Serving a Diverse Community
The practice has deep roots in the community: When it was founded in 1988 by Thomas Wiard, M.D., and Mary Vader, D.O., they were known to take chickens as payment, if that’s what patients had to give. This ethos continues to the present day, even as the practice has grown to include six owners, one full-time pediatric nurse practitioner, two full-time physician assistants and two part-time nurse practitioners.
A high poverty rate persists, with 18 percent of Montrose County residents and almost 17 percent of Delta County residents living below the poverty line, according to the American Community Survey from the U.S. Census Bureau.1 Many of these patients are covered by Medicaid. As a result, Pediatric Associates was a medical home prior to the concept becoming the new buzzword, says Shantel Tubbs, who is now the clinical manager and who has been with the practice for over 20 years.
“We were a safety net clinic before I even knew what that meant,” she says. “We were seeing that population of kids that didn’t have anywhere to go. We didn’t want anyone not to be seen. We were always here for them.”
The practice now sees roughly 6,500 patients per year from their unique patient count of 9,200, which translates into about 27,000 visits annually. They grew from coordinating this care organically – everyone pitching in to get children what they needed – to bringing a registered nurse and then a medical assistant in to manage that complex task.
“We were one of the first practices in our area to have an actual triage person in-house,” says Hickert.
It’s an important role, as this person does everything from connect with school nurses for routine care to help manage care for patients who need to see multiple specialists over the course of several years. Many of the children they see are faced with this eventuality.
“We have some extremely complex patients who have decided to live in the area because their support systems are here,” says Hickert. “This can be challenging when they have an acute illness that brings on complications or their own health condition is advanced, and a flight to Denver is sometimes the only answer.”
The area’s economic realities play a role, as chronic mental health conditions, developmental challenges, and other diagnoses often associated with sustained and generational poverty impact their patients. They also see a fair amount of injury resulting from outdoor recreation, like hunting and ATV riding.
If follow-up care requires a visit to a children’s hospital, this means a five-hour drive over the mountains, in good weather.
“We live in such a rural area where kids can’t get to a specialist, especially in the wintertime – it’s hard,” says Tubbs. “These kids are high poverty; they might not have access to a car.”
The practice’s chronic care nurse plays a key role in connecting families with the resources they need. A doctor with the practice runs a program to raise funds for patients who need assistance.
“I can’t tell you how many times we’ve bought bus tickets to get a family from here to Denver,” says Hickert.
And then add to these economic challenges a cultural dimension. The area is home to a sizeable Hispanic population, some of whom speak little to no English. According to the American Community Survey, about 19.7 percent of Montrose County residents and 14 percent of Delta County residents are Hispanic. And out of those roughly 6,000 Montrose County residents who speak English in addition to a primary language, about 39 percent of them report speaking English “less than very well”.2 In Delta County, that number is 42 percent of about 2,700 residents.2
Pediatric Associates has brought on interpreters both in-person and on the phone to help deliver the best care possible, and several medical assistants and doctors are fluent in Spanish. In addition, the entire staff has made a commitment to understand where their families are coming from, constantly connecting and reconnecting with the community to make sure their needs are met.