180: Rural health challenges and opportunities, Part 3: The clinicians’ perspective
In our latest podcast series, we’re taking a deep dive on rural health, going beyond the common tropes about rural America – the older, sicker, poorer narrative – and checking in with folks on the ground who are excited to do the work of promoting equitable health outcomes for rural Americans.
Today, Health Disparities podcast host Sarah Hohman talks with two rural health providers:
- Russell Wimmer is a physician associate practicing in a single provider clinic in the small rural town of Brownsville, Oregon.
- Dr. Caylor Johnson is a Family Medicine Physician with Medical Specialists, Inc., in Waynesboro, Georgia.
Johnson explains some of the unique challenges facing rural communities, which are incredibly diverse.
“In my county alone, I have multiple communities, and they each have their own challenges, their own culture, their own history and beliefs,” Johnson says. “And that all comes to the table when they come to the doctor, and I have to be prepared for that.”
Wimmer also shares what he loves about providing care in his rural community.
“When you walk around, people talk to you and you know them personally, and they know you,” Wimmer said. “They're not ignorant to the fact that you're working with limited resources. They know that they're remote, they know that it's hard for you to sometimes help them with what they need. But the fact that you're there with them every day is not lost on them. They appreciate everything that you've done. They know that you're what they've got.”
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The transcript from today’s episode has been lightly edited for clarity.
Dr. Caylor Johnson: Rural communities need help too, and it's challenging, but I also get to know these people and become a part of their families and their lives. And you know, we are in this journey together. So it's more of, as challenging it is, it is sometimes hard days, but it is so rewarding. I have worked in big hospital systems, and yeah, it can be easier sometimes, but you come out here and these people are so grateful for anything and everything that you can do and that you are here, and even if you cannot fix it, as long as you try, they will do anything in the world for you.
Sarah Hohman: You're listening to the Health Disparities podcast from Movement is Life. I'm Sarah Hohman, a member of the Movement Is Life steering committee, as well as the director of government affairs for the National Association of Rural Health Clinics. Our latest podcast series is taking a deep dive into rural health. We're going beyond the common tropes about rural America -- the older, sicker, poorer narrative -- and checking in with folks on the ground who are excited to do this work of promoting equitable health outcomes in rural America.
Today is part three of the series, and we're joined by two of those on the ground folks from different parts of the United States. Russell Wimmer is a physician associate practicing in a single-provider clinic in the small rural town of Brownsville, Oregon. And Dr. Caylor Johnson is a family medicine physician with Medical Specialists, Inc. in Waynesboro, Georgia. Both of you, welcome to the Health Disparities podcast.
To start, Russell, tell us a little bit about yourself and the rural health care system that you're part of in Oregon.
Russell Wimmer: Sure. So I am a physician associate. I live in Albany, Oregon, and I practice in a small, tiny, little town called Brownsville, Oregon, which has about 1700 residents. I work in a clinic that was brought in on train cars. It was ordered from an old Sears catalog in 1950, it has not changed since then. It's one big, all inclusive unit. So it really can't be changed. It took a year just to be able to install a X-ray door. So I work in that clinic on a daily basis, providing family medicine, primary care for the community, as well as kind of acting as the walk-in urgent care access for same-day, acute things. And it's a very agricultural community, so it is the grass seed capital of the world. It's also the location for the filming of Stand By Me, two things that community is very proud of. So we have a lot of agricultural related kind of health issues and injuries that occur. I was trained in Washington, a private college called Heritage University for my master's degree in physician associates practice. It's actually owned by the Native tribe up adjacent to Yakima in Toppenish, Washington.
Hohman: Great. Thank you. Dr. Johnson, what about you? Tell us about yourself and also the community that you serve in rural Georgia.
Johnson: I'm Caylor Johnson. I work in Waynesboro, Georgia, which is in Burke County. We serve a population, Waynesboro itself is about 5,000 people. We serve about 24,000 in the community in the county, it's a very rural county. We have one of the largest land masses of any county in Georgia with the smallest population. So lots of farms, lots of agriculture. We are known as the bird dog capital of the world, but really probably should be more like the cotton capital at this point. So we, I work in a clinic with six other providers. We are one of the only primary care clinics for the surrounding three or four counties. So we do pull patients from a large area. We do same days, primary care, prenatal care, my partners also do scopes etc, just because of lack of access in our area. So just all inclusive care. I went to MCG, Medical College of Georgia for medical school in Augusta, and stayed there for my residency. So I've actually been in the Augusta surrounding area for about 10 years now, and I've been serving Waynesboro for two and a half.
