Blog Post

Farewell to “the Old Family Doctor” and the “Local Hospital”: Now What?

Tom Timberman • March 20, 2019

The Current Situation:

Among those people lucky enough to live on Maryland’s Eastern Shore, there are some who are particularly blessed to live in the most rural areas. However, there are trade-offs and an increasingly critical one is easy access to comprehensive health care.

Many senior citizens and even many slightly younger long for a return to the last century, when there were family doctors, local hospitals, resident surgeons, obstetricians who delivered babies, and it all seemed so much easier. Of course, admittedly, many of today’s miracle drugs and organ transplants weren’t around then, but the basics were.

In 2019, beyond emergency wards or clinics, there are dwindling medical services found in the nine counties’ smaller, more isolated communities. There, older neighbors with chronic health problems need to schedule appointments with specialists frequently located at some distance.

Today, you need a car because adequate, scheduled public transportation is not available outside the Shore’s few cities. And then there’s the question of payment—health insurance, private, employer provided, Medicare or Medicaid, Obama Care, or uninsured. We all need to know exactly what our plan covers and what it doesn’t. Hospitalization or rehabilitation are usually very limited.

New Pressures on Rural Health Care Delivery:

These often arise when current physicians either close their practices and retire or convert to what is called Concierge Medicine.

If a doctor wants to reduce his/her patient load and yet retain some regular revenue stream, they may move to Concierge Medicine. To do this, they recruit some of their patients who are willing to pay an annual fee to remain with that doctor. The cost varies, but is generally $1400 – $2000 per person per year. The rest of the doctor’s patients then have to find another local doctor. This is often a difficult task as many medical practices are not taking new patients.

Who’s Responsible?

Really, no one; it’s called progress. The practice of medicine like other professions and businesses has been affected by the technology revolution and the younger generations’ willingness to move from position to position as they climb the different professional ladders.

The days of joining a company or opening a medical practice and staying there for thirty or forty years are over. Today’s hypermobility and constant information via cyber space mean firms and communities have to continually attract, and work hard to keep, good people. Rural, more isolated towns have been particularly hard hit by these changes.

Medicine and health care are, like much else, less a calling or an exercise in loyalty, but more a for-profit business with clear bottom lines. And the costs in the health care field have grown dramatically in the United States.

A stark example of the cost/benefit analysis and its impact on rural America is found in the medical specialty of obstetrics—pregnancy and childbirth. The population in most rural areas—including the Eastern Shore—is aging. This fact translates into insufficient numbers of babies being born to pay the high costs of obstetricians and their clinics. Thus, over 90% of these places have eliminated this fundamental service.

Adjusting to this New Reality:

The sad fact is that small town, rural community hospitals are no longer the centers of health care delivery. The 21st Century tiered methodology sees large regional critical care hospitals located in urban areas, hosting an array of specialists and surgical facilities. They are normally part of a larger system generally centered on a major teaching hospital, i.e., Johns Hopkins or the University of Maryland Medical School and hospital.

A summary of the problems faced by small towns and rural areas was presented in the 2018 Maryland Rural Health Care Plan ( MDRuralHealthPlan.org).


  • Access to quality health care
  • Sustainable, permanent funding sources to support this care
  • Chronic disease prevention and management
  • Health literacy and health insurance knowledge
  • Increased reliance on computer networks to access diagnostic experts and specialists; reduced human interaction
  • Transportation services
  • Emergency Medical Services

Varying Approaches to Filling Health Care Needs:

Different Eastern Shore counties have adopted different strategies to fill these widening gaps in health care delivery. For some, the overarching goal has been to pressure the owners of the small, local hospitals to keep a larger number of beds, at times by lobbying Maryland legislators. Others have focused on: (1) acquiring medical services tailored to their populations’ needs and (2) addressing the serious lack of transportation.

Still others have pursued acquiring a “Federally Qualified Health Center.” The second article in this series will discuss the only such Federally Qualified Health Center that exists on the Eastern Shore: The Choptank Community Health System.

