BOLLINGER COUNTY GETS SECOND DOCTOR; MELODIE ARMSTRONG IS PART OF THE NATIONAL HEALTH CORPS

MARBLE HILL -- Melodie Armstrong just got to town, but she has singlehandedly doubled Bollinger County residents' access to health care.

Armstrong is now the second doctor practicing in Bollinger County, which has a population of 11,200.

She is joining forces with Dr. John Englehart, who for many years was the county's only doctor. Both practice at Cross Trails Medical Center in Marble Hill.

"I came to serve an underserved area, and that's a nice feeling, knowing I can help," Armstrong said. "Hopefully I can relieve a little bit of the workload" on Englehart.

Armstrong is part of the National Health Corps, a federal program which places doctors in undeserved areas. She previously worked in public health care in western Kansas.

Getting doctors to set up practices in rural areas isn't easy. Residents in Bollinger County are lucky that they face a drive of less than an hour to get to medical facilities in Cape Girardeau; but in emergencies, even a 45-minute drive can be too long.

It can also be inconvenient, and may discourage people from seeking medical care.

It could be worse, said Armstrong.

"Our referrals in western Kansas were to Denver, which is three hours away. So this is pretty convenient," she said.

Armstrong's arrival is good news for residents, who won't have to wait as long to see a doctor or drive to Cape Girardeau or Jackson for primary care.

"It should be good news, because prior to her coming, (Bollinger County's) patient-to=doctor ratio was 11,200 to 1," said Harold Kirbey of the Missouri Health Department's Division of Health Resources. "Now it's 5,600 to 1, which still qualifies for a shortage area. It even qualifies it for a high-priority shortage area."

It's good news for Englehart, who says he's looking forward to not being quite as busy.

"It hasn't been as hopping since I got a little help," Englehart said. "We've been able to keep up a little better."

With a second doctor in town, he said, patients won't have to wait as long to see a doctor, and they won't have to rely on the emergency room for primary care. Regular access to a primary-care doctor is a key component in maintaining good health.

Leonard Davidson of Patton was waiting patiently last week to see a doctor at Cross Trails.

A second doctor "should make it a lot easier" to get medical care, Davidson said, adding there are no physicians in Patton.

Without Cross Trails, he said, he'd have to drive to Cape Girardeau or Jackson to see a doctor.

Counties are designated as health-professional shortage areas if the ratio of patients to doctors is higher than 3,000 or 3,500 to 1, Kirbey said. The threshold depends on a number of factors, including the county's infant mortality rate, fertility rate and percentage of people living in poverty, he said.

In Bollinger County, the ratio threshold is 3,000, Kirbey said, because of the county's high incidence of poverty. "So they'd have to bring almost four primary-care physicians into the county before they'd get off the list."

Englehart said he thinks the clinic is adequately staffed with two physicians, but more patients may start using the clinic because of quicker access and Bollinger County's population increasing.

More retired people are moving into the county, Englehart said, "which practically always creates a greater need for health care. So I think there's a potential we might need more."

Cape Girardeau County has a patient-to-doctor ratio of 1,861 to 1, but it's still considered a shortage area because of lack of primary-care access for Medicaid patients.

Other counties in Southeast Missouri designated as health care professional shortage areas include Mississippi County, with a ratio of 4,666 to 1; New Madrid, with a ratio of 5,374 to 1; Perry, with a ratio of 5,389 to 1; Reynolds, with a ratio of 4,782 to 1; Ripley, 3,325 to 1; Ste. Genevieve, 3,228 to 1; Stoddard, 3,600 to 1; and Washington, 4,942 to 1.

Scott County, with a ratio of 2,142 to 1, is also considered a shortage area because of lack of access for Medicaid patients.

Those numbers are based on the state's 1994 survey. The 1995 survey is in progress, Kirbey said.

Englehart began practicing in Marble Hill in 1962.

"There have been phases when I've had help" through the U.S. Public Health Service's Rural Health Initiative, he said. "I was solo for too many years. For the last eight, nine years, I've been by myself."

Cross Trails is a private, not-for-profit primary-care clinic for children and adults. A Cross Trails is also operational in Cape Girardeau, and a third is planned for Stoddard County.

The three clinics are funded through grants obtained by the county health administrators in those counties.