John Eich on Wisconsin's Declining Rural Health Care Options

Frederica Freyberg:
Governor Tony Evers visited Eau Claire this week where the community is still reeling from late notice about closures of two hospitals and 19 clinics. The governor said he was disappointed with the Hospital Sisters Health System’s lack of notification and how it was handled was wrong. In an interview, local Representative Karen Hurd shared her concerns.

Karen Hurd:
As far as the impact, I consider this to be huge. Not as big as the Maui fires, but certainly bigger than the East Palestine, Ohio train derailment where they had the big chemical spill. It’s bigger than that. I see it as bigger than that. This — people are — I see that people are going to die, but I want you to know that the state representatives for the Chippewa Valley, we are living, breathing this every moment and trying to come up with something, something to be able to help.

Frederica Freyberg:
For more on the greater impact of these closures and the overall trend of rural health access declining, we turn to John Eich, director of the Wisconsin Office of Rural Health at the UW School of Medicine and Public Health. John Eich, thanks very much for being here.

John Eich:
My pleasure.

Frederica Freyberg:
So when hospital systems like this pull out of rural areas in Wisconsin, how big of a shock is that to healthcare access?

John Eich:
In a lot of ways, I think it’s a shock. It’s a shock for patients who have to now drive further to get to appointments or to care for loved ones. It’s a shock to the EMS system in that they have to take patients longer and longer for care. And I think it’s also — its jobs and it’s also a hit to the local economy. A small community is more attractive to all kinds of new businesses if they have robust healthcare, and if that’s missing, that’s challenging as well.

Frederica Freyberg:
Because where are people finding care in the state of Wisconsin? We have a map to look at to show kind of the drive times that people experience getting to an emergency room.

John Eich:
Yeah, absolutely. So our office did an analysis of that drive time, and you can see that. So the green is 10 minutes. The yellow, 20. And the red, 30 minute access. So it’s fairly obvious where the gaps are. The north woods, has sort of the biggest challenges there, and you can see where in a sense the clusters are as well. And I think that cluster is relevant to this situation, where you have Eau Claire County so close to the Twin Cities and these are very large systems, they’re competing pretty fiercely with each other. And so there’s a lot of pressures on them. And so I think we see that in this situation particularly. I think there’s a reason that it happened here versus other parts of the state.

Frederica Freyberg:
Representative Hurd said people will die. Is that what we’re talking about?

John Eich:
Well, healthcare is always life and death, and so I do think that it’s going to take longer for people to get to care. It’s going to take — it’s going to be more challenging for them, for EMS in particularly in rural areas. We’re very concerned about drive times, and so that is possible, but I think that we have a robust healthcare system in this state and people are doing their best and are providing excellent care. So it is a challenge for sure.

Frederica Freyberg:
Healthcare providers, both urban and rural, face worker shortages. Is it worse in rural areas?

John Eich:
I think, you know, the pandemic brought this sort of social challenge, sort of the divisions, the partisan divisions where we take healthcare and politicize it. And so you have workers who went from being heroes to suddenly being pariahs or political operatives, and I think that really plays out in a smaller community, people know each other better. As someone walks past me in a city street, I may not know their healthcare provider, but if it’s a community where everyone knows who works at the hospital or the clinic, you’re more in a spotlight. Those challenges that I think we all felt with family, extended family and neighbors who disagree about topics, I think that’s very compelling. It’s very close to home in a smaller community. And so I think those kind of social issues impacted the workforce, not to mention the fact that they were day after day of this work and seeing people very sick and dying. It takes an emotional toll, and I don’t think it’s as easy as we don’t have to wear masks anymore. I think it’s I still don’t feel great at my job. Maybe I should consider an early retirement or maybe I should consider a different line of work.

Frederica Freyberg:
And that persists?

John Eich:
It does. I think — in business, they talk about how culture eats strategy for lunch. These are cultural issues and that means that we’re going to see — these are hard to change issues and they’re going to take a while. It’s going to take a lot of different solutions and I don’t think we’ll see it go away quickly. People are working very hard on it, but it will take time.

Frederica Freyberg:
Speaking of solutions, what kind of measures are needed to expand access to quality rural health care?

John Eich:
I think in Wisconsin, we’re very lucky. Up until recently, we haven’t seen a lot of hospital closures, and so I think we’re doing well. We have to fill in these gaps that have been created and I think healthcare systems will do that. I think we have to look at building back the workforce. That’s a long process as well, and I think also broadband is very important if we’re providing care to patients who have a drive to get into a follow-up appointment or a check-in, them being able to communicate with their providers from their home or from a mobile situation is really important, but there just isn’t the broadband and cellular coverage in rural areas that we need.

Frederica Freyberg:
John Eich, thanks very much.

John Eich:
Thanks for inviting me.

Frederica Freyberg:
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