PITTSBURGH — When one of Jim Mancini’s young patients needs a pediatric dentist, he has to send them 90 miles south to Pittsburgh to get treatment.
Mancini is a dentist with Meadville Dental Center, a service that provides dental care at several rural health clinics in Crawford County, Pennsylvania. As a general dentist, he can do routine dental check-ups and fluoride treatments for children. If a child needs more involved care that would require sedation, they must see a pediatric specialist. The easiest way to do that is to send them to Children’s Hospital of Pittsburgh, he said.
There are 39 counties in Pennsylvania that don’t have a pediatric dentist, Mancini said, and Crawford County is one of them.
“There were some [pediatric dentists] in Erie, but they retired,” he said. “The big problem is that most dentists north of Interstate 80 look like me. I’m a dinosaur. I could be an exhibit in this building.”
Mancini testified before the Pennsylvania House Agriculture and Rural Affairs committee during a special hearing May 18 on challenges in rural healthcare held at the Carnegie Museum of Natural History.
Essential
Members of the committee heard from three other healthcare professionals based in western Pennsylvania during the hearing, including Dr. Beth Piccione, president of UPMC Jameson and UPMC Horizon.
Piccione, a New Castle native and cardiologist, said if rural hospitals like the three she oversees in Lawrence and Mercer Counties aren’t supported, vulnerable people won’t be just inconvenienced, “they’ll be in dire straits.”
“In so many areas, we are the sole provider of essential services,” she said. “The challenges to providing these services are very real.”
An example of this is the situation with maternity wards in rural areas. Of Pennsylvania’s 42 rural hospitals, only 17 provide obstetrics services, according to a recent report from the Center for Healthcare Quality and Payment Reform.
“To provide a safe place for childbirth, you have to have a pediatrician, an anesthesiologist and an obstetrician readily available,” Piccione said. “The economic realities of securing these services is what has led many hospitals to close their obstetric services.”
The Birth Place at UPMC Horizon’s Shenango Valley hospital campus, in Farrell, which opened in 2021, offers labor and delivery, C-section services, mother-baby and level I and II nurseries, making it the only childbirth facility within the two counties for the past two years, she said.
Piccione said her facilities are the only providers of gastrointestinal, rheumatology, endocrinology and neurology services within the two rural counties. All three hospital campuses have cancer services available locally. UPMC Jameson has Lawrence County’s only cardiac catheterization lab, which can improve outcomes for a person suffering from a heart attack.
“Being able to drive 5 miles to a hospital or having to drive 60 miles,” can make a difference of life or death, she said.
Solutions
What won’t help is state-mandated staff to patient ratios, as is proposed in House Bill 106, which went before the Pennsylvania House Health Committee earlier this month.
“Mandating staffing ratios does not create more nurses,” she said, nor does it create more support staff. It could force rural hospitals to reduce services, therefore reducing access to healthcare, she said.
Piccione suggests instead investing in nursing education. She said the UPMC Jameson nursing program has a wait list for students to get in, so there’s not a lack of interest in the field. There is a lack of clinical instructors.
Loan repayment for doctors and other healthcare workers could also help. Mancini, who is also an adjunct professor at the University of Pittsburgh, said they send dental students to work in public health offices in rural Pennsylvania, and they love it. But when he asks where they’re going to work after school, many say they’re going out of state because loan repayment options are better elsewhere.
“We need to give them a reason to stay here,” he said.
Average medical student debt coming from school is around $200,000. Pennsylvania’s Primary Care Loan Repayment program will reimburse up to $80,000 for full-time physicians, dentists and psychologists who work a two-year contract in an unserved area. Some states offer more than $100,000 in loan repayment, with several offering up to $200,000.
(Reporter Rachel Wagoner can be reached at rachel@farmanddairy.com or 724-201-1544.)