Vote 2024. Image: CSES design
By Peter Heck November 19, 2024
It’s probably too early for a real analysis of why the Harris/Walz ticket was defeated in this year’s presidential election, although there are plenty of people taking a crack at it. For a couple of interesting examples, take a look at Heather Cox Richardson’s Nov. 6 column , or David Brooks in the New York Times. Important factors certainly included sexism and racism. Many Americans still aren’t ready to accept a woman leader — especially a Black woman. And I spoke to one local person who said that many Black men he knew were wary of voting for Harris because she had been a prosecutor, putting other Black men and minorities behind bars. Whether or not that was a factor, Harris’s share of the Black vote was some 10% lower than Biden’s. But the most significant factor was probably voter turnout. According to a Nov. 11 New York Times story , Democratic turnout was significantly lower than in 2020. This helped produce a narrow majority in the popular vote for the Republican ticket. Trump’s total nationwide was about 74 million votes, roughly the same as he received in 2020. Harris, on the other hand, was at 70 million — roughly 11 million less than President Biden’s 2020 total. If those voters had come out again and voted mostly Democratic, Harris would have some 81 million votes to Trump’s 74 million, giving her the popular vote. Depending on where the voters lived, that could have produced a very different result in the Electoral College and the election itself. Though the Electoral College totals imply otherwise, this was really a close election. Incidentally, a reaction against incumbents may be another significant factor, and a global rather than a U.S. phenomenon. An article in the Financial Times notes that every incumbent party — on both ends of the political spectrum — in developed countries lost significant vote share in an election this year — an astonishing turn of events. Here on the Eastern Shore, nobody should be surprised that the majority of the voting public went for the Republicans. The area, after all, is predominantly rural and conservative, with a few blue enclaves such as Easton and Chestertown. While town-by-town results on the Shore are not yet available, in Talbot County, in which Easton is the largest town, Trump won by some 500 votes. Queen Anne’s gave Trump the win by about 9,000 votes. Local elections were not on the ballot in 2024, but local officials on the Shore — mayors, sheriffs, state’s attorneys, county commissioners, delegates to the General Assembly, etc. — largely reflect that Republican dominance. And day-to-day life is more directly affected by these people in all communities than by anyone in Washington. Still, what happens on the national level will have its effect on all of us. The architects and supporters of Project 2025 are going to be part of the new Trump administration, and he has appointed some of the project’s supporters already. Those appointees are probably going to be quite adamant in pushing through their agenda. Even if they can’t accomplish everything, some of the proposed plans ought to be cause for concern, above all the weakening of women’s rights, especially reproductive freedom. And with the Senate, possibly the House, and the Supreme Court effectively on the same page as the administration, the constitutional checks and balances will be severely weakened. If, as he said he would, Trump imposes heavy tariffs on imports, almost every economist predicts that consumer prices will rise, thus making it harder to control inflation. If a mass deportation of immigrants gets underway, many jobs will go unfilled, particularly in construction and food service. This will further hurt the economy. It’s possible that pressure to fill those jobs could raise wages. If RFK Jr. brings his anti-vaccine beliefs to the health department, another pandemic — a new covid strain, or just the regular flu — could kill millions. If Elon Musk starts cutting back what he perceives as governmental waste, programs benefitting local communities are likely to suffer, again removing dollars from local and state economies. The foreign policy implications of some of Trump’s statements could be significant. He has threatened to pull the U.S. out of NATO. This may be unlikely, but that political stance may encourage current and would-be aggressors in Europe and the Middle East. And Trump has said he will end the war in Ukraine in one day. Does he really have that much influence on Putin? Or does Putin have that much influence on Trump? Time will tell. Looking down the road, one also has to consider Trump’s health. Born in June 1946, he will be 82 by the end of his term. What if he becomes incapacitated, physically or mentally? A stroke, a heart attack, or just the rigors of old age in a stressful