Dr. Katherine Fitting was darting from room to room in the small South Park Health Care facility in Fairplay, giving out doses of the Moderna COVID-19 shot during a recent vaccination drive. This rural area, surrounded by mountain passes difficult to traverse, does not have the facilities to store the Pfizer-BioNTech vaccine at its requisite sub-zero temperatures.
One man Fitting treated didn’t want to give his name because he said his wife is suspicious of vaccines and didn’t want him getting the shot. Another woman in her late 60s was still immunocompromised after recently beating stage-three cancer. She said she was only getting the shot “because if I get (COVID) now, I’m dead.”
Dr. Fitting remained upbeat, joking with the patients and acknowledging their misgivings before passing on a card with information about their next dose and moving on to the next room. She described the clinics as energizing.
“Everybody who walks through that door wants to be there, is excited about getting their shot and for a lot of our people, this is the biggest social event they’ve attended since COVID started,” she said.
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Fitting, 70, is the only general practice doctor based in Park County — an area nearly the size of the state of Delaware. She started her medical office in Fairplay in 2004 after spending almost 20 years in Denver as a kidney specialist. She moved to Fairplay because she longed for the patient-centered work she did during her early career.
Fitting oversaw the construction of the South Park Health Clinic building and — seeing that as an appropriate career capstone — retired in 2013 after having some of her own health complications.
Yet, the facility did not survive. Fitting’s retirement left Fairplay without a doctor like her, and for five years her beloved clinic remained shuttered. After years of trying to recruit a new family physician and failing, Dr. Fitting decided the people of Fairplay needed her: She has been keeping the clinic open with the help of a small staff for almost a year during the coronavirus pandemic.
It’s a stark example of the persistent difficulty in recruiting young talent for the daunting workloads facing Colorado’s most isolated medical outposts.
A report from the Colorado Rural Health Center says less than 40 percent of primary care providers in rural areas remain in the same community for five consecutive years. Additionally, the report says it takes an average of one to three years to recruit a doctor to practice in a rural place, and that rural places in Colorado have only 9 percent of the state’s physicians.
Struggles persist, even as a big health care system moves in
Several years after the health clinic in Park County was mothballed following her retirement, Fitting was not only scrambling to find someone to take over her practice — she needed to find a way to get the money to keep it running.
“It’s incredibly hard to stay sustainable and especially financially viable because it’s kind of a losing game unless you have a really high volume of patients,” said Adam Mastroianni, operations director for the South Park Health Care clinic through Health One, the largest health care system in the Denver Metro Area.
In a campaign spearheaded in part by Fitting, local officials convinced residents to pass a 1-percent increase in local sales taxes to create a new Health Service District in 2016. That provided enough funding for the county to shop around for a partnership with a major health provider.
Mastroianni said Health One’s management of the clinic, which reopened in the fall of 2019, is still not breaking even.
“It’s still definitely a loss for us,” he said. “But, partnering with Health One, we have the ability … with economy of scale, to have the appetite for some of these other ventures in our community.”
Health One is hoping to gain insight from operating the facility to help with its wider rural health care outreach.
Michelle Mills, CEO of the Colorado Rural Health Center, said the arrangement between Park County and Health One is a fairly unique one in the state. Other rural areas that have instituted similar health districts use the funds to operate independently owned health care facilities.
She said working with a larger health system like Health One gives the clinic access to more resources, like specialists from the Front Range who make scheduled visits.
“The downside of that is you give up a little bit of the local control of your health care,” Mills said.
Finding the next Dr. Fitting
In August 2019, Health One announced the hiring of physician Kevin Hattaway, who was to begin seeing patients at South Park Health Care beginning in October that year.
Hattaway said in a release from Health One that he chose Fairplay “in order to return to what motivated me to become a doctor in the first place: to treat people with compassion and respect as their family doctor and not just a ‘health care provider.’”
But by April 2020, Dr. Hattaway quit his position.
“(Fairplay is) not Breckenridge, although a lot of people think it is,” Fitting said. “There’s no escape, that’s the thing. If you don’t have the personality for this type of practice, you’re going to feel very trapped.”
Following Hattaway’s departure, Fitting told Health One she felt well enough to resume her old post.
“I don’t like being retired. I would much rather be working,” Fitting said. “I’ve been very fortunate in that I’ve done well and I feel like I am back where I belong.”
Some help has arrived for Dr. Fitting. A new full-time nurse practitioner has joined her in the clinic. She does have hope that initiatives such as the rural track program at CU Anschutz medical school will be able to find somebody “who was 30 years younger and [was] going to stay here another 30 years.”
As much as she loves being back in the clinic, she said she’d give up the job in a minute to secure that. But, she said, she’d still want to cover their days off.