This week on Rural Health Leadership Radio, we’re talking about pharmacy in rural areas. We’re having that conversation with David Bowyer, Department Chair and Associate Professor of Pharmacy Practice at the University of Charleston, School of Pharmacy.
“You have to be willing to take chances and be willing to stand up for what you believe in…”
David is a West Virginia native, where he attended West Virginia University and graduated from the School of Pharmacy. David has been a pharmacist for 35 years, having served in both hospital and community pharmacy, and made the switch to academia fourteen years ago.
“What excites me the most is the acceptance and willingness of the medical community to utilize the pharmacist and other members of the healthcare team to develop a real team approach to healthcare.”
David now serves as the Department Chair and Associate Professor at the University of Charleston, where he has 12 pharmacists working under him. To David, pharmacy was a way to remain in healthcare and take care of patients in a different way than other healthcare professionals.
This week on Rural Health Leadership Radio we’re talking about the work done through rural health organizations. We’re having that conversation with Maggie Sauer, Director of the State of North Carolina’s Office of Rural Health.
“People are committed to their community, they’re committed to the people in their community, and people volunteer across the community.”
The Office of Rural Health seeks to assist underserved communities through improved access, quality, and cost-effectiveness of healthcare. Maggie’s office administers over 300 contracts designed to improve these facets of healthcare for rural and underserved populations, returning over 86% of its budget directly back to North Carolina communities. Maggie also works to provide in-depth technical assistance to North Carolina’s Safety Net system.
“People in rural are amazing and should be held up as leaders in our country.”
Maggie is a Colorado native but has called North Carolina her home for 28 years. She grew up on the rural eastern plains of Colorado and credits her childhood experiences for her passion to serve and work in rural environments. She joined the Department of Health and Human Services’ Office of Rural Health as director in June 2017. She continued to serve as the President and CEO of the Foundation for Health Leadership and Innovation in North Carolina for over five years. Maggie’s Office of Rural Health will celebrate its 45th anniversary of serving the underserved this year!
Happy National Rural Health Day!
This week on Rural Health Leadership Radio, we have a special episode in celebration of National Rural Health Day.
“National Rural Health Day began as a way to positively recognize and celebrate the individuals and teams who give their very best selves in the name of rural health.”
We’ll hear from several rural health leaders including Karen Madden, the inventor of National Rural Health Day and Director of the Charles D. Cook Office of Rural Health within the New York State Department of Health, Shannon Calhoun, a rural health leadership expert, Kathy Whitmire, CEO of Transformation Health Partners, Hunter Nostrant, CEO of Helen Newberry Joy Hospital in Michigan, and Rena Salamacha, CEO of Mee Memorial Hospital in California.
“Giving people that team concept, having strength and understanding of their teammates really gives a super-solid foundation for success.”
We’re also talking about rural health leadership innovations. Rural health is known for innovation, and our conversation today is on the top 5 rural health leadership innovations. Those innovations include:
Check out these rural health leadership innovations and let us know what you think!
This week on Rural Health Leadership Radio we’re having a special conversation in recognition of Veterans Day by talking about military service and its connection to rural health. We’re having that conversation with Bill Sexton, past president of the National Rural Health Association and retired Air Force Lieutenant Colonel.
"As we would say in the military, boots on the ground to understand the true needs of our rural community."
~Colonel Bill Sexton
After leaving the military, Bill served in leadership positions in rural hospitals, most recently as the Chief Executive Officer at Crossing Rivers Health in Wisconsin. He is a board-certified Fellow of the American College of Healthcare Executives, as well as having a Master’s in Healthcare Administration from the University of Minnesota and an MBA from Southern Illinois University.
"Leadership is a vision that transcends the present with the ability to inspire commitment and a plan that sets expectations and monitors progress."
~Colonel Bill Sexton
Bill served as the President of the National Rural Health Association in 2006, and continues to serve as the chair of its subsidiary, Services Corporation. Bill grew up in a rural community in Illinois, and felt that rural healthcare needed strong leadership. He also works extensively to improve healthcare quality and access for veterans in rural areas.
We’re talking about the bridge between rural and public health with Michael Meit, co-director of the NORC Walsh Center for Rural Health Analysis.
“I am just blown away by our youth in our rural communities. They give me hope for the future. They excite me. They are out future leaders.”