office — all are possible. Would Vice President-elect Vance, a former venture capitalist in the technology sector, continue Trump’s policies, or would he have ideas of his own? At one time, Vance criticized many of Trump’s positions. If Trump is no longer in charge, could there be a period of infighting as various factions within the party and administration assert their own priorities? Any of that could have significant effects, and it’s not unlikely, given Trump’s age. So it looks as if we are about to live in “interesting times.” Some people are talking about leaving the country, while others are still trying to understand what just happened. Many are already looking forward and starting to concentrate on the 2026 midterms, when Republicans could consolidate their gains or Democrats could make a comeback. May we all get through these times to the point where we can tell a younger generation the kinds of stories our elders told us about the Great Depression or the Civil Rights movement — hopefully, with something resembling a happy ending. Peter Heck is a Chestertown-based writer and editor, who spent 10 years at the Kent County News and three more with the Chestertown Spy. He is the author of 10 novels and co-author of four plays, a book reviewer for Asimov’s and Kirkus Reviews, and an incorrigible guitarist. 
No mandate. Image: CSES design.
By Jan Plotczyk November 19, 2024
 The 2024 presidential election was over swiftly. The Associated Press called it at 5:34 am on Nov. 6, and by 8 am, President-elect Donald Trump was crowing about the “ historic mandate ” given to him by the American people. A “mandate”? Turns out not. Trump jumped to an early lead on election night, but in the following days, his lead diminished as mail-in and provisional ballots were counted. A Baltimore Banner article on Nov. 6 highlighted the “Trump shift” that had occurred in every political subdivision in Maryland, even in counties where Democrat Kamala Harris won. This shift described the increase in Trump support since his loss to President Joe Biden in 2020 . As of Nov. 6, the biggest Trump shift was an 8.1% increase in his support in red Cecil County, but there were also shifts in the central Maryland counties that are the state’s Democratic strongholds — 4.3% in Montgomery and lesser amounts in other blue counties. Fourteen counties recorded shifts of 4% or more. On the Eastern Shore, every county had a shift over 4.5% except Talbot (2.7%), and the five largest shifts were Shore counties. For the state’s Democrats, it did not look encouraging. But as mail-in and provisional ballots were counted across the state, the Trump shift was reduced everywhere, and as of Nov. 16, disappeared altogether in Garrett (-1.2%) and Charles (-0.1%) counties. The shift dropped below 3% in all Maryland counties. Cecil’s shift became 2.1%. Montgomery’s shift dropped to 2.9%. Talbot’s shift declined to 0.2%, lowest of the Eastern Shore counties. Now, instead of five, only two of the highest five shifts were in Eastern Shore counties. The red bars in the chart below represent the Trump shift percentage values as of Nov. 16, in ascending order. The grey bars represent the misleading (and ephemeral) Trump shift percentage values as of Nov. 6. Please note the degree to which the Trump shift lessened and disappeared in the 10 days after the election. Another red mirage. But if you had only read the Nov. 6 article and not looked at the updated data, you would have been fooled into thinking Trump support is stronger than it is.
School board elections. Image: CSES design
By Jim Block November 19, 2024
How many times were Common Sense readers told that the 2024 election would be the most important ever? Whoever the winner, people knew the results would not unite the country but further divide it. One place of divisive conflict on the Eastern Shore, indeed almost everywhere, is the local school system. Two extreme right-wing organizations targeting school board control have made their presence known on the Eastern Shore. Moms for Liberty , according to its website , wants “to empower parents to defend parental rights at all levels of government.” In the recent election, Moms for Liberty endorsed at least two Cecil Co. Board of Education candidates. One of them, Sam J. Davis (who got 44% of the total vote ), lost his race to Diane Racine Heath (55%). Another Moms for Liberty candidate, Tierney Farlan Davis, Sr. (57%), defeated Dita Watson (42%). Both defeated candidates were endorsed by the Cecil County Classroom Teachers Association . A second active conservative organization is the 1776 Project PAC . This PAC’s mission statement declares that it “is committed to reigniting the spark and spirit of that revolution by reforming school boards across America. Since progressive-led efforts to lockdown schools during the