Hohman: Wonderful. Thank you both. So let's start big picture. What do you feel are the greatest challenges when it comes to the provision of rural health care today, Russell, we can start with you.
Wimmer: Oh, that is a very large topic to cover. I'll narrow in on some of the things that I deal with on a daily basis, and I assume that that probably translates to most rural practice. Some of the real challenges that we have are typically an older population with longer times between seeking access, limited financial resources, which really involve kind of social determinants of health. So food instability, subpar housing, longer transportation costs, barriers to transportation to any form of care. And on top of that, there's a significant access issue when it comes to trying to access specialty services, and that may be surgical and non surgical, so as simple as dermatology and considering a procedure as a more selective and sensitive tool to be using for a suspicious malignancy that may not be accessible. And in the same token, when you're dealing with fairly complex patients that have advanced renal disease, where you'd really love to work with a nephrologist, that can be quite challenging, you may not have the availability of those specialty providers. As far as getting them established with the patient. I'm lucky enough to be able to reach out through a network and kind of consult, but I end up managing a lot more of those conditions than I think would normally be handled in the primary setting, just based on restricted access and the barriers for patients to be able to establish. So I think that, in my experience, we're commonly dealing with patients that have a lot of barriers to being able to get the quality of care that they need, the specialty care that they need, and they tend to be an older population with a lot of social determinants that have typically modified their health to be kind of lower than more urban areas.
Hohman: Thank you. Dr. Johnson, from your perspective?
Johnson: Yeah, second all of that, biggest thing, you know, we serve a very spread out area, and a lot of the patients have no ability for any type of transport, especially not to the city. You know, they're lucky to catch a ride to the office asking them to go to town and see somebody that maybe an hour away is not going to happen in most cases. And so it is limiting they, you know, like Russell said, they also tend to wait a long time before they come see us, and so when we do get them, we are usually dealing with a very complex medical history that, you know, we were not able to catch in in at a time when we could have made huge differences. And that's a lot of it is lack of access, lack of ability to, you know, these people are working. They are hard working people. They, you know, and they a lot of times that interferes with their ability to seek care as well. So food instability, huge, you know, lack of access to any type of fresh produce or fresh any type of food at this point in our area is limiting. And so another thing that we deal with in our area is, and I don't know if Russell has issues with this, is lack of prenatal care. So we deal with a lot of, you know, moms and babies that are not getting the care that they need. So really working with, you know, you think about a mom that's about to have a baby, you know, she needs to be seen every two weeks or more sometimes, and when they don't have transportation or the doctor, you know, our prenatal care is an hour away, it can be challenging. And so, you know, we're dealing with those outcomes that are, they're not always what they would be if we lived in a city.
Hohman: Great. And despite this, or maybe because of these challenges, you both have decided to continue practicing in rural areas. So can you talk a little bit about the why behind that and why it's so important to you to be part of continuing that, that access?
Johnson: Yeah, so I don't know about Russell, but I have always wanted to do rural medicine. I grew up in a rural area. My family medicine doctor growing up was everything. I mean, he, we went to him for everything, and so I kind of had that role model. He kind of instilled that, you know, rural communities need help too, and it's challenging, but I also get to know these people and become a part of their families and their lives. And you know, we are in this journey together. So it's more of, as challenging as it is, it is sometimes hard days, but it is so rewarding. I have worked in big hospital systems, and, yeah, it can be easier sometimes, but you come out here, and these people are so grateful for anything and everything that you can do and that you are here, and even if you cannot fix it, as long as you try, they will do anything in the world for you. And so it is just a very rewarding job, even on the hard days.
