Despite rural-to-urban migration trends, millions of Americans still live in rural communities. Census figures show that they make up 25% of the nation's total population; yet fewer than 10% of U.S. physicians practice in rural communities, according to the National Rural Health Association. The situation is likely to get worse as older rural physicians retire and new medical school graduates choose high-paying, non-primary care specialties better suited for urban settings.
The consequences are predictable. A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that one out of every four people living in rural areas said they couldn't get the health care they needed recently. And about a quarter of those said the reason was that their health care location was too far or difficult to get to.
To address the unmet demand for healthcare access in rural areas, an increasing number of rural hospital emergency departments are having to serve as safety-nets. "By 2016, nearly one-fifth of all ED visits occurred in the rural setting" (JAMA Network Open, 2019). During the years 2005 to 2016, "rural ED visit rates increased by more than 50%, from 36.5 to 64.5 visits per 100 persons, outpacing urban ED visits, which increased from 40.2 to 42.8 visits per 100 persons."
Expanding the reach of telemedicine is frequently touted as the answer to the rural healthcare dilemma. Unfortunately, the lack of broadband access in many rural areas is a major stumbling block to providing telemedicine to the areas most in need, according to a recent study published in the Annals of Internal Medicine (May 21, 2019). The researchers concluded that "Although telemedicine has the potential to address geographic barriers that result from long drive times to receive care, its potential will not be realized until the telecommunications infrastructure improves and public and commercial insurers develop and expand policies to reimburse telemedicine visits from patients' homes, particularly in the most rural counties."
In a rare bipartisan agreement in the national healthcare debate, a recent poll reveals that "voters want 2020 candidates to start talking about access to healthcare in rural America," according to an article in Becker's Hospital Review (June 12, 2019). "Three in five voters said they would be more likely to vote for a candidate who includes expanding rural healthcare access as part of their platform."
But there's still the question of how to persuade a young physician to choose a career in primary care with the objective of practicing in a rural community. A 2018 survey of graduates from U.S. medical schools found that fewer than four percent said they wanted to practice in a rural area or a town with fewer than 10,000 people (Association of American Medical Colleges). Perhaps physician recruiters need to go outside the U.S. "Doctors who graduate from international medical schools are more likely to serve rural patients," says Dr. Richard Liebowitz, vice chancellor of St. George's University School of Medicine in Grenada (fosters.com, June 2, 2019). "To improve rural patients' lives," says Dr. Liebowitz, "it's time to recruit more well-qualified international medical school graduates to America."
Ken Teufel, M.D.