PRINCETON ? It's barely past daybreak when Dr. Kurt Crowe starts checking on patients at the only hospital in this mid-Illinois city. He's skipped the white lab coat and is dressed casually in a short-sleeved shirt. His shoes pad softly down the hospital's main wing before stopping near the end of the hall. Inside a room, an elderly man with congestive heart failure lies diagonally across his bed. Crowe checks on him before slipping to another room, where the morning news spills from a television.
"Hello, sweetie," he greets a baby girl with breathing problems. Turning to her parents, he asks, "Is she doing any better?" On he moves. Back and forth, from the elderly to the very young, Crowe continues about his day as a family doctor in a small town.
It's up to the 35-year-old Crowe to be an expert on all ailments. He can't call upon a gerontologist for his elderly patient or a pediatrician for the infant. Crowe faces more challenges in this town of 7,500, about 94 miles southwest of Rockford. Some patients drive 40 miles to see a doctor, so many don't get follow-up care or come in until they're quite ill.
After two years in practice, Crowe works harder than he did as a paramedic or medical student in Rockford. He heads into his office each morning, expecting to see 20 patients. He usually sees 35 to 40 by day's end. Still, Crowe said he feels prepared for those challenges. He was among the first to complete training as a rural doctor from the University of Illinois College of Medicine at Rockford.
The largest of its kind in Illinois, the Rural Medical Education Program is designed to prepare students for work in the 80 percent of rural Illinois counties that don't have enough doctors. The first two classes have graduated and are heading to rural communities such as Princeton. The college soon will begin training nurses and pharmacists how to better serve rural patients.
State of rural care
Midmorning at Crowe's clinic brings a wave of babies for routine check-ups. A little boy receives a clean bill of health, then Crowe notices he can't give the child a routine shot. "We don't take (Medicaid) cards for that here," he tells the boy's mother. "But if you go down to the health department, they'll take care of it for you."
Rural towns, including Princeton, bring such challenges to doctors: The elderly constitute more of the population in rural areas. In 1998, 18.4 percent of the rural population was elderly, compared with 15 percent in urban areas. Elderly people frequently require more medical care than younger people.
Poverty is especially high in rural areas. A greater share of rural residents are unemployed, and nearly half of the poor receive government health insurance. Many farm workers lack private health insurance. In 1999, 35 percent of rural residents did not have private insurance. Crowe routinely stashes away free drug samples for them. Some patients drive significant distances to visit a doctor and schedule appointments only when something is wrong.
That means Crowe often shuffles his busy schedule to fit such patients in. Several times each morning, a nurse replaces the list of patients on his office wall with an updated schedule. On average, he said he sees 10 to 15 more patients each day than he would as a family physician at Swedish American Health System in Rockford.
Crowe tries to remember each patient's special needs before he walks into an examination room.
"The underlying question for everybody is, what kind of insurance do they have?" he said. "Every time I walk in, those things are running through my mind."
He also knows that smoking-related illnesses are a big issue in small towns. Crowe thinks his best bet is to address that problem one-on-one with patients.
"I think we need to do a better job just talking to people about their health," he said. "Too often, doctors just assume they'll be upset if we talk about them quitting smoking."
Crowe finds that working as a rural physician requires confidence and self-sufficiency. "You can't always rely on other people for help," he said. "Other people won't be there."
As one of about 10 full-time physicians in Princeton, Crowe sees an extraordinary number of children and pregnant women. That's because there are no pediatricians and only one obstetrician in town.
"You never know what you'll find yourself dealing with," he said. "I don't have a cardiologist. If someone is having a heart attack and comes here, I have to take care of it."
Life as a rural doctor
A boy and his mother are waiting in one of three exam rooms in Crowe's office. After a quick conversation with his nurse, Crowe greets them with a smile. The boy's eye is red and sore. His mother strikes up a conversation as Crowe examines the boy.
"So have you met the new family that moved into the neighborhood?" she asked.
Large cities might have newer technologies and higher salaries, but rural towns offer community connections. Crowe prefers rural life to his years as a Rockford paramedic, rushing to emergency scenes and barely making relationships with patients.
In Princeton, life moves more slowly. A small girl recognizes him in the hospital cafeteria. And home ? where he eats lunch with his family every day ? is minutes from the hospital.
"I've always liked small towns where you know everybody," said Crowe, who grew up in a 1,000-resident Wisconsin town. "I could work somewhere else and make more money, but do I want the lifestyle?"
Dr. Mary Simmons, also a graduate of the Rockford medical college's rural doctor program, also appreciates that closeness. "I have that sense of community," said Simmons, who practices in Belvidere with SwedishAmerican Health System. "We've all had a similar experience living in Belvidere and Boone County."
Still, working as a small-town physician can be frustrating. Crowe wishes he could spend more time on community education. He wants to take a few extra minutes to chat with patients about other problems in their lives. But there often isn't time.
"I'm already working 80 hours a week seeing people," he said. "Really what I'm doing is keeping my head above water day to day."
Rural medical education
A shortage of technicians, pharmacists and nurses has hospitals everywhere struggling to recruit workers. That problem is exacerbated in small towns. Crowe regularly sees nurses at Princeton's Perry Memorial Hospital carry heavier workloads as a result of understaffing.
"This hospital in particular is getting killed by it," he said. "Nurses can go somewhere like St. Francis in Peoria, make twice as much and not be on call every other night."
The Rockford medical college is creating a center to teach doctors, nurses, social workers, pharmacists and dentists about cooperation in small towns.
"If they are out there, they need to learn to work with other disciplines and be able to look at it from other perspectives," said Cheryl Carlson, who heads the Rural Health Professions Education, Evaluation and Research Center.
So far, most of the applicants for the rural program are white. Although there have been a handful of Asian and Hispanic students, the program hasn't pushed to racially diversify its classes. "If there are rural communities with large concentrations of minorities, we would love to have them," said Michael Glasser, assistant dean for rural health professions. The true evaluation of the rural medical program's success is yet to come. The real measure will be whether graduates stay committed to rural medicine.
"The story isn't done yet," said Crowe. "Four to five years down the road, (the college) will be able to see who went on to work in rural communities, and then they'll be able to see if they're successful."
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Are the millions really worth it.
Maybe its time to get back to basics.
....Obivously hurting the people who now have to pay more of a gap, and also putting a larger strain on the public health fund.
