‘Where are our country docs? | Munfordville doctor fears for future of rural medicine

Published: Apr. 6, 2021 at 8:15 PM EDT
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MUNFORDVILLE, Ky. (WBKO) - There’s a serious issue in the shortage of doctors, but more specifically rural doctors.

Forty-seven percent of Kentucky’s Appalachian counties lost primary care doctors between 2010 and 2018.

“My problem is I got to carry this with me all the time because I’m on call seven days a week,” Dr. James Middleton said as he looked down at his ringing cell phone.

“First of all, I think I’m one of the luckiest guys in the world,” said Middleton. “I got the best profession, the best specialty in medicine, being a country doc I really feel strongly about that.”

Dr. Middleton, of the Family Medical Center in Munfordville, calls himself one of the very few country docs who has been practicing for nearly half a century in Munfordville.

As Dr. Middleton sits in the clinic he built in the 70′s, he shuffles among pages of handwritten notes he prepared for the interview. His eagerness and efficiency to get in front of the camera stem from a plea.

“Where are our country docs? There are just not very many of them. And the numbers are declining. And I don’t think that bodes very well for healthcare and in rural areas, particularly in poor rural areas.”

A Hart County native, Dr. Middleton graduated from the University of Louisville’s medical school.

“I think that’s the best decision of my life was to come home to be a country doc.”

The UK College of Medicine Bowling Green campus says the heart of their program is recruiting rural doctors.

“Right now, Western Kentucky is one of the areas in our state that is hardest hit and needs doctors in particular, but actually all healthcare providers,” said Dr. Todd Cheever, Associate Dean of the UK College of Medicine-Bowling Green Campus.

“Hospitals, large groups and other organizations can just outbid us because they can pay a lot more than they can earn here in, you know, a rural family practice. It’s really frustrating.”

Dr. Middleton says they’ve sent letters to every graduating family practitioner in the United States coming out of their training programs.

“The last mailing we had was for 19,000 letters we sent out, we got three replies back, one of which is, take me off your mailing list,” he expressed.

So what is the reason for the shortage of country docs? Overall, it’s money.

“They’re [new doctors] very nervous about having that kind of debt. They want security, and they got to make enough money to pay off those notes. It’s very difficult for us to earn enough money here in a rural area to pay your salary that can pay off those kinds of notes,” said Middleton.

He adds it’s also the lack of money not coming in from the federal government and insurance companies.

“You go into the pavilion at Glasgow, and Glasgow, the hospital gets paid a facility fee, I think around 30 to $30. Just to walk in the door, they pay that plus whatever the medical charges are,” explained Dr. Middleton.

He calls it, ‘an unlevel playing field.’ Meanwhile, rural residents are the ones needing the most care.

“Our incidence of lung cancer, bladder cancer, throat cancer is much higher than the average,” Dr. Middleton explains.

However, this rural doctor believes he has several solutions. His clinic did a study to analyze the cost of health care that he provides compared to the same services at an east Louisville clinic. What they found was the private insurance would save money by working with more rural clinics like his.

“BlueCross, and BlueShield, pay 25% more to take care of their patients in East Louisville than they pay us down here in rural Kentucky. So they need more guys like us, it will save them 25% on the health care costs,” he expressed.

Additionally, he believes a facility fee, like the one the commercial facilities get, would help.

“We don’t get a facility fee here. We see between 25 and 30,000 patients a year in this clinic,” he said. “You give me 30 bucks a head, and I can hire a new doc.”

The lack of ‘country docs’ has created a health care crisis. One, for some folks, could be the difference between life or death. Even though Dr. Middleton doesn’t want to retire anytime soon, he fears what will happen when he does.

“I don’t want to retire. I do have a feeling of who’s gonna take care of these people out here what’s gonna happen if I’m not here but I don’t want to retire greatest thing I can do is come in here every day,” he said.

Dr. Middleton said when he began his practice, there were eight doctors in Hart County, and now there are three.

MORE: Metcalfe, Hart, Edmonson counties considered ‘medically underserved’ for decades

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