Written by Katie McCall

FAMILY-OWNED RESTAURANTS, community traditions and, of course, high school football. These are just a few of the reasons why rural Texas is a great place to live. Of Texas’ 254 counties, 70% are considered rural. Despite all of the benefits that come with rural living, one reality is far from ideal: access to health care.

Out of the state’s more than 600 hospitals, only about 160 are in rural areas. Texas has experienced more rural hospital closures than any other state, with 20 shuttering their doors since 2013, and countless others closing vital service lines. Unfortunately, it is the local residents who suffer the consequences, sacrificing time and money to travel far distances for the medical care and emergency services they need.

Fortunately, hope is on the horizon. Rural hospitals across Texas are implementing solutions to narrow the health care gap. By laying the groundwork today, these leaders are ensuring future generations of rural Texans have proper access to reliable health care tomorrow.

Chamber of Commerce sign for Big Lake, Texas
Big Lake, Texas, has a populaton of 3,239

A Community Effort

In the heart of Reagan County, famously known as “the birthplace of the Permian Basin,” sits Big Lake, Tex. While the big lake is now dry, this small Texas town’s name is a memorable reflection of what was once the largest natural spring-fed lake in the state. No matter if born and raised in Big Lake, or recently relocated to work in the booming oil and gas industry, the 3,000 locals are proud of their little town.

Among one of the recent residents is Jonathon Voelkel, CEO of Reagan Hospital District. After arriving in Big Lake in the fall of 2018, he was warmly welcomed into the community. “Big Lake is just like Cheers, everybody knows your name,” said Voelkel.

Jonathon Voelkel
Voelkel

The tight knight community regularly comes together, cheering on the Reagan County High School Owls under Friday night lights, serving on local task forces and committees or celebrating the Fourth of July with a bang at the giant Star-Spangled Celebration every summer.

From his perspective, Voelkel acknowledges the challenges faced by his patients, friends and neighbors. “Big Lake is a working community, not a retirement community. Most of our residents are supporting growing families, just trying to make ends meet,” said Voelkel.

Reagan Hospital District is focused on keeping things simple. With a wellness center, nursing home, retail pharmacy and rural health clinic all under the same roof, families can get the care they need while staying close by. “The nursing home means a lot for people to be able to have loved ones close to home,” said Voelkel. “The close proximity makes it possible for a husband to come visit his wife and take her to Dairy Queen for an ice cream cone.”

The wellness center boasts a state-of-the-art gym stocked with exercise equipment. The gym is especially popular among the oil field workers who come exercise in their free time at a small fee. The program’s success has yielded an unexpected, and quite helpful, increase in revenue for the hospital.

photo of a wellness center stocked with exercise equipment
Reagan Hospital District boasts a state-of-the-art wellness center

Like most rural hospitals, Reagan Hospital District does not offer a few key service areas, which means residents must travel more than an hour to San Angelo or Midland for specialty services. Big Lake’s health care leadership has a long-game strategy, making great strides through community collaboration to improve access to specialized care. For example, Big Lake is in the process of retrofitting an old, standalone facility to offer various medical specialties. By mid-summer 2020, the new clinic will officially open its doors, where a cardiologist and orthopedic group will operate a once-a-month practice, and a dentist will offer full time services.

Additionally, Reagan Hospital District is collaborating with Big Lake’s high school to develop a dual-enrollment certified nursing program. Eligible high school students have the option to enroll and take classes during their senior year, complete the certification after graduating from high school and then apply for a job at the hospital. “It’s a great option for young people who want to stay close to home and get a good job,” said Voelkel. Reagan Hospital District will even offer tuition reimbursement for employees pursuing an RN or LVN degree, provided they remain employed by the hospital for a certain period of time.

hospitals workers working at computers
Local business leaders in Midland are collaborating with Texas universities to build a pipeline of homegrown medical talent.

Homegrown Talent May Be the Answer to the Physician Shortage Crisis

Russell Meyers is the CEO of Midland Health, the only acute care hospital in Midland County. With over 18 years at the hospital, Meyers knows what it takes to serve a growing patient population in the heart of the Permian Basin. Although not considered a rural hospital itself, Midland Health is responsible for serving patients in nearby rural counties - a population which accounts for 21% of the hospital’s total business.