covid epidemic, test scores have declined, parents and students are increasingly worried about violence both in and out of the classroom, while politicians and activists push their own ideology.” Of the eight Eastern Shore school board candidates the 1776 PAC supported, three were unopposed. The five competitive races were won by 1776 PAC candidates; the average margin of victory was about 12%. The Talbot Co. candidate Ann O’Connor wrote a piece for the Delmarva Times and the Easton Gazette denying that her candidacy had received “endorsements from Moms for Liberty or any other group.” On the other hand, on X , we read that the 1776 PAC gave “huge congratulations to Ann O’Connor . . . for being elected to the now-conservative Talbot County Board of Education!” One might wonder whether or not any group gave her an endorsement. In a late October, the Washington Post ran a long story about the significant partisan cash flowing into Maryland school board races. In theory, Maryland school board elections are nonpartisan, because state law prohibits party labels on school board ballots. On the other hand, according to the Post, the 1776 PAC “has spent a total of $75,409.58 on 13 Maryland school board candidates across Cecil, Queen Anne’s, Talbot, Calvert, Somerset and St. Mary’s counties.” That sum and the other money spent on school board candidates does not indicate the strength of passion in the candidates and their supporters. Our governments are obligated to allow, if not to support, all citizens in their exercise of their First Amendment rights. Assuming freedom of speech applies to students and teachers , the last thing public school administrations should do is wrongly to restrict material that teachers teach and students learn. But when students learn that school systems inappropriately control what is taught, they will be at best confused. On one hand, they are taught they have free speech; on the other hand, they learn that in school, they don’t. Have we just been through American history’s most important election? If these school board elections diminish our Constitutional rights, the sad answer is yes. Jim Block taught English at Northfield Mount Hermon, a boarding school in Western Mass. He coached cross-country and advised the newspaper and the debate society there. He taught at Marlborough College in England and Robert College in Istanbul. He and his wife retired to Chestertown, Md., in 2014. 
Woman in gynecologist’s office. Image: CSES design
By Jeanette E. Sherbondy November 19, 2024
Although the election of Trump as president represents an open threat to maternal health according to the statements in Project 2025, there were some wins for women’s health at the voting booths. One major win for Maryland is the election of Angela Alsobrooks to the Senate. She has stated her position explicitly . She promised to co-sponsor the Women’s Health Protection Act, which would reinstate a nationwide right to abortion care by codifying Roe v. Wade . Even more strongly, she declares she will oppose any judicial nominee who does not support abortion rights. She firmly believes Congress and the Supreme Court should respect women’s health care decisions and leave them to be made between women and their doctors. Maryland also is a winner for passing a ballot measure to add the right to abortion into the state constitution. Six other states did the same: Arizona, Colorado, Missouri, Montana, New York, and Nevada. The National Law Review stated, “In Colorado, Maryland, New York, and Nevada, abortion was already protected under state law, so the ballot measures did not change what employers and health insurers will need to do to comply with the law. However, the ballot measures enshrined the right to abortion in those state constitutions, so it will be harder for future lawmakers to revoke these protections in the future.” Similar ballot measures failed in three states: Florida, Nebraska, and South Dakota. Maryland’s measure states that every person “has the fundamental right to reproductive freedom, including but not limited to the ability to make and effectuate decisions to prevent, continue, or end one’s pregnancy. The state may not, directly or indirectly, deny, burden, or abridge the right unless justified by a compelling state interest achieved by the least restrictive means.” Ironically, Amanda Marcotte in Salon noted that “In state after state, voters backed both Trump and ballot initiatives that advanced and protected progressive goals.” Fortunately, many organizations have reaffirmed their intention to continue to fight for women’s health. Moms Rising , for example, affirms its dedication to maternal health: “Focusing on equity in pregnancy, childbirth, and the period after childbirth, our organizing is built on understanding and lived experience of greater systemic issues