Michael serves as the Senior Fellow in the NORC at the University of Chicago Public Health Research Department as well as serving in his co-director position. He has spent over twenty years working to bridge research in the fields of rural health and public health, conducting extensive research through mixed-methods approaches. Michael hopes to create a better understanding of health disparities through this research.
“Rather than focusing so much on rural challenges, I think we really need to tell the positive story about what is good and strong about Rural America.”
Michael recently led studies covering rural food security issues in youths, rural disparities in overdose mortality, along with how strengths and assets can be leveraged to improve rural health equity. Before his role at the NORC, Michael worked in public health academia as the director of the University Of Pittsburgh Center for Rural Health Practice. Michael is also on the editorial and advisory boards for Public Health Reports, the Journal of Public Health Management and Practice, and the Journal of Appalachian Health.
We’re having a conversation about health disparities in rural health with Romae Morgan, recent graduate from the University of Florida.
“I think the most forward step in rural communities and rural health is that the communities are moving forward.”
Romae grew up in Kingston, Jamaica and currently lives in South Florida with her family. After moving to Florida, she experienced quality health care, sparking her interest in the field. She began to grow her interest through volunteer work, eventually working her way to developing an independent study on childhood obesity. She chose to focus on rural health because she saw the disproportionate risk for illness that rural individuals face.
“Community involvement and engagement, and overall community support, is on the rise and increasing.”
After graduating from the University of Florida with a Bachelor of Science degree in Nutritional Sciences, she started her Master’s in Public Health degree at UF this past Fall. Romae grew her passion for community work and mental health during her undergraduate career, and participated in multiple organizations to continually grow her leadership skills. She enjoys engaging with the community, spending time with friends and family, and exercising.
We’re taking about healthcare management with Randy McKinney, Rural Health Clinic Administrator at Bienville Family Clinic.
“In these times, we have got to work together to get things done for the betterment of our community and for the health of our people.”
Randy is the Administrator at Bienville Family Clinic in Arcadia, Louisiana. He earned a Bachelor’s Degree in Business Administration from Dallas Baptist University as well as a Master’s Degree in Public Administration from the University of North Texas and a Master’s Degree in Criminal Justice from Grambling State University.
“If we’re to get something of value accomplished for those that we serve…collaboration is what it will all be about for today and for the future.”
Randy became a licensed nursing facility administrator in 1994, and started his journey at the Louisiana Department of Health and Hospital’s Bureau of Primary Care and Rural Health as a Practice Management Consultant. He then came to Bienville Family Clinic, where he has dedicated over 25 years to management and healthcare.
This week on Rural Health Leadership Radio we’re talking about medical anthropology in healthcare. We’re having that conversation with Dr. Matthew Dalstrom, professor at Saint Anthony College of Nursing.
“If we’re able to get them out into the community, we’re able to build this personal connection and empathy with patients that will improve overall patient care.”
~Dr. Matthew Dalstrom
Dr. Dalstrom teaches public health and mentors graduate nursing students at Saint Anthony College of Nursing, through community-based and qualitative methods. His research focuses on anthropological and public health perspectives to determine how health policy and social determinants of health influence health-seeking behaviors, access to care, and health outcomes.
“It’s more than being culturally competent…it’s learning how to interact with individuals and the way that you’re able to do that is it’s very simplistic. It’s by talking to them.”
~Dr. Matthew Dalstrom
Dr. Dalstrom also collaborates with health systems, local government organizations, and academic institutions on health promotion and interventions. He also works to ensure that his students understand how to build connections and work collaboratively within their community.
On Rural Health Leadership Radio, we’re talking about local and global rural health. We’re having that conversation with Kacie Hoyle Denton, a medical student at East Tennessee University.
“Continue to connect with members in the community. Form relationships with people. Learn from their perspectives so that you can best learn how to serve others and thereby leading them.”
~Kacie Hoyle Denton
Kacie, who has already received her MPH, is a fourth-year medical student in the Quillen College of Medicine. She previously graduated from Carson-Newman University with a BS in biochemistry as well as a BA in biology with honors. Having grown up in rural Appalachia, she has an interest in rural health and hopes to practice pediatric medicine in rural areas.
“Awareness is crucial and as awareness continues, that is really going to affect how rural health changes in the future.”
