August 3rd, 2005

There’s something special about life in a small town that keeps people there. But it’s getting harder for those who stay to find needed services close to home. At a time when local grocery stores, gas stations and hardware stores are closing, Great River Health Systems is committed to keeping health care in five communities.

The Dallas City (Ill.) Clinic, Mediapolis Clinic, Morning Sun Clinic, Wapello Clinic and West Point Clinic fall under the health-systems’ corporate umbrella. They are covered by physician assistants, physicians and staff who are part of the communities in which they work.

“I said I’d stay only one year because this is a little dinky community. It’s been a very long year,” said Certified Physician Assistant Judith Giertz, a Chicago native who, in 1990, quickly assimilated to life in Morning Sun. “In a small town, my patients are my friends. What happens to my patients happens to me. You are part of the births, the funerals, the graduations.”

On the other hand, David Hull, D.O., planned on having a small, rural practice, complete with an old roll-top desk in his office. He works half days at the Dallas City and West Point clinics.

In Wapello, Lori Lafayette, P.A.-C., knows that injuries and illnesses can happen at any time. Lafayette opens the clinic after hours several times a month to provide emergency services, such as repairing lacerations and treating ear infections.

“It’s a lot cheaper and closer than the Emergency Department,” she said. Wapello is 30 miles north of Great River Medical Center in West Burlington.

Keeping clinics open

All five clinics were private physicians’ offices that were destined to become empty buildings when the physicians retired or left town. Communities tried to recruit new physicians, but few are willing to work in private rural practices.

Great River Health Systems’ first community clinic opened in West Point in 1982. Dr. Hull moved from Morning Sun to a house next door to the West Point Clinic. He extended his practice into Illinois when Great River Health Systems opened the Dallas City Clinic in 1990. In 2002, the clinic began sharing space several hours each week with Great River Women’s Health, a private practice not affiliated with Great River Health Systems. Obstetrician and gynecologist Kimberly Marshall, M.D., is from the Dallas City area and wanted to provide services in that community.

In Morning Sun, the health system bought the practice of Robert Carleton, D.O., in 1988. He was joined by Rich Koffend, P.A.-C., who transferred to Burlington Area Family Practice Center in 1991 and now works at Southeast Iowa Cardiovascular Associates. Giertz came in 1990 and worked with Dr. Carleton until he left in 1996.

When Mediapolis physician J. Fredric Roules, M.D., retired in 1993, the community’s campaign included buying his office as an incentive to bring a new physician to town. It worked—for a short while. Russell Lyons, M.D., moved his practice from Davenport in 1994. But he was diagnosed with cancer and retired in 1997. He died in 2000.

Great River Health Systems purchased the building and equipment in 1998. Dr. Roules began seeing patients again, sharing hours with Olufemi Oladele-Ajose, M.D., and Paul Hay, P.A.-C., who now works full time in the Emergency Department. Frank Micucci, P.A.-C., became the full-time care provider in 1999.

Great River Health Systems purchased the Wapello Clinic in 1981, and rented it to physicians until 1987. The health system provided coverage by various physicians until Lafayette came in 1993.

Connections improve small-town service

Physician assistants at the Mediapolis, Morning Sun and Wapello clinics work independently but are supervised by physicians affiliated with Burlington Area Family Practice Center. Every other week, William Daft, M.D., makes a trip to the Mediapolis Clinic, and Thomas Boyd, D.O., goes to the Morning Sun and Wapello clinics.

Micucci enjoys the diversity of his job. “I like the concept of treating and taking care of the whole family instead of a single person,” he said. “Also, I like being part of the community I work in.”

The five clinics’ affiliation with Great River Health Systems provides access to several hospital services, including the Intranet, a patient-information management system, electronic medical records and on-line education modules. A courier from Great River Medical Center delivers mail and picks up blood samples for testing every day.

Some clinics provide “one-stop shopping,” preventing patients from traveling outside their communities for services. For instance, the Morning Sun Clinic has a small pharmacy because there isn’t a retail pharmacy in town. The Mediapolis Clinic is getting a portable X-ray machine that had been used at the hospital. Micucci will take the images, and radiologists at the hospital will read them.

“These are things a small clinic couldn’t do on its own,” said Mediapolis Clinic Coordinator Jean Eberhardt.

Between 15 and 20 patients are seen at each clinic every day, most on the same day they call for an appointment. If patients can’t come to the clinics, the clinics reach out to them. On the way to or from work, staff are likely to stop at elderly people’s homes to take their blood pressures or draw blood for tests.

“The communities are very happy to have health-care services in town,” Dr. Hull said. “They’re very proud of their clinics.”

New patients come from these communities and beyond—some for the convenience; others for the reputations of the caregivers.

“People drive a long way to the Wapello Clinic because of Lori. She has an excellent bedside manner,” said Ursula Petty, receptionist. “Once they come, they’re here to stay.”

The physician assistants and Dr. Hull work hard to provide high-quality services. Giertz and Lafayette each has been named Iowa Physician Assistant of the Year. Micucci earned a master’s degree in family medicine last year, and Dr. Hull was certified in 1997 by the American College of Osteopathic Family Physicians.

Bringing education home

Great River Health Systems’ five clinics also reach out into their communities to provide education and free and reduced-price screenings. Last summer, Dr. Hull and the physician assistants conducted 285 student athletic physicals for a reduced price. Great River Health Systems donated half of the fees--$4,275--to local school districts. This year, the Mediapolis, West Point and Dallas City clinics sponsored visits by the Med-Force helicopter, which is based at Great River Medical Center.

Other community-outreach programs include:

  • Alzheimer’s and dementia education program at Morning Sun Clinic
  • Free cholesterol screenings at all clinics
  • Free colon cancer screening kits and a presentation by gastroenterologist Daniel Peasley, D.O., at Mediapolis City Hall
  • Free hearing screenings at all clinics by Great River Medical Center audiologists
  • Free lung-function testing at the Wapello Clinic
  • Free professional and self-breast examination clinic in Wapello
  • Hypertension screening and education program at Morning Sun Clinic

Taking care of their own

Giertz confidently walks through the Morning Sun Clinic with a different Pez® dispenser in her pocket every day for sweet rewards for young patients. Woodcarvings and intricate wood-burned pictures—her own creations—provide the décor.

“How do you feel at this very moment?,” she says as she stops to touch the cheek of an elderly patient making his way out of the clinic. “You don’t have a bit of color in your body. You go home and rest. Call back this afternoon if you have any problems.”

Working in a community clinic means more than providing medical care. Lafayette insists on spending more than 15 minutes with each patient.

“There’s a lot to catch up on—their trips to Florida to visit kids, their pets,” she said. “That stuff is important to me. I have a lot of interaction with patients as people, not just the medical issues. I want to know about their lives. We’re like a family.”

What Is a Physician Assistant?

Physician assistants (PAs) are licensed to practice medicine with physician supervision. They can conduct physical examinations, diagnose and treat illnesses, order and interpret tests, take X-rays and write prescriptions. They make decisions independently, but also rely on their supervising physicians for consultation.

PAs are certified by the National Commission on Certification of Physician Assistants. To maintain their certification, they must have 100 hours of continuing medication education every two years and take the recertification examination every six years.

The physician assistant curriculum was developed in the 1960s when physicians and educators recognized a shortage and uneven distribution of primary-care physicians. The curriculum was based in part on the fast-track training physicians received during World War II.

Today, PAs provide primary care and specialty care, such as orthopedics. The typical physician assistant program is 24 to 27 months long and requires at least two years of college and some health-care experience before admission. Most students have bachelor’s degrees and 45 months of health-care experience before beginning a PA program.