Russel Meyers
Meyers

While rural communities are no stranger to physician shortages, Midland Health is now feeling the effects as well. Due to a rapidly growing population, there’s not enough workforce to do the work demanded in this booming oil city. “We’re competing against food and beverage, hospitality and oil field jobs. We have recruiting challenges in every role in the hospital, from the lowest paid employee on our staff to our physicians,” said Meyers.

Despite efforts to recruit physicians from across the country, geographic distance and Midland’s high cost of living is often a deterrent for qualified candidates. “No matter how attractive the opportunity, it is a big ask to expect providers to relocate to a new city that is quite far from home,” said Meyers.

To combat this shortage, local business leaders are collaborating with Texas universities to build a pipeline of homegrown medical talent. Ultimately, graduates will choose to reside and practice in the greater Midland area, providing more family care physicians in the region. “If family doctors are trained here, they are much more likely to stay here,” said Meyers.

several medical buildings

The partnership between Midland Health, Midland College, the University of North Texas and UNT’s Health Science Center creates a pathway for students who have great ambition to join the field, but do not necessarily have the financial means to obtain a bachelor’s degree.

With UNT managing admissions, high performing students are selected and placed on a pre-med track. Students complete two years of basic courses at Midland College and finish the last two years on the UNT campus in Denton, Tex. before medical school admission.

The Texas Department of
Health and Human Services
predicts a statewide
SHORTAGE
OF 3,375
PRIMARY CARE
PHYSICIANS

in Texas by 2030,
67% INCREASE.

In related news, a consortium of oil and gas companies, known as the Permian Strategic Partnership, is coming together to fund the expansion of Texas Tech’s family medicine program into Midland and rural communities in the Permian Basin. With the first three years of funding already secured, the residency program is slated to begin July 1, 2020.

photo of Navarro Regional Hospital
Navarro Regional Hospital is in Corsicana, a town of about 23,000.

A Modern Kind of Doctor’s Visit

Corsicana is a small Texas town with a lot of heart and grit. Take a stroll downtown and you’ll find charming streets lit up with sparkling Christmas lights year-round, lined with historic buildings and pianos on the sidewalks so people can tickle the ivories at their leisure. It’s a safe, friendly place with a down-to-earth, diverse socioeconomic population. Rooted in tradition of all kinds, Corsicana is also home to the Navarro College’s 14 time National Championship award-winning cheerleading team, depicted on the popular Netflix docuseries, Cheer.

Dona Townsend
Townsend

Dona Townsend is a career nurse with 20 years of executive experience. For the last five years, she has served as chief nursing officer of Navarro Regional, a hospital whose motto is “friends and family taking care of friends and family.”

The hospital offers emergency room services, labor and delivery, women and children’s services, general and orthopedic surgery and a wide variety of cardiac services including stress testing and diagnostics. However, there are many key specialty services that require transportation to Dallas, meaning patients must be flown via helicopter or taken by EMS around 55 miles to be seen.

To reduce the distance factor, Navarro Regional is using telemedicine technology to remotely connect its patients with skilled specialists in larger cities. “What we can do with telemedicine is amazing,” said Townsend. “We have an army of telemedicine carts ready to serve our patients.”

photo of ER Outpatient building

There are three Dallas-based neurologists who work as part of the Navarro Regional team via two-way communication computers attached to carts, of which Townsend affectionately refers to as “Dr. Neuro.” The neurologist on call maneuvers the cart through the exam room, conducting a thorough assessment of the patient.

Even though these doctors are physically over 55 miles away, the interactive carts make it feel as though they are in the room with the patients, nurses and family members, who can all ask questions.

These new advancements mean a rural patient can be seen by Dr. Neuro within 20 minutes of arriving at the hospital, which is often quicker than being seen in person at a larger hospital. “In most cases, a stroke patient receives a CT scan in 10 minutes after arriving at the hospital and is seen by Dr. Neuro within 10 minutes of returning from the scan,” said Townsend.

Recently, an older gentleman with a history of strokes was admitted to Navarro Regional’s emergency room. Through the utilization of teleneurology, he was able to be evaluated within 10 minutes and received lifesaving thrombolytics, instantly correcting his slurred speech and reestablishing the use of his right arm. Positive results like these have led Navarro Regional to broaden their telemedicine offerings – expanding the program to include telepsychiatry by spring of 2020.