~Kacie Hoyle Denton
Kacie is currently part of the rural primary care track and engages in various communities, helping in the medical field. Kacie also has a passion for the extension of rural health globally, having served in Belize and South Africa. She has worked on multiple research projects focused on rural health in Tennessee and Belize. Kacie’s interests also include global health, gastroenterology, and rural medicine.
Our topic is leadership and innovation in rural hospitals with Dr. Maria Ryan, CEO of Cottage Hospital in Woodsville, New Hampshire.
“Create a vision, a realistic vision, and work towards it. Talk about it, because other people may be thinking about it, too.”
~Dr. Maria Ryan
Dr. Maria Ryan worked in a variety of settings including for-profit, non-profit, and tertiary care and started her career in healthcare as a CNA. She later became a nurse practitioner where she developed both her clinical and leadership skills. Dr. Ryan would continue to become the Director of an Emergency Department, the Chief Nursing Officer, Chief Operating Officer and finally the Chief Executive Officer. She brings a high-integrity, energetic form of leadership as well as the ability to envision and create successful outcomes in the face of complex obstacles.
“We have to work through others, we have to allow them to be experts in their field but also, we have to work through them to gain whatever it is we want to accomplish.”
~Dr. Maria Ryan
Dr. Ryan has brought many accomplishments to Cottage Hospital including HealthStrong Award for Excellence in Efficiency, HealthStrong Top 100 Critical Access Hospital by iVantage Health Analytics, a Top 20 Critical Access Hospital - Best Practices in Quality designation by the National Rural Health Association and the 2015 Business of the Year Award from the Cohase Chamber of Commerce. Dr. Ryan has been recognized by multiple organizations for her achievement in healthcare and business, including Becker’s Healthcare Review, NH Business Magazine, and NH Business Review.
On Rural Health Leadership Radio, we’re having a conversation about rural and community health in West Virginia. We’re having that conversation with Dr. Quintin Brubaker, the resident physician in Family Medicine at West Virginia University.
“If we can just cooperate a little better, the stuff we need to provide good care to every American might already be available to us.”
~Dr. Quintin Brubaker
Quintin Brubaker grew up in Virginia, where he majored in History at the University of Virginia. After receiving his bachelor’s degree, he worked as an EMT and raft guide while also completing pre-med courses. Dr. Brubaker participated in the Rural Track, Rural Health Interest Group, the Rural Education Alliance for Community Health, and the Family Medicine Rural Scholars Recruitment initiative while in medical school at West Virginia University.
“We could learn a lot from other healthcare systems to create our own solutions, drawing from a broader basket of ideas.”
~Dr. Quintin Brubaker
Dr. Brubaker received the NRHA Student Leadership Award in May, and continues to grow his knowledge in healthcare. After completing his residency, Dr. Brubaker plans to continue practicing in West Virginia, with support from the West Virginia Institute for Community and Rural Health.
We’re talking about the impact of rural community health centers in Florida with Andy Behrman, the President and CEO, and Ben Browning, Vice President, of the Florida Association of Community Health Centers, Inc.
“I know that we have a chance to make sure that at the end of the day, access to care in rural America is not going to go away.”
Andy Behrman has been in healthcare in Florida for 45 years, working in multiple areas within the industry. He was the first AHEC center director in the State of Florida before starting at the Florida Association of Community Health Centers. Ben Browning has been working with Andy for almost 10 years now, where they work together to expand community health centers and improve access for patients across Florida.
“The increased focus and the strengthened interest in rural communities excites me and I’m hoping it continues its push forward.”
Andy and Ben have recently been working to address issues stemming from the 340-B program. While the program provides opportunities to save money to reinvest into patients, many organizations have taken advantage of this program. Ben and Andy are both working to bring these issues to the forefront, working with legislators and the Agency for Health Care Administration to address these obstacles.
Rural Health Leadership Radio is having a conversation about rural broadband service and economic development. We’re having that conversation with Dr. Brian Whitacre, professor and extension economist in the Agricultural Economics Department at Oklahoma State University.
“I think it’s great to have that kind of a support system and I think there’s a lot of really good people working this area that are going to put a positive impact on rural in general.”
Dr. Whitacre helps rural areas identify what they can do to improve their economic situation, which often revolves around health. Dr. Whitacre works in the general area of rural economic development, while also teaching an undergraduate course on the topic and working with small communities across Oklahoma to help improve their quality of life.
“We want our rural facilities to have good broadband access available to them. So talk to local providers, talk to the local healthcare institutions about their connectivity needs and let’s find a way.”
