Kristina May, 19, has come by to get medical forms filled out for medical lab technician school. The problem is she needs a TB test, which has to be read in 48 to 72 hours - which will be Saturday or Sunday when the office is closed. Now she will have to come back twice - from 40 minutes away in Westernport.
"Why do you come all the way out here to see me?" he asks.
"It's either that or 40 minutes the other way," she tells him.
Filing and billing
Between patients, Buczynski takes a sip from an insulated cup - water in the morning, coffee in the afternoon - and enters into his computer information about each visit, including a diagnosis, any drugs prescribed and whatever else his staff needs to make sure he gets paid. Most of his patients are on Medicaid or Medicare. He says few employers in town even offer private health insurance.
The escalating cost of malpractice insurance has been another financial hardship. State and local subsidies have allowed Garrett County's physicians to continue delivering babies, but officials are struggling to find a permanent solution to what could be a true crisis.
Without the local family doctors delivering babies, women would have to travel more than an hour to Cumberland or Morgantown, W.Va., for care - a trek made more difficult in the winter, when heavy snows blanket these mountains.
When necessary, patients do make those journeys to see specialists, to handle problems that require a more intense level of treatment. But researchers say that doesn't make rural health care inferior.
"For the first time, people are realizing that more intensive, more specialty care may not give you better outcomes," says Dr. Roger Rosenblatt, vice dean of family medicine at the University of Washington.
In urban and suburban areas with more choices, Battista says, patients often self-refer to specialists they don't necessarily need, wasting health care dollars. A rural family doctor is forced to fine-tune care - usually with better results, Battista says.
In Rosenblatt's view, those talking about health care reform need to find a way to get more doctors out to places such as Western Maryland, where the physicians they do have must work doubly hard to keep up with the overwhelming demands, often at the expense of their personal lives.