Wimmer: Yeah, I would second a lot of that. I got my feet wet in practice, out of school for a number of years before I really pushed further into rural and I was in a semi rural area that had a local hospital and there were some resources. So it felt a bit like rural medicine, but it wasn't where I work now. And when the opportunity came up about two and a half years ago, the clinician I had been doing the job, who had been running the clinic as the single clinician, called me personally and said, Hey, I'm going to be leaving. I think you're a good fit. And I had covered out in Brownsville a couple times just for a walk in and I said, Well, what is it like? Give me a better understanding of what your days are like. What does a week look like? It's got to be different from what I'm used to just doing walking for you when you're on vacation. And he said, Well, have you ever seen the movie Doc Hollywood, which is a great Michael J Fox film from quite a while ago. So I wouldn't be surprised if you haven't seen it. It is very much like that. If you've seen the film. At one point, he's given a pig as a thank you, and the pig follows him through the rest of the movie. And it becomes kind of a character in the movie. And it's about a wholesome, a very wholesome town where everywhere he walks, you know, there's, morning doc, how you doing today? And he's, he's from a big city, and he kind of discounts all of this, and then he starts to kind of understand the romanticized idea of the small community where everyone knows everyone, and that is 100% where I work. I got a, gosh, it's got to be a 40 pound bag of hazelnuts on Monday from a client who owns a huge orchard, and he just dropped it off for the clinic, not because we've done anything for him. I don't think I've seen him for a couple months. It's just a thank you, because you're a part of that community.
And so when you walk around, people talk to you and you know them personally, and they know you, and Dr. Johnson is 100% right. They're not ignorant to the fact that you're working with limited resources. They know that they're remote. They know that it's hard for you to sometimes help them with what they need. But the fact that you're there with them every day is not lost on them. They appreciate everything that you've done. They know that you're what they've got. And so there's a unique phenomenon that tends to happen once a provider is established. On the rare occasion that I'm I take a day, a personal day, or a vacation day, which I honestly don't do that, often, people will come in and they'll notice that my car is not in the parking lot, and they'll come to the front desk, and our receptors will say, Hey, are you coming in for walking? Or, is Russell here? No, he's not in, but we have someone covering. I'll come back, and then they just leave. And it's not that they, you know, don't necessarily trust whoever it is. They just don't know them. And they know me and I know them, and I have found that there's this fantastic level of honesty where you can say, I don't actually know what's going on today, but we're going to figure it out. And I want to see in a couple days, here's where we're going to start, here's where I'm hoping to get a better idea, and we're going to figure this out together. And the ability to be that transparent and honest with your patients, the good, the bad, the ugly, the up and the down, is a unique opportunity to have them participate in care in a way that you often don't get the opportunity, and that that's been why I keep coming. That's why I probably won't leave. I love the community that's involved in this, and I I recognize the challenges in the same way that Dr. Johnson probably does as well. And some days you are 100% right. Some days are hard. Some days you go home and you feel defeated. But if you can kind of redefine what a win means for you, it's not hard to find wins on a daily basis in these in these environments.
Hohman: I love that. Thank you both. First of all, you're a PA, and in recent years, you've worked to pass the PA Modernization Act in Oregon, transitioning from a supervision to a collaborative practice model. With this came a name change. Oregon's now the first state to adopt the name change from physician assistant to Physician Associate. Tell us a bit more about the significance of that change for you, and I'd love to hear a little bit more about your thoughts of the role of PAs and in providing health care in in rural America.
Wimmer: Absolutely. So I'm actually the chair of the Oregon State Physician Associates professional organizations, so the chair of the Government Affairs Committee. So for the last probably about five years, I've been able to be a part of a lot of legislative goals and changes in the state of Oregon, and a little bit at the national level. And two of those big accomplishments have been that the two things that you you mentioned, the PA Modernization Act, which changed from a supervisory to a collaborative model, I think that that plays directly into pas being able to practice in a rural environment. And so the previous supervisory agreement required that there was a certain amount of direct supervision and chart review, and it became a big barrier to hiring, and not because PA is reviewed as inferior or not sufficiently educated or experienced, but because clinicians are pushed to their limits. I mean, the health system, in every environment is really struggling to keep up with the demand for quality healthcare and provide access to every patient who genuinely needs care. And clinicians are spread very thin. There's not a lot left over of many of us at the end of the day. And so for a physician who is typically fully paneled, or in most cases, over paneled, who's trying to do everything they can for their panel, their patience, their practice, and then also go home at the end of the day and have some balance of work life and sustainability. The idea of having to now review 8, 10, 12 charts a day is just overwhelming. And so they were finding that it was very difficult for organizations to feel like they could accommodate that.
And so it became a barrier to hiring physician associates in any environment, and the more distance you became from a central hospital system where that burden may have been able to be shared between a number of clinicians, or clinician pool that got harder and harder to accommodate. And so when you're now a single practice that may have one or two or three providers, again, the idea of reviewing a whole bunch of charts is highly difficult to accommodate. And so it became a barrier to hiring pas in the most needed environments, which are the ones that are more and more rural. And so moving away from the supervisory to a collaborative agreement where you get to determine and define the terms of how the PA works within the greater care model and the greater care team allowed for a lot more flexibility. And so research and data has really supported that outcomes for patients, when you remove do MD and PPA for an equally experienced provider, does not change outcome. Patient outcomes are equal across the board. And so being data driven in this industry, if we're saying that patients are just as safe in the hands of all of these providers, then we should be removing barriers to hiring providers and putting them these environments so we can all practice at the top of our scope within a collaborative team.