The majority of Dr. Whitacre’s recent work and research has focused on broadband and healthcare connectivity gaps in hospital and private care practices in rural areas. He has also conducted studies on the relationship between housing values and broadband, and continues to explore the significance and uses for broadband in rural healthcare. A link to the article discussed in this episode can also be found here.
We’re having a conversation about the work being done at Stone Mountain Health Services, recognizes as an Outstanding Rural Health Organization by the NRHA. We’re having that conversation with Jim Werth, Director of the Black Lung Program at Stone Mountain Health Services.
“I understood the folks and appreciated the values and opportunities that rural life has.”
Jim Werth received his PhD in Counseling Psychology from Auburn University, as well as his Master of Legal Studies from the University of Nebraska. He is currently the Behavioral Health and Wellness Service Director in addition to serving as the Director of the Black Lung Program at Stone Mountain Health Services.
“We need to look at our experiences and values as we continue to move forward, and not just focus on diseases of despair.”
Previously, Jim spent years doing health-related policy work in Oregon after moving on to become an assistant professor at the University of Akron. Jim then became the director of the PsyD program at Radford University, focusing on rural mental health. He would then come to his current position at Stone Mountain Health Services, where he works to provide training for those working on the frontlines. Jim is also becoming the CEO of another community health center in Virginia.
Today's topic is hospital transformation and sustainability. We’re having that conversation with Kathy Whitmire, CEO of Transformation Health Partners.
“My mission continues to be helping rural hospitals survive, to transform them and help them maintain a strong bottom line.”
Kathy Whitmire was born and raised in Greenville, South Carolina where she would earn her first degree in marketing and communications at Greenville Technical College. She received her degree in healthcare administration in 2005 and has served rural hospitals by developing their services and educating them for the last 20 years. Kathy recently served as COO and Chief Transformation Officer at Stephens County Hospital in Toccoa, Georgia, leading a $10 million financial turnaround and revenue cycle transformation.
“It takes a servant leader with a new set of skills to focus on providing patient-centered care.”
Kathy works to help rural hospitals transform and remain viable to serve their communities, through training and equipping healthcare executives with the skills and knowledge to transform their bottom line. Kathy was also the Vice President of Business Development for Caravan Health for two years, and was the Executive Director for HomeTown Health, LLC, for fifteen years. She was also named a Rural Health Fellow by the National Rural Health Association in 2017, and is an active member of the American College of Healthcare Executives and HFMA.
We’re talking about best practices of a Top 20 Rural Community Hospital with Perry Gay, President and CEO of Logansport Memorial Hospital in Logansport, Indiana.
“We put emphasis on community, quality, and outcomes to make sure our patients see the great things we are doing.”
Perry was born and raised in Lakeland, Florida and received his Master’s of Business Administration degree from St. Leo University. Perry has been serving Logansport Memorial Hospital since 2015, but has worked in various leadership roles with multiple health systems where he found success in driving organizational, service-line, and capital growth.
“Instead of just treating people, how are we going to keep you well and get you to the best state of health that you can be?”
Perry also leads LMH’s commitment to exceptional quality, which led to their being named as one of the Top 100 Rural and Community Hospitals in 2019 by iVintage Analytics and as a Top 20 Rural Community Hospital by the National Rural Health Association. Perry also advocates at the state and national level for continual improvements in healthcare.
Our topic today is research and creative approaches to serving rural and vulnerable populations. We’re having that conversation with Anudeep Udumula, a student researcher at the University of Central Florida.
“There is always research you can do no matter how formal or informal it is.”
Anudeep was born and raised in Delaware and is now a Burnett Medical Scholar at the University of Central Florida, studying economics and biology. Anudeep explored health economics for two years by working at an NIH-funded research group as a health disparity analyst to better understand the gap between rural and urban areas. Anudeep presented his research, “Creative Approaches to Meeting Diabetic Needs in Rural Florida”, at the National Rural Health Association’s conference in May, where he examined diabetes-related hospitalizations in lower income rural residents in Florida.
“Your job as a leader is to help people and give them a chance to showcase their skills and their talent.”
Anudeep has also worked with underserved populations in Orlando and volunteers at a free clinic for uninsured and low-income patients as well. Anudeep plans to attend medical school after graduating from UCF and hopes to continue to make a positive impact as a physician.
