(The Center Square) – The facts and figures around rural healthcare in Pennsylvania are grave.
That’s why it was unsurprising to hear Gov. Josh Shapiro say in a press conference on rural healthcare that Sullivan County, home to just under 6,000 people and falling, did not have a single physician.
Dr. Sam Schrack operates the Laporte Health Center where he’s been for three years.
“I’ll be in office tomorrow as usual,” he wrote in an email to The Center Square. “If you really want to find out what the issues are with rural health, come up sometime and visit.”
So, this reporter did just that.
Shapiro got his figure from Sen. Gene Yaw, R-Wellsboro, who was privy to news that Rural Health Corporation of Northeastern Pennsylvania would be pulling out of Laporte. Schrack’s office would indeed be going through a change of management, but for now family medicine in Sullivan County survives, supported by the local commissioners.
The center is making the switch to Laurel Health which will allow it to continue running as a Federally Qualified Health Center. Such community-based centers, Schrack believes, are the future of medicine, providing care to patients on a sliding scale regardless of insurance. There would be a week off for the transition, but otherwise, it’s business as usual in the tiny county seat.
The drive from the Harrisburg area is about two and a half hours following the Susquehanna River north into the mountains. The last 20 or so winding miles off the highway demonstrate that the area’s small population has left space for natural beauty. The higher altitude and colder climate lags just slightly behind the early signs of spring in the “flatlands.” In a few months’ time, vacationers from more congested parts of the commonwealth will make the trek to their second homes in towns like nearby Eagles Mere.
The area’s recreational draw seems to have been the inspiration for what is now Laporte Health Center. In Schrack’s story a tobogganist – and in another a golfer – suffered a fatal heart attack in front of Philadelphia College of Osteopathic Medicine President Fred Barth, too far from a hospital for help. Barth then set out to create healthcare access for the people of Sullivan County.
Legend has it that the administrator soon won the keys to the Mokoma Inn, the original site of the center, in a game of poker, wrote 2016 college student Benjamin Whitfield. From 1971 to 2021, Laporte served as a home for the school’s Sullivan County rotation in rural medicine.
Monthly, the center cycled through medical students in groups of six who slept in dorms above the office. Overseen by permanent staff, they performed day-to-day work and responded to after hours emergencies at the sound of a bell. By Whitfield’s count, the town had been a temporary home to over 2,500 students five years before the program ended.
Today, it’s just Schrack. But in a place like Laporte, one physician means access to care for a whole host of aging, often isolated, patients who can’t easily access regional medical facilities in surrounding counties. From here, it’s about a 40-minute drive south on U.S. 220 to UPMC Muncy or 40 minutes north to Guthrie Robert Packer. Hospitals in Williamsport and Danville are each just shy of an hour away.
Nearby, DuShore is a relatively more active town than Laporte, laying claim to the only stoplight in the county. It’s also home to the only pharmacy between Muncy and Towanda. Its clinic is currently down on permanent physicians, filling the vacancy with a rotation of per diem professionals from regional centers.
“Good luck with recruiting a doc,” says Schrack.
Recruitment is one large piece of the puzzle when it comes to solving the state’s – and the nation’s – rural healthcare crisis. Currently, a bill is moving through the General Assembly that hopes to incentivize medical professionals by offering to repay student loans for those willing to work in a rural community for at least three years.
Legislation like this would certainly help counties like Sullivan. Even just the one-month placement in Laporte allowed the college to meet Laporte’s medical needs for decades. Whether the program will prove enough for students to stay is a murkier question.
“The doctors that were here were paying back their loans. This was National Health Service Corps loans that paid for their med schools,” said Schrack of the full-time physicians who staffed the center. “They’d do their three years and say ‘Sorry, I’m out of here.”
For Schrack, the solution is to find physicians and other professionals with rural roots who are interested in moving back. Doctors, however, aren’t the only ones forsaking rural communities for opportunity elsewhere. In a town like Laporte with no grocery store and no restaurants, it can be hard for young people to see a future here. The commonwealth suffers from a rapidly aging population with its rural areas beginning to see more deaths than births.
Schrack himself grew up in Clinton County near Lock Haven. He hopes that residents completing rural tracks at hospitals like Soldiers and Sailors in Wellsboro and Charles Cole in Coudersport, both now owned by UPMC, will have connections to the area that inspire them to invest in it.
“I need to ride off into the sunset, right?” he said.
In Forrest Gump-like fashion, Schrack’s career has snaked its way through many of the issues now vexing Pennsylvania lawmakers. Not wanting to fight in Vietnam, he began his medical training in the Pennsylvania National Guard. His nursing experience took him to State Correctional Institution Rockview, which today faces closure.
Schrack then went on to graduate from Drexel’s now-closed Hahnemann University Hospital in one of the first classes of physician assistants in the country. He says that physician assistants and other mid-level staff like nurse practitioners have a vital role to play but should not be autonomous. Hahnemann, which largely served low-income patients, was a 2019 casualty of private equity’s forays into medical care.
After a stint as Clinton County Coroner while working as a physician assistant in Mill Hall, Schrack returned to school at 34-years-old to become a family medicine doctor, completing a residency in Williamsport. As a medical director at Muncy State Correctional Institute, he helped launch their medication assisted treatment, or MAT, program for those struggling with substance use disorder, an experience that led him to working with the state’s Law Enforcement Treatment Initiative.
When asked if his pocket of rural Pennsylvania had seen the ravages of the opioid epidemic, he said it wasn’t as big of a problem as alcohol and marijuana locally, though the patients he has had have made full recoveries with MAT. He emphasized that the medication assists the treatment, rather than replaces it, a problem he says he’s seen with some doctors prescribing drugs like Suboxone. Accessing the psychosocial aspects of recovery can be much harder.
“You gotta be doing your AA, your aftercare, your mental health. So, mental health in Pennsylvania? Oh my God. Forget it. It’s not existent. So, where do I get mental health services?” asks Schrack. With the recent addition of broadband to the area, he sees telehealth as an option for talk therapy.
Yet other doctor’s visits, Schrack said, can’t be adequately conducted remotely, even when patients have the technology required to do so, something that is by no means a given in a county where the median age is 55.
“It’s not the same,” he said. “I can’t listen to your heart.”
For Schrack, the doctor-patient relationship is everything. In family medicine, he’s seen his patients “from the cradle to the grave,” and laments a “golden age” of medicine in which doctors had the time and authority to treat their patients outside today’s complex web of insurance authorizations, regulations and demands.
“We’re no longer in control,” says Schrack. “We gave away the store, so to speak.”
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But it isn’t all bad news. Schrack says that while it isn’t profitable, rural healthcare gives doctors the opportunity to have fun, something rarely spoken of in a time of medical burnout and patient dissatisfaction that often careens into abuse. In an office that may see about 10 patients a day, he has time to sit with them to discuss heart disease, diabetes or even how their grandkids are doing. It’s an opportunity many physicians choosing lucrative specialties and urban postings simply don’t have.
Until new blood comes to revive rural healthcare, “I’ll be here as long as I’m on this side of the grass,” says Schrack. His legacy? “The patients.”