Physicians serve rural Nevada under federally-funded program

Dr. Fernando De Castro of the Philippines practices medicine at Sierra Family Health Center in a simply furnished office on Division Street under the auspices of a federally funded program.

As such, he is part of the solution for Nevada's underserved rural and urban populations.

It's a challenge De Castro embraces.

He was hired by Nevada Rural Health Centers after completing his residency in internal medicine at Harlem Hospital in New York and remained in this country through a waiver that stipulates he work in the U. S.with an underserved population.

De Castro said the program gives him the chance to give something back to this country as well as make a real contribution.

"It's like practicing medicine before managed care," De Castro said, noting the program gives him the luxury of being able to spend time with his patients which makes his work more satisfying. Private practices are more lucrative, but De Castro said he isn't in it for the money.

These physicians are an important part of the answer to rural Nevada's physician crunch, according to Steve Hansen, chief operations officer for Nevada Rural Health Centers.

"These are highly qualified physicians from prestigious residency programs," Hansen said.

De Castro's residency program was affiliated with New York's Columbia University. His first assignment three years ago in Gerlach was far from the streets of New York City. He misses that a little, but the birth of his son five years ago changed a lot of things for him.

He didn't want to raise his son in New York, and the pace was hectic. He saw between 30 and 40 patients a day during his residency. The drop in patient load here gave him an opportunity to spend more time with his family.

An added bonus: the people of Gerlach.

"They appreciated having me there, and we (he and his family) never experienced any discrimination as a minority," he said. He has not been replaced there and tries to return one day a week to see patients, but that is increasingly difficult because his practice here is getting busy. He has been practicing in Carson City for 2 1/2 months.

Northeast of Pyramid Lake, Gerlach and Empire together have a population of about 600 and for the most part, Hansen noted, American physicians don't want this kind of work.

"It takes between 3,500 and 4,000 people to support one primary care physician," he said.

De Castro backed those figures. A physicians' office has to see at least 13 to 14 patients a day just to break even, and while some days are busier than others, there was clearly a shortfall in the Gerlach-Empire area.

The federally funded community health center program has operated primary care medical clinics in rural and frontier Nevada for almost two decades. The organization is a private, nonprofit corporation supported by local, state, and federal grants and contracts.

All counties provide an office location and some funding. Patient revenue, grants and federal assistance make up the rest of the budget for these rural clinics, but problems are compounded by lack of funding at the state level, according to Hansen.