We’re talking about the importance of serving vulnerable populations with Dr. Cara James, the Director of the Office of Minority Health at the Centers for Medicare and Medicaid Services and the co-chair of the CMS Rural Health Council.
“It really does take all of us working together to identify those issues, but also to identify what is working.”
~ Dr. Cara James
Dr. James is a nationally recognized expert and thought leader in health disparities, health equity, and improving health outcomes for vulnerable populations. She received her A.B. in Psychology and her Ph.D. in Health Policy from Harvard University. Dr. James is trained as a Health Policy Researcher, and has always had a passion for helping those who are in need. Her work impacts not only racial and ethnic minorities, but also people with disabilities, rural communities, and sexual and gender minorities.
“We need to make sure that we are helping empower communities and giving them the support and resources they need to make changes.”
~ Dr. Cara James
Dr. James has worked to develop the CMS Equity Plan to Improve Quality in Medicare, an initiative focusing on helping individuals understand their coverage, connect to care, and increase the collection and reporting of health disparities data. Dr. James was a member of the National Academy of Medicine Roundtable on the Promotion of Health Equity until 2019, and was as co-led the creation of the CMS Rural Health Strategy.
It's our third anniversary! We are celebrating with our intern, Sydney, and having a conversation about what she has learned in her time with RHLR! Sydney is a Master of Healthcare Administration student at the University of South Florida, and has been with RHLR since May.
“We should focus on consistently chipping away at our problems and always look for improvement.”
Sydney Grant is starting her second year in the Master of Healthcare Administration program at the University of South Florida, graduating in 2020. She received her bachelor of science from Florida State University in 2018, majoring in Political Science with a minor in Communication. She has interned with the Quality, Safety and Risk department at USF Health, measuring Medical Assistants’ adherence to blood pressure measurement guidelines, and is currently interning with Dr. Bill Auxier and Rural Health Leadership Radio.
“Rural healthcare faces unique challenges and barriers, which leaves so much room for creative problem solving.”
Sydney has worked with Rural Health Leadership Radio podcast production, research, cataloging past episodes, and much more. She is an active member in the West Florida Chapter of ACHE, as well as being a member of the Communications Committee for WFC ACHE. She is the Membership Engagement Officer for the USF Health Management Student Association (HMSA), and is a member of the HMSA Gala Committee.
Today we have another special episode of Rural Health Leadership Radio! We are having a panel discussion at the Indiana Rural Health Association’s Annual Conference, with several guests lined up to chat with us!
“We need to work in our own communities to build the workforce from the ground up.”
The panel discussion covers topics ranging from access to quality medical care in rural communities, finding new models of education to train students in real-life environments, cultural issues in the community, to the humanizing technology. The panelists touched on issues they have experienced within their organizations and areas, and shared their best practices and unique solutions that helped bring their community closer together. Along with creative problem solving, the discussion also included what rural healthcare leaders can look to in the future, as well as ways the rural community can work to break down barriers to receiving quality healthcare.
“You see those emerging innovative solutions that are born out of necessity, where CEOs are able to innovate across borders without labels.”
Today, we will hear from Michael Snyder, Emma Eckrote, Jim Ballard, and Dennis Weatherford.
It's a special episode of Rural Health Leadership Radio! We are at the Indiana Rural Health Association’s Annual Conference in French Lick, IN, and we have several attendees lined up to have a brief conversation with us.
The Indiana Rural Health Association was founded in 1997 as a not-for-profit corporation for the purpose of improving the health of all rural citizens in Indiana. Since the organization’s inception, RHA has developed collaborative relationships with several state agencies, including the Indiana Primary Health Care Association, the Indiana University School of Medicine, the Richard G. Lugar Center for Rural Health, Indiana Hospital Association, ISDH-State Office of Rural Health, Health Care Excel and the American Heart Association. IRHA is a state member of the National Rural Health Association.
We are having a conversation about the importance of innovation and collaboration in rural healthcare with Greg Ruberg, the President and CEO of Lake View Hospital.
“It’s my passion in healthcare to be working with rural health and helping to advance rural health whenever I can.”