mothers experience throughout motherhood due to race, class, and gender disparities. This work includes campaigns on maternal mortality/morbidity, as well as mass incarceration and police reform.” According to the Centers for Disease Control and Prevention , the maternal mortality rate in the United States is 32.9 deaths per 100,000 live births. In 2021, 1,205 women died of maternal causes compared to 861 in 2020 and 754 in 2019. That does not include all deaths occurring to pregnant or recently pregnant women. According to the American Medical Association, this spike in maternal deaths is the highest since 1965. The reasons are many. Dr. Sandra Fryhofer stated that “Black women are three times likelier than White women to die from a pregnancy-related cause. Health care access problems, underlying chronic conditions, and structural racism and implicit bias all contribute to these bleak statistics. “Poor insurance coverage prior to, during, and after pregnancy; lack of interprofessional teams trained in best practices; and closure of maternity units in many rural and urban communities” are other factors that contribute to bad maternal outcomes according to the AMA. It recommends expanding access to medical and mental health care and social services for postpartum women. The Commonwealth Fund wrote, “The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the covid-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80% — are likely preventable.” In her recent book, Eve (2023), Cat Bohannon explores women’s health within the largest framework possible — the last 200 million years of human evolution. She explains that humans have relied on gynecological aid for millennia because giving birth is very risky. However, when well supported and cared for, women can give birth successfully to the future generations, that is, as long as they have special care before, during, and after birth. According to the Commonwealth Fund , “Nearly two of three maternal deaths in the U.S. occur during the postpartum period, up to 42 days following birth. Compared to women in the other countries we studied, U.S. women are the least likely to have supports such as home visits and guaranteed paid leave during this critical time. The U.S. and Canada have the lowest supply of midwives and ob-gyns.” Given that mothers shape the health and growth of new generations, a society needs to put special emphasis into promoting the health and education and social well-being of infants and children by their moms. That means supporting women. Countries that do this benefit economically on the national scale and those that don’t fall behind. Racism and misogyny embedded in cultural practices, such as giving preference to males in detriment to females, to White people instead of to Black and Brown people, have long reaching deleterious effects. Egalitarianism has always been a human tendency that improves the chances of human survival. Jeanette E. Sherbondy is a retired anthropology professor from Washington College and has lived here since 1986. In retirement she has been active with the Kent County Historical Society and Sumner Hall, one of the organizers of Legacy Day, and helped get highway /historical markers recognizing Henry Highland Garnet. She published an article on her ethnohistorical research of the free Black village, Morgnec.
Graphic from the Salisbury Comprehensive Plan Report, Nov 2023. Image: Salisbury website
By Jared Schablein November 19, 2024
There is an urgent issue in Salisbury requiring immediate engagement. Mayor Randy Taylor's administration is trying to hide from our community that they intend to internally and unilaterally rewrite our 10-year Comprehensive Plan, without the knowledge of the Salisbury City Council. We need to encourage Mayor Randy Taylor and the City Administration that our council and our community deserve to be a part of this vital process. Last week public comments were collected at the City Headquarters Building. Residents submitted written comments and could share a three-minute comment addressing why this plan to subvert the Comprehensive Plan approval process is concerning to them. You can still help! Share this Email . We need to show the City that our residents are ready to take action! Please consider sending an email with this form to directly express your concerns to the Mayor's Office. Jared Schablein is the chair of Shore Progress.
Native American beadwork
By Lisa Michelle King November 19, 2024
Too often, K-12 social studies classes in the U.S. teach a mostly glossed-over story of U.S. settlement. Textbooks tell the stories of adventurous European explorers founding colonies in the “New World,” and stories of the “first Thanksgiving” frequently portray happy colonists and Native Americans feasting together.
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