Posted on 12/18/2023 9:30:52 PM PST by nickcarraway
Dr. Zita Magloire carefully adjusted a soft measuring tape across Kenadie Evans' pregnant belly.
Determining a baby's size during a 28-week obstetrical visit is routine. But Magloire, a family physician trained in obstetrics, knows that finding the mother's uterus and, thus, checking the baby, can be tricky for inexperienced doctors.
"Sometimes it's, like, off to the side," Magloire said, showing a visiting medical student how to press down firmly and complete the hands-on exam. She moved her finger slightly to calculate the fetus' height: "There she is, right here."
Evans smiled and later said Magloire made her "comfortable."
The 21-year-old had recently relocated from Louisiana to southeastern Georgia, two states where both maternal and infant mortality are persistently high. She moved in with her mother and grandfather near Cairo, an agricultural community where the hospital has a busy labor and delivery unit. Magloire and other doctors at the local clinic where she works deliver hundreds of babies there each year.
Scenes like the one between Evans and Magloire regularly play out in this rural corner of Georgia despite grim realities mothers and babies face nationwide. Maternal deaths keep rising, with Black and Indigenous mothers most at risk; the number of babies who died before their 1st birthday climbed last year; and more than half of all rural counties in the United States have no hospital services for delivering babies, increasing travel time for parents-to-be and causing declines in prenatal care.
Kenadie Evans with her 3-year-old, Khloe Johnson, at their new home in southeastern Georgia. Evans is pregnant and says she intentionally chose Dr. Zita Magloire to manage her delivery. Sarah Jane Tribble / KFF Health News / KFF Health News Kenadie Evans with her 3-year-old, Khloe Johnson, at their new home in southeastern Georgia. Evans is pregnant and says she intentionally chose Dr. Zita Magloire to manage her delivery. There are many reasons labor and delivery units close, including high operating costs, declining populations, low Medicaid reimbursement rates, and staffing shortages. Family medicine physicians still provide the majority of labor and delivery care in rural America, but few new doctors recruited to less populated areas offer obstetrics care, partly because they don't want to be on call 24/7. Now, with rural America hemorrhaging health care providers, the federal government is investing dollars and attention to increase the ranks.
"Obviously the crisis is here," said Hana Hinkle, executive director of the Rural Training Track Collaborative, which works with more than 70 rural residency training programs. Federal grants have boosted training programs in recent years, Hinkle said.
In July, the Department of Health and Human Services announced a nearly $11 million investment in new rural programs, including family medicine residencies that focus on obstetrical training.
Nationwide, a declining number of primary care doctors — internal and family medicine — has made it difficult for patients to book appointments and, in some cases, find a doctor at all. In rural America, training family medicine doctors in obstetrics can be more daunting because of low government reimbursement and increasing medical liability costs, said Hinkle, who is also assistant dean of Rural Health Professions at the University of Illinois College of Medicine in Rockford.
In the 1980s, about 43% of general family physicians who completed their residencies were trained in obstetrics. In 2021, the American Academy of Family Physicians' annual practice profile survey found that 15% of respondents had practiced obstetrics.
Yet family doctors, who also provide the full spectrum of primary care services, are "the backbone of rural deliveries," said Julie Wood, a doctor and senior vice president of research, science, and health of the public at the AAFP.
In a survey of 216 rural hospitals in 10 states, family practice doctors delivered babies in 67% of the hospitals, and at 27% of the hospitals they were the only ones who delivered babies. The data counted babies delivered from 2013 to 2017. And, the authors found, if those family physicians hadn't been there, many patients would have driven an average of 86 miles round-trip for care.
Mark Deutchman, the report's lead author, said he was "on call for 12 years" when he worked in a town of 2,000 residents in rural Washington. Clarifying that he was exaggerating, Deutchman explained that he was one of just two local doctors who performed cesarean sections. He said the best way to ensure family physicians can bolster obstetric units is to make sure they work as part of a team to prevent burnout, rather than as solo do-it-all doctors of old.
There needs to be a core group of physicians, nurses, and a supportive hospital administration to share the workload "so that somebody isn't on call 365 days a year," said Deutchman, who is also associate dean for rural health at the University of Colorado Anschutz Medical Campus School of Medicine. The school's College of Nursing received a $2 million federal grant this fall to train midwives to work in rural areas of Colorado.