Greg Ruberg is the President and CEO of Lake View Hospital and is the Vice-President of Saint Luke’s Hospital in Minnesota. He also serves as administrative support to North Shore Health and Board Chair of Wilderness Health to North Shore Health. Greg has had a passion for rural healthcare since high school, where his interest in physical therapy would eventually lead him to his career in rural health. Greg values innovation with his teams and embraces the importance of collaborating within the community. Greg was able to co-locate the local outpatient behavioral health clinic to the Lake View campus, bringing high quality, integrated care to their patients.
“In rural healthcare, we have to be open to innovation and drive change to bring more value to our patients.”
Greg has also collaborated with local law enforcement to tackle issues together, such as patients in a mental health crisis. The relationship has carried on for five years, allowing for a team effort to better serve their community. Greg has also brought forth other valuable connections with the local school district to stimulate student interest in the healthcare profession.
We’re talking about occupational health issues within the agricultural community with Knesha Rose-Davison, the Health Communications Director at AgriSafe.
“We known farming is a tough occupation but they have some of the hardest working, and most dedicated people…”
Knesha was born in Arkansas Delta, with many of her family members working in agriculture. She received her Bachelor of Science in Biological Sciences in 2002, and in 2016, obtained a certificate in Agricultural Medicine, focusing on rural occupational health and environmental health safety. At AgriSafe, they focus on protecting the people that feed the world, and through the Total Farmer Health Program, Knesha and her team is able to look at all of the potential factors that can affect a producer’s health and wellbeing.
“Everything impacts a farmer or producer’s life and we have to take that into consideration…and try to provide information to help them alleviate some of those concerns…”
Knesha also serves as the 72nd president of the Louisiana Public Health Association and is a March of Dimes Gretchen C. Carlson Advocacy fellow. She has covered the spectrum on care, ranging from infants to the elderly, and eventually took her position with AgriSafe, bringing her back to her Delta roots. Knesha has over twelve years of public health experience, and is passionate about serving vulnerable populations and increasing health care access and equity.
Below are the resources mentioned during our conversation:
We’re talking about empowering rural communities to address impactful health disparities with Dr. Fran Feltner, Director of the University Of Kentucky Center Of Excellence in Rural Health.
“Within these beautiful mountains there’s a lot of poverty and people who need our help and need improved access to care.”
~ Dr. Fran Feltner
Dr. Feltner was born and raised in rural Kentucky, having served rural health care in numerous different ways. She has held positions ranging from office nurse, to delivering babies, to caring for elderly patients, and has enjoyed every moment of being a nurse in rural health care. Dr. Feltner became the Clinical Director of the HRSA program, which would eventually lead to her role as the Director of Lay Health Worker Division, at the University of Kentucky. Dr. Feltner would later become the Director of the Kentucky Homeplace Program, with the main goal of increasing access to care and reducing health disparities in rural Kentucky.
“Take care of yourself first so that you can take care of other people.”
~ Dr. Fran Feltner
Dr. Feltner would then become the CEO or Director of the Center of Excellence in Rural Health. The main goal for Dr. Feltner and her team is to work across rural Kentucky with assisting people in their communities to solve problems. Dr. Feltner researches links between vulnerable communities and their health care system, social determinants of health and their effects on health outcomes, as well as the role and impact of community health workers. She thoroughly enjoys both the research and community engagement that comes with her work, and how she and her team really become a part of the community that they serve.
We’re talking about obstetric care in rural health with Dr. Valerie Taglione, resident physician at UP Health Systems – Marquette.
“I think it’s important for us physicians to lead patients by teaching them how to improve their health and then make a decision together…”
~Dr. Valerie Taglione
Dr. Taglione grew up in Portland, Michigan where she was inspired by her sister’s trips to medical schools to focus her career in medicine, and eventually began shadowing in rural emergency rooms. She attended Michigan Technological University, where she earned her degree in Medical Laboratory Sciences. Right after college, she went on to attend medical school at Michigan State University, in the College of Human Medicine. Dr. Taglione completed her clinical training in the Marquette, Michigan, receiving education in rural medicine and completing her training in the rural physician’s program.
“…there’s a new spark for passion in rural health that I think is really promising.”
~Dr. Valerie Taglione
Dr. Taglione helped conduct a study on obstetric care in rural health, looking at the access to maternity care in rural Michigan. She looked specifically at prenatal care, labor and delivery services, and specialized obstetric throughout the Upper Peninsula, the Northern Lower Peninsula, and some counties in the Southern Lower Peninsula. The study mapped out counties in these areas and looked to identify gaps of coverage in obstetric care.