And so the PA Modernization Act, which has been passed in a number of states, or something similar to it, has really, I think, allowed more and more PAs to become employed in these rural environments that are desperately in need of more providers of any kind. So the the name change, I think, is just a, it's the first change in the name since we were established in the 1960s and I think it just kind of clarifies our role a little bit better, from assistant, the onus being that if a physician assistant seems to imply that the that we are assisting the physician directly, and especially moving to a collaborative model, that that somewhat gets confusing. And so physician associates still ties us in with the team that says, hey, we're all associated versus directly assisting.
Hohman: Thank you for explaining that and for your work on the state advocacy side of things. We'll get into policy priorities and things like that in a little bit. Dr. Johnson, there's this idea that if you've seen one rural community you've seen one rural community, and certainly there are things that that transcend across, that you've both shared in terms of challenges and also the beauty of providing care in rural America. But can you talk a little bit about the diversity of rural America that I don't think it's gets talked about enough?
Johnson: So, you know, I grew up in a rural community on the west side of Georgia. I now work in a rural community on the east side of Georgia, and I will tell you that it is a very different place, and that is just in one state. I'm sure that Russell and I could come up with a lot of differences that we deal with every day. In my county alone, I have multiple communities, and they each have their own challenges, their own culture, their own history and beliefs, and that all comes to the table when they come to the doctor. And you know, I have to be prepared for that. I have, you know, I can look at addresses and know this is what is going to be a challenge today, you know, and, and it's an amazing thing, you know, yes, you think of rural America is agriculture and, you know, blue collar workers, but there are so many different people that live in my community, even as small as it is, and it is a great place to live and to work. But just because we're rural does not mean that rural Alabama or Illinois or Wisconsin, they have different challenges, and their medical complexity is different. They're they're, you know, you look at, you know, I deal with a lot of families, right? It's a beautiful thing. I get to see every generation of a family, and we may have different genetics that they are predisposed to this. Other areas in the country are going to have different experiences, and so it's really hard to blanket policy or blanket experiences or expectations across each one of these communities, because they all need a little bit different care. They all have a little bit different challenges. And I've been in my area for two and a half years, and I feel like probably the last six months or so, I'm finally starting to learn, or have a good understanding of my people that I am seeing every day, and have gotten to know them well enough to know what their lives look like every day. And so I don't know, I know it's hard when you live in a city, you know, when you've never lived outside of the city, to just look and say, Oh, well, they're all cornfields. That's it. But it's really not. It's factories, it's agriculture, it's, you know, livestock, there are so many differences, and their injuries and their wear and tear on their bodies is so different depending on what experiences they've had.
Hohman: Yeah, absolutely. I grew up in rural Pennsylvania, and it's certainly different than the South in a lot of ways. So I can absolutely agree with that. Russell, in addition to the primary care that you offer, you also provide addiction medicine services, including residential and outpatient management and methadone services. So the opioid crisis is certainly an ongoing concern in both urban and rural communities. But how has addiction affected the communities that you serve? And I'd be curious to hear this from both of your perspectives, but Russell, we can start with you. And what made you interested in getting involved in addiction treatment as well?
Wimmer: Yeah, it's played a fairly significant role in a lot of what I do. And I think this speaks really well to Dr. Johnson's point you just made, which is that each community has its own unique barriers and challenges and obstacles, and you're dealing with social elements and genetic elements and cultural elements for sure, and religious and all of that plays in and so in different environments, there are different expectations of how that community addresses and even views the idea of substance use disorder. So in my environment, there's a lot of, so grassy capital the world now, historically, lots of lumber, timber and paper and in the '80s and the '90s, a lot of those industries actually shut down. And so large mills, lumber mills and paper mills specifically shut down. And there was a huge reduction in what sort of very stable labor force, a lot of blue collar work just disappeared overnight. There was no preparation, there was no communication. It's just they shut down, and 1000s of people were out of jobs, and with that came the decision to move and leave a community which most of those individuals were multi generational, like their their family line had not left that area for since they'd probably initially come there in a lot of circumstances.