Nationwide, teams of providers are ensuring rural obstetric units stay busy. In Lakin, Kansas, Drew Miller works with five other family physicians and a physician assistant who has done an obstetrical fellowship. Together, they deliver about 340 babies a year, up from just over 100 annually when Miller first moved there in 2010. Word-of-mouth and two nearby obstetric unit closures have increased their deliveries. Miller said he has seen friends and partners "from surrounding communities stop delivering just from sheer burnout."
Deanna Buckins holds her sleeping infant, Hayden. The boy's birth was handled by the family's primary care doctor and was "by far the best delivery ever," says Buckins, who has three older children. Sarah Jane Tribble / KFF Health News / KFF Health News Deanna Buckins holds her sleeping infant, Hayden. The boy's birth was handled by the family's primary care doctor and was "by far the best delivery ever," says Buckins, who has three older children. In Galesburg, Illinois, Annevay Conlee has watched four nearby obstetric units close since 2012, forcing some pregnant people to drive up to an hour and a half for care. Conlee is a practicing family medicine doctor and medical director overseeing four rural areas with a team of OB-GYNs, family physicians, and a nurse-midwife. "There's no longer the ability to be on 24/7 call for your women to deliver," Conlee said. "There needs to be a little more harmony when recruiting in to really support a team of physicians and midwives."
In Cairo, Magloire said practicing obstetrics is "just essential care." In fact, pregnancy care represents just a slice of her patient visits in this Georgia town of about 10,000 people. On a recent morning, Magloire's patients included two pregnant women as well as a teen concerned about hip pain and an ecstatic 47-year-old who celebrated losing weight.
Cairo Medical Care, an independent clinic situated across the street from the 60-bed Archbold Grady hospital, is in a community best known for its peanut crops and as the birthplace of baseball legend Jackie Robinson. The historical downtown has brick-accented streets and the oldest movie theater in Georgia, and a corner of the library is dedicated to local history.
YaSheka Shaw (left) celebrates losing weight during a checkup with medical student Kaniya Pierre Louis (center) and Dr. Zita Magloire. Sarah Jane Tribble / KFF Health News / KFF Health News YaSheka Shaw (left) celebrates losing weight during a checkup with medical student Kaniya Pierre Louis (center) and Dr. Zita Magloire. The clinic's six doctors, who are a mix of family medicine practitioners, like Magloire, and obstetrician-gynecologists, pull in patients from the surrounding counties and together deliver nearly 300 babies at the hospital each year.
Deanna Buckins, a 36-year-old mother of four boys, said she was relieved when she found "Dr. Z" because she "completely changed our lives."
"She actually listens to me and accepts my decisions instead of pushing things upon me," said Buckins, as she held her 3-week-old son, whom Magloire had delivered. Years earlier, Magloire helped diagnose one of Buckins' older children with autism and built trust with the family.
"Say I go in with one kid; before we leave, we've talked about every single kid on how they're doing and, you know, getting caught up with life," Buckins said.
Magloire grew up in Tallahassee, Florida, and did her residency in rural Kansas. The smallness of Cairo, she said, allows her to see patients as they grow — chatting up the kids when the mothers or siblings come for appointments.
"She's very friendly," Evans said of Magloire. Evans, whose first child was delivered by an OB-GYN, said she was nervous about finding the right doctor. The kind of specialist her doctor was didn't matter as much as being with "someone who cares," she said.
As a primary care doctor, Magloire can care for Evans and her children for years to come.
Article completely white washes the reason people don’t want to do obgyn...
liability.
For which we can thank the government for interfering with our health care.
In those days, a general practice doc did surgeries, family medicine and OB/Gyn. He did it all with an office practice, made house calls and also admitted and cared for his patients in the hospital.
That model worked until the governments started to dictate how medicine was delivered.
I do not think we have better care today than what was delivered back then (and at a lower cost then!)
Did they account for death by abortion?
Just send lots of conjured Federal money!
