need medical care.

"We have 96-year-olds who are still living on their farms, and they can't drive their cars to Bismarck in the winter," Baker said. She added, "They've had two or three different practitioners that come and go. I've been here five years, and it's really made a difference in the trust level in the community."

Baker is a member of the National Health Service Program, which offers support to health care professionals in remote or underserved communities. The NHSP's Loan Repayment Program that Baker is part of helps pay off students' loans if they work in these communities. Programs like this are filling in the hole of health care in many remote areas throughout the country.

Baker's salary is not great, she said. "I don't think there's a physician in North Dakota who would work in my practice for what I make. But it's the best job I've ever had."

And, she's flying solo. North Dakota nurse practitioners two years ago successfully pushed to appeal a law requiring the presence of a collaborating physician in a licensed health care clinic.

That opened the door to health care services in areas where people might otherwise slip through the cracks, she said.

In Florida, the regulations are more stringent. According to the Florida Association of Nurse Practitioners' website, Florida requires nurse practitioners to follow strict supervisory protocols. It is also one of only two states that restricts their ability to obtain a drug enforcement administration license to prescribe certain drugs.

Many experts believe lifting some of the restrictions would help amend a shortage of health care in rural areas — and as a result help detect cancer earlier.

"If we had PAs (physicians' assistants) and nurse practitioners doing some of these standard exams earlier, we might detect these cancers earlier," said Dr. Henrietta Logan, a professor at the UF dental school and the director of the Southeast Center for Research to Reduce Disparities.

Baker said that although she can't actually perform cancer screening tests such as colonoscopies, she can get the ball rolling for people to have necessary screenings in Bismarck.

She recalls one person who had a colonoscopy on her suggestion and it revealed cancer.

"In a little town, one person has a positive result like that, and the whole town gets tested," she said, adding that she sees a big part of her role in primary care as promoting preventive medicine.

Plus, being in such a small community gives Baker the bonus of getting to know her patients really well so she can personalize their care.

"The best part about the practice that I have is that if you need to stay 45 minutes, you get 45 minutes. It's not in and out in 10 minutes. That's when you miss the cues," she said.

Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.

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