The other barrier to that, of course, is financial. If you don't have another job to go to, if you're hoping to go find one, that is a huge financial barrier and undertaking with a lot of risk to try and go find another labor job or another community you're not familiar with. And so those communities did fall quite far, and with that came a lot of substance use. And specifically this area was methamphetamine. And over time, I've begun to see a number of patients that are clear, multi generational substance use disorder and severe, persistent mental illness, and those two play very closely together, which shouldn't come as any surprise to anyone who is in healthcare, two things that no matter what environment or specialty you work in, you will come across, are going to be severe, persistent mental illness and substance use disorder. And so that was very prevalent in my earlier practices, and I worked with a phenomenal peer and mentor of mine, Dr. Simmons, and he had an amazing saying that you cannot penalize a patient with mental illness for acting like someone who has mental illness, you know, not coming to an appointment, being late, calling in, in mental crisis. That's clearly them working through a borderline personality disorder. Those are all reflections of their health, right, their actual mental health disorder, and the same thing is substance use disorder. And often, those patients are discounted or pushed away, or they find consequences with accessing care because they're working through consequences of their own mental health and substance use disorder.
And so we created an environment where our team started to take on all of those patients, the severe, persistent mental illness and substance illness and substance use disorders, to try and begin creating a trauma informed team that works with a psychiatrist and a psychologist and a behaviorist, and we tried to incorporate into their care reasonable expectations and boundaries so that they knew what the expectations were, but removed the consequence for them working through it was clearly kind of reflective of their condition. And so over time, that allowed me to learn more and get more of a foot in the door when we as an organization, started opening the idea of an inpatient management I kind of jumped into learning as much as I could about that. I made a number of contacts and networks within that community. Of providers, and began to work on my day off in a methadone clinic that does daily methadone dispensing in an adjacent community, and was able to expand my knowledge base into that as well. So in my rural community, I do see a lot of people that are honestly in their 60s and 70s, that are still fairly consistent methamphetamine users, and part of the culture in that environment is that many of them have been using it since their 20s or 30s, and they see it very similar to alcohol, which is, well, this isn't a substance use problem, I just use it when I need it. And it's hard to break through that perspective.
So the culture itself kind of is something that you get used to, and I've found that, much like Dr. Johnson's earlier kind of statement, people don't like to go to town for things, no matter what it is. And so a lot of them will say, when I try and bring up the topic of, I have some specialists, I have a counselor that you can work with, like, why don't I start managing medication stuff, and we can start going down this road together? Well, let's get you with someone who's lived this experience. I haven't lived this experience. It's a unique experience. Why don't I get you and they just don't want to go to town. So I think that in a lot of environments, once you go from the pre-contemplated to contemplated, if you're able to get someone in your office for a warm handoff, you can make the hook, you can make the handoff. You can get them transitioned into early participation of recovery. And in my environment, that's not an option, so I end up kind of doing a lot more soft touches. And to use Dr. Simmons again, one of his sayings was, we just keep offering the pizza, and one day they'll be hungry enough to take some. And so I find myself offering the pizza appointment after appointment. And some of those patients really do eventually convert, become contemplated, and we start getting into some early intervention stuff. And plenty of the patients, they don't, but we're doing some harm reduction with at least continuing to talk about it.
Hohman: Great. Thanks. Dr. Johnson, anything to add from your perspective, your experience with the crisis in your community?
Johnson: So we do not do Addiction Medicine here. We do have a wonderful community health board that's actually our neighbor, and they work with that community, and so we are able to kind of do the warm handoff with them for that care. Our community does not currently have an overwhelming addiction issue. However, some of our surrounding communities do, so it is still something that we encounter on a daily basis, but definitely something we've been very blessed with. So you know, we are able to have the resources that we need, and we have not had an overwhelming effect in our community at this time.
Hohman: Thanks for sharing. In our opening episode of this Rural Health Series, we heard from folks at the CDC and at HHS who have a focus on the policy side of enhancing rural health access and care in rural America. If you could pick one or two, what would you say are your top policy recommendations, things that you feel would make a big difference for improving the health of rural Americans. Dr. Johnson, we can start with you.
