Dunn Memorial Hospital closed its doors on Dec 16th, leaving IU Health Bedford the sole provider of specialized care. (Devan Ridgway - WFIU/WTIU)
Imagine for moment you have intense chest pains in your home, then have to drive 45 minutes to the nearest hospital to see if you’re having a heart attack.
For many Hoosiers, this isn’t a hypothetical. It’s how those in rural areas live every day.
In Bedford last month, Ascension St. Vincent Dunn Medical Center closed its doors after operating in the area for nearly 80 years. The community of Bedford luckily has a second hospital in town from IU Health, but that facility will find it difficult to take on a new influx of patients when the flu, RSV, and COVID are straining the medical system.
Larry Bailey is the Chief Operating Officer at IU Health’s Bedford hospital. He says that since the closure announcement in September they’ve been preparing for this new wave of patients to come through the doors.
“We have brought on additional staff. For instance, in our walk-in clinic, we are now staffing that on Sunday, we have Sunday afternoon hours we didn't previously,” he said. “And we're staffing that with an additional provider through on the weekdays. In our emergency department, we've added a second nurse practitioner. And then we've also added some physician hours as well in our emergency department.”
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Bailey has experience in rural healthcare. He worked at IU Health Paoli for 11 years before taking this position in Bedford. For him, this issue is nothing out of the ordinary.
“We've seen some not closed but cut back on services,” he said. “There have been a lot of hospitals that have cut back on obstetric services, and then other programs that maybe weren't pulling their weight financially. It is a struggle for rural facilities.”
Crawford County is another spot in Indiana that’s had struggles with specialized medical care.
Jesse Belcher, executive director of the Crawford County Economic Development Partnership, has seen how not having a strong medical provider nearby can cause issues when it comes to city planning.
“In the last couple of years we have opened a second EMS station on the south side of the county, so that we can respond to things quicker,” he said. “It makes it so urgent to get there as quickly as you possibly can, because you have to transfer somebody outside of the county for almost any situation.”
One of the main problems rural areas face when trying to improve medical care in the area is attracting talent. Attracting workforce requires having good amenities, and having good amenities requires a strong workforce.
It’s a constant battle of asking which comes first, the chicken, or the egg.
“You need those kinds of amenities in order to attract businesses and in order to attract workforce,” Belcher said. “But in order to attract those types of amenities, you have to have the population base. So you're trying to do both at the same time. And for us, we can't really prioritize one over the other, we have to try to work on both.”
New ideas target the problem. Telemedicine has become increasingly more available than it once was, allowing residents the ability to get a doctor’s opinion before making the trek to the nearest hospital. In Crawford County specifically, fiber internet is on its way for many.
“I think that's becoming a more realistic option for this area as people's high-speed internet options become a lot more realistic,” he said.
Another change on its way for many areas like this is a rotating roster of specialists that come to the area. Instead of having to build out multiple locations for multiple specialists, a specialist could come to a general practitioner’s office for a short time before rotating to another community. Theoretically, one specialist could cover five different locations in a week or two.
“Realistically that's going to be an opportunity for rural communities like ourselves, because we don't necessarily have the population to sustain a heart specialist or a cancer specialist or an eye specialist for five days a week, 52 weeks a year,” he said. “But maybe we have enough of a population base, enough of a patient base to make it where we could sustain each one of those one or two days a week or one or two days every other week.”
For Belcher, a hybrid combination of the two might be the most accessible for many communities.
“I think to me, telehealth by itself is probably not a fantastic option for a lot of problems,” he said. “But a hybrid approach like that, where if we had a brick-and-mortar location, to where you could meet with a general practitioner, or a nurse practitioner or something like that, and then they can pull in specialists as needed, it could certainly cut down on how many trips you have to make out of the area.”
Individuals in need of emergency care are most at risk throughout the state. According to the 2022 annual report from the Indiana Maternal Mortality Review Committee, only individuals within a 30-minute drive of Indianapolis have access to all of the highest levels of care available in the state.
Everyone outside of that circle could be in a medical desert, depending on what services you’re looking for.
Elaine Hernandez is an assistant professor in the Department of Sociology at IU. She boiled the issue down to everyone’s favorite limiting factor: money.
“There are just fewer people in rural areas. And if you think about the objectives of a hospital or a clinic, they're going to want to make money,” she said. “And you're going to make money if you have your clinics and your hospitals in places where there are more people.”
States like Montana have tried to tackle this issue head-on by offering to pay a portion of med student loans if they relocate to practice in a rural area.
This issue is exacerbated by the consolidation of the healthcare industry.
“A lot of what were formerly private practices, even in Indiana and in Bloomington, get bought out, and then they are part of these larger healthcare systems,” Hernandez said. “And then those larger healthcare systems operate as a system, their objective is to try to do what is best for their healthcare system, rather than what is best for x small city.”
This is arguably what happened in Bedford. St. Vincent, part of Ascension which is based in St. Louis, bought the former community hospital 12 years ago. Ascension did not respond for comment, but did share a statement with media:
“After exploring the options available, including conducting an unsuccessful search for a buyer for the hospital, it was clear that other providers with a larger presence in the region are better positioned to efficiently serve the residents of Bedford and neighboring communities."
That leaves IU Health to serve the Bedford community to the best of its ability.
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