FORT SCOTT, Kan. _ Dr. Max Self grabbed a sanitary wipe and cleaned off the small flashlight in his hands. More than 20 years as a family doctor in rural Fort Scott, Kan., has taught him a few tricks: "I've got my flashlight. See? Look, you want to hold it?"
Two-year-old Taelyn's brown eyes grow round and her tiny hand reaches out. But, first, Self makes sure she opens her mouth wide and he peers down. Behind him sits another staff member _ a medical scribe. Self's scribe gives him the ability to "focus on people," rather than toggling between a computer screen and the patient. It's a new perk he didn't have when he worked at Mercy Hospital.
That beloved hospital closed one year ago and, in the passing months, the small town's anger and fear evolved into grief, nervousness and _ lately _ pragmatic hope. Most of the handful of physicians in town stayed, taking jobs at a regional federally qualified health care center that took over much of the clinic work from Mercy. The emergency department, after closing for 18 days, was reopened temporarily _ run by a hospital 30 miles south.
It's not "all gloom and doom, although we all wish we had a hospital _ no doubt about it," insurance agent Don Doherty said during the town's weekly Chamber of Commerce coffee on Dec. 12.
Nationwide, death rates have been higher in rural America compared with urban areas since the 1980s, and the gap continues to widen. More rural residents live with chronic conditions, like diabetes, that affect their daily lives, and there is a higher percentage of older residents. Rates of smoking and premature births are relatively high, and people often die younger here than the national average.
Since 2010, 120 rural hospitals have closed across the country _ 19 in this year alone, according to data from the University of North Carolina's Cecil G. Sheps Center for Health Services Research. A national analysis of Medicare cost reports found that 21% of the nation's remaining rural hospitals are at high risk of closing.
"Frankly, it's not getting better," said Dr. Daniel DeBehnke, study co-author and a managing director with Navigant's health care practice.
A year ago, after Mercy gave a 90-day notice that it would close, City Manager Dave Martin said the betrayal felt by city leaders led to lawyers and calls with other health care systems about taking over the facility. Now, Martin has realized "we will not have _ or do we need _ a hospital."
But, if not a hospital to care for rural communities like Fort Scott with its 7,800 residents, what is needed? The answers to that question play out every day here and could hold lessons for the rest of the country.