Johnson: I think that, one of my big things is in Georgia, over the last 10 years, we've seen a lot of our critical access hospitals close. And so one of the big things that we have, we lack ers, we lack L&Ds, we lack access to care. And when you look at Georgia, we've got four or five cities that have that access in an entire state. And so a lot of times, people are having to travel long distances to get basic access to emergency services, to EMS to deliver a baby. And so unfortunately that you know, comes out in our statistics, we have a lot of issues with infant mortality, maternal mortality, and so I think that it would be, it would be great if we could bring some of that access back, opening the smaller L&Ds, opening the smaller access hospitals that we have lost over the years.
I think also just continuing to work on access and insurance coverage in my rural communities, we really struggle with that, not only necessarily just the patient, the barrier to getting it some you know, needing someone to help us make sure that these patients are getting what they can and and knowing how to go about that, the system is very convoluted in a lot of ways. And so there are so many barriers when we don't have internet, you know, I mean, everything's online now, right, you know. And so most of my area doesn't have ready, you know, access to internet. And so a lot of those things that you know. When you live in Atlanta, you don't think about, you know, because you have internet, you have all these things, and we don't. And so a lot of times, my patients just aren't aware of the resources that they do have. And so that can be a huge barrier for their care.
Hohman: Absolutely. Russell?
Wimmer: Yeah, I'm a huge supporter of some critical access hospitals, ED and labor and delivery, for sure. So there's some interesting rules around rural health clinics and billing. And so one of them is that you can't do more than one service on the same day. So for example, you can do a Medicare wellness visit and also address what is very commonly the laundry list of concerns that they have, because they only come in every three to six months. And so they just start saving them and saving them. And some of them, you go, Whoa, did you just say chest pain with exertion? And then you're trying to go back and start with that when it's the third one on their list. But you can't, you can't actually get reimbursed for them. And so when we talk about the healthcare systems, whether we like it or not as clinicians, there's a business behind it, and it has to be financially sustainable. And so when you have very limited access to primary care, and you can't do telehealth from home because there is no internet, or you don't have a smartphone, or you have difficulty getting in the ability to bundle services and get reimbursed for them, because the system and the clinician are putting in the work for the patient's wellness.
It would be a crucial change to making this more sustainable, both improving patient outcomes and making it more sustainable for rural environments to continue to provide these care the care to the patients we're losing small, remote clinics, and even the smaller, individually owned clinics are being absorbed by larger systems, and then the systems can't integrate them, and then they eventually get closed. And this is a way to make a big change, and kind of piggybacking on that, I have a lot of patients that can't do telehealth. And since COVID, we've had this great opportunity to do telehealth with specialists and other providers, but they can't do those at home. And so it would be great to find a way to bundle a service where they come into the clinic, where they, we do have internet. We do have computers, have them sit down with one of our staff, the care coordinator, and MA, or do a kind of a concurrent appointment with myself and the specialty and be able to charge insurance to say, hey, we did a care coordination appointment with the specialist who actually did all of the consulting they got to charge for their appointment because they did one. I was here to help integrate. We did an education system like kind of session, asked afterwards, there's a great opportunity to try and look at what day to day practice actually means for these patients with limited resources, and then find creative ways to do it. And I think that Dr. Johnson and clinicians that work day in and day out across the country in rural clinics have great ideas to do this. And so connecting with some of them to say, hey, what do you have? would open some doors.
Hohman: Yeah, absolutely. And I'm so glad that you brought up telehealth, particularly from the rural health clinics perspective, because, you know, so often I think folks in Washington see telehealth as a silver bullet for a lot of the access concerns that we have in rural America and where there's a lot of potential, and you know, I hope that that continues to grow. You know, data currently shows that as rurality increases, telehealth utilization decreases. And there's a lot of reasons for that, right, but reimbursement being one of them, just broadband access and things like that. But I think finding that balance between, you know, patient interest and access to telehealth, but also without, without giving up, you know, the in person access to care and seeing just how valuable that is for the patients that that trust you as their providers in their communities physically.
So this conversation has been really wonderful. You know, I am in DC, and you know, don't have the ability to be in your clinics on a daily basis, but conversations like this, just encourage and inspire the work that we do and advocacy that we do on behalf of clinics and providers across the country. So I want to thank you both so much for being here and sharing a little bit about your rural communities and the work that you do, which is so critically important to access to care.
You can learn more about our guests and the work that they do at the links in our show notes. Thank you again, Russell and Dr. Johnson, for joining us in this important discussion. Thank you so much for taking the time. That brings us to the end of another episode of the Health Disparities podcast, from Movement Is Life. I'm Sarah Hohman until next time, be safe and be well.