Rural areas face need for free clinics

The need for free clinics is growing. Not just here in Central Virginia, but across the state. That was the message delivered during the June meeting of the Committee on Advancing Rural and Small Town Healthcare.

Created earlier this year, the Virginia House committee held their latest meeting at Longwood University, where they heard from Rufus Phillips. He serves as executive director of the Virginia Association of Free and Charitable Clinics, of which the Heart of Virginia Free Clinic in Farmville is a member.

What the Virginia House members heard were two problems. More people find themselves needing free clinics and a majority of those patients are suffering from chronic conditions.

“We’re seeing some growth in the rural communities,” Phillips said.

For example, 30 of the group’s 68 free clinics in Virginia are based in rural or generally small town communities like Farmville. Those 30 serve 33,000 patients now, compared to 22,000 before Medicaid expansion. But beyond that, Phillips said rural patient demand grew 10% in 2023 and is growing further this year across the state. He said that was due to both Medicaid unwinding and continuing economic pressures, such as inflation and low wages in some areas. When he refers to Medicaid unwinding, Phillips is talking about how officials were ordered to examine if everyone on the plan was still eligible post-pandemic. By the end of last year, an estimated 160,000 Virginians lost their access to Medicaid, no longer qualifying as the rules reverted to normal after the pandemic. Those residents may not qualify anymore, but still find themselves in need of services. As a result, they’ve flooded many of the free clinics.

And as mentioned, these patients are often dealing with chronic conditions.

“Anxiety and depression is the top (diagnosis) in rural clinics, whereas it’s #3 overall (in Virginia),” Phillips said.

Second is diabetes, with hypertension as the third. Obesity is fourth and asthma is fifth in rural areas.

WHAT DOES THE DATA SHOW?

The data Phillips presented also surprised some in attendance, as it showed information counter to stereotypes. The traditional mindset, in some cases, is that free clinics in rural areas are used mainly by the elderly. Only 10% of patients in Virginia’s rural free clinics are 65 and older. The majority are between 30 and 64. A total of 21% are between 30 and 44, with 27% in the 45 to 64 range. The third highest age category are children under 18, with 20% of the number.

As for income status, 28% of those getting help at rural free clinics are at or below the federal poverty line. Another 15% are just over the poverty line. The biggest number is the one we don’t know. A total of 38% of patients don’t share that information.

So that’s the data. But what are the challenges these rural free clinics face?

The first is travel distance and a lack of transportation services, Phillips explained. The Heart of Virginia Free Clinic in Farmville, for example, is the only one to help patients in a six-county region. But what happens if a patient is in Charlotte or Lunenburg and can’t get a ride? Yes, volunteers help, but there’s still a problem because that’s not always an option. Lack of broadband access is another issue, one we’ve covered just this past week. For some patients, a virtual doctor visit would be the easiest option, taking away the need to find travel, but in some of these cases, broadband internet isn’t in the area yet. That however should change for most in this region by the end of 2025, beginning of 2026.

Also an issue is the lack of providers, medical and dental, as well as the lack of hospitals or rather one hospital that serves a large number of counties, in some cases. Added to all of that is the fact many practices aren’t accepting new patients. So what happens if you relocate for work, but can’t find a primary care doctor? In a detailed survey, Phillips said he and his group heard from a number of people that this is a problem.

One person, kept anonymous by Phillips, wrote that “in our area, none of the primary healthcare practices are accepting new patients. Patients are put on waiting lists for 6-7 months out.” Another comment belonged to a doctor, also kept anonymous, who reported that “access to specialty care is an ongoing issue, we have fewer partners offering free or reduced cost specialty services to our patients.”

WHAT’S THE SOLUTION?

So we’ve heard the problems, but what’s the solution? Phillips told the lawmakers his group was looking into several options. That includes mobile clinics, able to travel between counties day after day. They’re also looking into telehealth options and remote health monitoring, now that broadband is being established in some of these areas. For example, the Virginia Telemental Health Initiative, is now available in 22 free clinics in Virginia, including 12 rural clinics. Volunteer mental health providers are able to talk with residents and address their needs. Some preventive work is also being put together to do in schools. By that we’re talking about in-school screenings, vaccinations and providing more health education.

But the solutions aren’t cheap. And Phillips asked lawmakers to try and find some dollars in the next budget to help support the free clinics.

WHAT ABOUT THE FREE CLINIC?

In this region, we have the Heart of Virginia Free Clinic, which is located at 401 East Third Street in Farmville. Their hours are 10 a.m. to 4 p.m., Monday through Thursday and you can call to make an appointment at 434-315-5701.

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