By Peter Marcus, DENVER DAILY NEWS
Rural Colorado doctors say health care reform must include steps to increase access to medical care in such communities.
In a conference call on Friday with U.S. Sen. Mark Udall, D-Colo., doctors and medical professionals from Mancos, Cortez and Alamosa said their patients experience barriers to getting care, including a shortage of primary care doctors.
Concerns also break down into demographics, with women relying on their OB/GYN instead of family practitioners for primary care, as well as Hispanic and other minority groups in rural areas of the state going without any primary medical care.
“It’s the broken health insurance system, because our health programs are intact and they’re strong — primary care, though, is something that, where community health centers are not located, is still a problem,” said Marguerite Salazar, chief executive of Valley-Wide Health Systems in Alamosa.

Residency programs
Doctors in rural areas are calling for reform efforts to include funding for residency programs to train primary care doctors and then retain those doctors in rural communities.
“Our biggest barriers to care here is enough primary care physicians and mid-level providers,” said Dr. Dianna Fury, a family practitioner who works in a rural health clinic in Cortez. “It’s very difficult to get people to move here and to start working here because of our low economic status. Folks who are just out of residency can’t pay their loans back here very easily, and so it takes a very special effort to get physicians to the area to take care of folks.”
Udall said he believes health care reform should include an increase in money for post-MD medical training programs in rural areas, such as opening programs operated by the Accreditation Council for Graduate Medical Education.
“We can do better. We want to make sure that any health care reform package doesn’t leave rural America and rural Colorado behind,” said Udall.
Dr. Luke Casias, of Mancos Valley Health Center, said incentives and reimbursement programs need to be established to assist doctors with their primary care training programs and operations.
“It’s pretty simple for me when you look at what’s causing this issue, and that’s access,” he said. “And the reason we have access issues is because reimbursement for primary care is so poor.”
Casias also believes strongly in pumping money into medical training at rural health centers.
“You want to get more individuals to go to rural areas and stay there,” he said.
Udall said the greatest thing lawmakers can do is craft a health care reform package that can sustain itself financially over time.
“My goal of fixing the broken health insurance system and strengthening our health care delivery system certainly is also founded on the concept that we’ve got to ensure that we pay for it, and that’s because it won’t be sustainable if we don’t figure out the right way to pay for it,” he said. “That’s clearly one of the reasons we’re continuing to labor back here … to create the right legislative product to bring to the full Senate.”

Distributed by Colorado Capitol Reporters