My wife had #11 and #12 at home, on purpose. So much better than the Cash Cow Labor & Delivery at Liability Memorial Hospital, jab-nazi dectective/pediatricians and OBs "on roller skates" that never show up.
Let the overnourished, drug addict, STD riddled: "most at risks" have them and drag their crisis-propaganda, birthcontrol-biowarfare, diabolical-test and funding waterfall feedback loops
Medicare Advantage Plans are closing hospitals, killing people, and making record profits.
Something must be done NOW.
Why do you say that?
My dad was was a Navy doc in WW2 and then Korea. He came home to be a small town doctor from 1952-90.>>>Can family doctors deliver rural America from its maternal health crisis?<<<
In those days, a general practice doc did surgeries, family medicine and OB/Gyn. He did it all with an office practice, made house calls and also admitted and cared for his patients in the hospital.
That model worked until the governments started to dictate how medicine was delivered.
An old-fashioned, Can-Do country Doc really can save the day.
Help IS on the way.
In ancient times, when word of a *Deliverer* was spreading throughout the land, the forces of evil fixated on the... *deliveries*.
Few ever catch on, and by then it's too late.
Try as it might, the Dark Side is not able to stop Christmas from coming.
It's just not bright enough. Q.E.D. 😄
Merry Christmas!
(This post might look like yet another round of punny nonsense, until it doesn't. Hopefully some of this stuff has been sticking, even if for the annoying 'cryptic' absurdity of it all. Well what can I say -- it's a public service.)
Now, both United Healthcare and Humana use an AI algorithm to determine what procedures are necessary.
As a result, they are denying major procedures at an alarming rate and killing people. Dr’s no longer make the decisions, AI does.
This system is about to explode as people are getting angry as treatment stops and insurance companies profits skyrocket.
Per the article linked below:
“When decisions made by the algorithm are appealed, they are allegedly overturned 90% of the time.
“Despite the high rate of wrongful denials, Humana continues to systemically use this flawed AI model to deny claims because they know that only a tiny minority of policyholders will appeal denied claims,” the plaintiff’s attorneys wrote.”
Humana used AI tool from UnitedHealth to deny Medicare Advantage claims, lawsuit alleges
Corporate and government health groups have become nothing more that fascist facilitators for the death cult of big pharma and the WEF and Bill Gates/Anthony Fauci.
Not the least bit surprising.
AI by nature (and design) has no humanity, no soul. Same with anything that becomes a beast system. E.g. massive government programs mean that some entrenched bureaucracy takes care of everything, until it doesn’t. Then who is able to untangle the web of dysfunction and deceit in order to receive the promised service, much less compensation for grotesque negligence and wrongdoing. Good luck with that, like the innocent family whose house was destroyed by gearqueers on a wrong address SWAT raid.
When the masks drop from those slithering around in the darkness of the nooks and crannies of legalese, the bamboozled realize that these systems (and the corrupt humans behind them) only exist to keep themselves in business, forever.
It the Dark Side’s attempt at creating its own tree of life. Government, medicine, academia, science, supply chains, big business, religion...
They create problems and then come right along with the “solutions”.
I could go on, but you know all of this already.
The alternative is the simple, direct care, love your neighbor model of responsibility, discernment, one-on-one assessment, and personalized service.
Oh who invited that guy! Just the type to expose those who throw OPM down a poverty rathole 10,000 miles away (or at least as far as D.C.), with all of the illusion of charity and love that the schemes provide.
Well, like I said... help is on the way.
AI is artificial intelligence, because there is no such thing as artificial ingenuity. Ingenuity is the trump card that decides when it’s Game Over.
***
From Latin
ingenuitās f (genitive ingenuitātis); third declension
(originally) The condition of being free-born or noble
noble-mindedness, ingenuousness
***
So much writing just to say that it’s not complicated. 🙃
It's true. The costs of malpractice insurance for doctors are very high, with general medicine costing the least (around $50K per year), but doing surgery in highly populous areas costing over $200,000 per year. Add to that the doctor's debt for medical school and the need to support self and family, and his or her medical practice would have to rake in more than most rural areas could support, even if working punishing hours.
And as the article points out, there is a great need for more than one doc in a rural area, so that there is someone else on call. Otherwise, burnout and closing the practice.
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