Patagonia to get new primary care provider, clinic upgrades

If you are old enough to remember Marcus Welby, M.D. — or Doc Mock, for Patagonia long-timers — you’re old enough to know that such medical practices don’t exist in the modern day and age.

The beloved town doctor with a kind bedside manner who made house calls and knew his patients on a first-name basis is so 20th century, done in by a combination of demographics, economics and healthcare consolidation that has made small-town medical practices difficult to sustain.

Residents of eastern Santa Cruz County, a largely older demographic, which by nature comes with added medical burdens, are fortunate enough to have a fulltime clinic in the community — Mariposa Health’s Family Health Center in Patagonia — but the tricky part for Mariposa has been providing the continuity of care that the community needs.

“We want to make sure the community knows and that we recognize it’s been difficult over the last seven to eight years without having a consistent long-term strategy for providers,” said Amy Taylor, Mariposa’s chief executive officer and chief operating officer. “And it’s due to recruitment challenges. It’s very, very hard to recruit providers to rural places.”

This issue is not that doctors have been unavailable at Patagonia’s clinic, just that it’s been a rotating cast of providers who are there one day, gone the next.

Taylor is optimistic that this concern is about to change with the hiring of a new family medicine doctor whose primary base will be Patagonia. Dr. Christian Barr will start his new duties in November and be working in Patagonia on Monday, Tuesday and Wednesday. Dr. Carlos Gonzalez will be stationed in Patagonia on Thursday, and Dr. Sean O’Brien will continue with his Friday shift.

The hiring of Dr. Barr and a fixed rotation of providers is one of several initiatives being undertaken to upgrade the quality of medical care in the eastern part of the county, some of which are included in the so-called Early Actions agreement being funded by South32.

For Mariposa, the initiatives, at various stages of readiness, include the purchase of transportation vehicles to provide more convenient access for patients; a mobile health clinic to bring services to remote and underserved areas; and a residency program for training new doctors and, hopefully, introducing them to a community where they want to live and work.

Meanwhile, the town of Patagonia, which owns the building that houses the clinic, is getting funding from South32 to study reconfiguring or expanding the facility to provide additional services that have been identified by Mariposa as high-priority community needs.

“One would be creating more space for behavioral health and care coordination services,” Taylor said. “Two would be for creating a dedicated space for pharmacy so that people have a better experience with picking up their medications and potentially purchasing very, very affordable, over-the-counter type of needs that they might have. And then also just looking at reconfiguring the flow of the practice so there’s more access for patient visits.”

“I think what matters to people who live in Patagonia is that we’re going to have consistent providers, and providers who really want to be there and are very dedicated to serving the community,”

Amy Taylor, Mariposa Health chief executive officer

While a full-time pharmacist in Patagonia is not feasible, Taylor pointed out two benefits to expanded pharmacy services. Having over-the-counter products such as pain medications available would be not only an added convenience, but they would be “very, very inexpensive. Better prices than Costco.” Second, when customers use the Mariposa pharmacy as opposed to a chain drug store, the pharmacy revenues are plowed back into services such as transportation and community health programs.

“If you’re a Mariposa patient,” she said, “you should really come to us because you’re not paying more money for your prescriptions, but you’re paying Mariposa’s pharmacy, which then gives us money that we can reinvest in our services, as opposed to a for-profit national chain and their shareholders.”

The mobile clinic is another key component. Mariposa is already in possession of the vehicle courtesy of a state grant, but it cannot provide services until it is credentialed by the state, so it has contracted with a vendor to help expedite the process.

Patagonia Mayor Andy Wood and Town Manager Ron Robinson explained that the town’s fire department gets frequent 911 calls for nonemergency medical situations such as blood-pressure checks or medication questions.

“Whether they’re homebound or whatever reason, they don’t go to the clinic for it,” Robinson said. “So, what we’re trying to do is take the pressure off the 911 calls, because as the fire chief mentioned, there’s possible real emergencies that need to be taken care of.”

Added Taylor: “If they don’t feel comfortable coming into the clinic, we can go to them. We have community health workers who can go to people in the homes, do blood-pressure checks, medication reconciliation work, safety checks. There are a lot of things our community health workers can do to help bridge that gap and hopefully encourage them to become involved in long-term primary care.”

The “rural-track” residency program, in association with Creighton University’s Phoenix campus, is a longer-term piece of the puzzle. The three-year training program will see two residents assigned to Mariposa each year, doing roughly 60-plus percent of their training in the community.

“Our hope is that every year, at least one will stay so that will help reduce the issues we’re having with recruitment,” said Dr. Eddie Pereira, Mariposa’s chief medical officer. Dr. Pereira said a shortage of family-practice doctors is a nationwide issue, but it’s particularly acute in rural areas, despite higher compensation rates than in metropolitan practices.

“I have to remind myself that not every doctor is suited to work in a rural area,” Dr. Pereira said. “There has to be a culture fit.”

Ideally, the residency participants would live in community where they are training, and to that end, South32 is funding a feasibility study for residency housing.

“If they live here and they fall in love with Santa Cruz County and they fall in love with somebody that’s here, the likelihood that they stay is that much greater,” Taylor said.

Added Dr. Pereira: “The challenge is how do we integrate them into the community. Not just the medical training, but how they participate in the activities that make them want to be here.”

Robinson and Wood praised Taylor for serving as a “catalyst” in addressing the community’s concerns.

Taylor acknowledged the need to.

“The more present in the community and rebuild the trust and lost relationships that we had.”

Case in point: Mayor Wood. She said she switched her primary care to a practice in Sierra Vista due to consistency issues: “I don’t like the fact that if you don’t have a consistent doctor, then every time there’s a new doctor you have to re-explain your health history.”

Taylor said Mariposa is hoping to earn another chance.

“I think what matters to people who live in Patagonia is that we’re going to have consistent providers, and providers who really want to be there and are very dedicated to serving the community,” she said.