West Virginia is almost all rural. The biggest town in the state in Charleston and it's only got 54,000 people. It's a big deal for some families to drive two or three hours and some of the patients are even five hours away. When I go to Beckley I will see patients that maybe have driven an hour and a half to get to the clinic.
I am primarily a pediatrician, but we do the same thing for adults with subspecialty problems. We have a doctor who does an outreach rheumatology clinic in the coal country in the southern part of the state. We have an ophthalmologist and a neurologist who go there too.
HLM: Why are there so few subspecialists venturing to these outreach clinics?
Rhodes: It's kind of an ivory tower mentality that 'I am here and they will come here.' Frequently when we think about rural healthcare, we think about primary care physicians, who are the cornerstone to the whole thing and who are very important.
But sometimes the patients with acute special healthcare needs are not lost in the shuffle, but we don't think enough about them at times. We just assume they will come back to the tertiary care center for follow up. I have patients who will cancel a clinic visit because they can't find the $50 to put gas in the car.
Or they may find that they can get a ride to an outreach clinic with a neighbor who is willing to drive them a half hour but they are not willing to drive two and a half or three hours and wait for the appointment and drive back.