LITTLE ROCK, Ark. -- If Grace Seligman had only one or two ailments, selecting a primary-care physician in her hometown of Dumas would be an easier choice.
However, when the 85-year-old needs her regular medical checkup, she also needs to see an audiologist, a dermatologist, a cancer specialist and an ophthalmologist.
And that requires a 90-mile drive, one way, to Little Rock. She hires a driver for the daylong visit to the University of Arkansas for Medical Sciences so she can receive specialized care with the latest technology at its hospital and clinics.
''There are not too many doctors that pay attention (to patient's needs), particularly to the elderly,'' said Seligman, who has lived in the same town all of her life. ''And it is hard to get doctors to come to small towns -- especially new, young doctors.''
Dumas, a Delta town of 5,238 people, has a good hospital and good doctors, she says, but she has too many medical needs to have all of them met here.
Regardless of a patient's age, quick access to health care is an ordeal in rural, generally poor states like Arkansas, says Dr. Sue Griffin, a professor of geriatrics at the University of Arkansas for Medical Sciences. She said Arkansas' lack of adequate access to health care can be attributed to several factors.
''Arkansas is rural, poor and undereducated. One hates to point out one's own flaws, but in this case, something has to be done,'' Griffin said. ''We've had these problems in the past but we're still sinking.''
Griffin said poverty is the main deterrent to good health -- a problem she said exists nationally and can contribute to health problems in the elderly.
Elsewhere in Arkansas, many patients who don't need the specialized attention of a major hospital at Little Rock still must travel quite a distance for medical help.
Dr. Thomas Bailey, a Helena family physician, is one of two doctors who deliver babies in the region. Bailey said his situation is typical of rural physicians who serve communities with limited healthcare access.
''Most family practitioners will deliver babies, but the trend seems to be moving away from this and it has to with insurance and the (financial) risks involved,'' Bailey said. ''It could get to a point where it doesn't even pay to deliver babies anymore.''
Butch Frazier, chief operating officer at Northwest Mississippi Regional Medical Center, said some Phillips County residents travel across the Mississippi River to have their babies and to see various specialists at the Clarksdale, Miss., hospital.
''I think access (to health care) is still a problem all over the United States but especially in rural areas,'' Frazier said. ''Docs are working as hard as they can.''
Frazier said high insurance rates caused in part by frivolous lawsuits could eventually result in physicians practicing in only metropolitan areas.
Lynn Zeno, director of governmental affairs for the Arkansas Medical Society, said Arkansas could be in a similar crisis.
''Family doctors in rural Arkansas have virtually stopped delivering babies, many doctors are discontinuing nursing home practice, and some doctors are simply retiring early,'' Zeno said. ''What's happened is that, in the last 18 months, professional liability insurance has become unaffordable or unavailable ... and many doctors are making changes in their practices.''
Zeno said during the past year, the number of malpractice lawsuits and the size in the amount of monetary awards to plaintiffs has increased more than 40 percent, causing malpractice premiums to rise 50 percent to 150 percent, depending on physician specialty. He said Arkansas currently has only one malpractice insurance carrier -- it had 10 just a year ago.
''Doctors are in a unique position because they can't cost-shift,'' Zeno said. ''And because of the increased liability, some doctors must practice more defensive medicine.''
Zeno said the University of Arkansas for Medical Sciences will propose legislation this month to create a more favorable insurance climate and attract more malpractice companies back to the state.
''We're in danger of losing doctors ... and this is a nationwide problem,'' Zeno said. ''We hope to address some of the problems before it becomes a true crisis.''
Help is already on the way for the elderly.
Dr. Claudia Beverly, director of the Arkansas Aging Initiative and associate director of the Donald W. Reynolds Center on Aging, said the center is developing satellite centers throughout the state in order to better serve aged Arkansans.
''We are increasing access to interdisciplinary health care so elderly citizens don't have to travel from the far ends of the state to Little Rock,'' Beverly said. ''We are trying to get quality care out close to them.''
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