With the state of American health care and COVID-19 both front and center in the last election and in our everyday lives, this topic seems to be overlooked amidst the politicking, shouting, and lack depth in what is offered as news. The inequality in our healthcare insurance system is certainly no secret, but what may not be well known is the inequality in our country’s access to healthcare.
Licensed medical care can be easy to find in major cities, highly populated suburbs, and wealthier towns. Doctors’ offices, community health centers, urgent care centers, but what about small towns and rural areas?
Urban areas tend to receive more medical attention, while rural areas typically don’t have as many medical treatment options. When people in these towns have an emergency and need a doctor’s help immediately, they have limited options.
Sometimes, people living in rural towns must drive hundreds of miles to get to a doctor’s office or hospital. This hindrance to access is made even more dangerous by the fact that rural populations tend to have more chronic illnesses and dependent on federal medical programs. COVID-19 has made these disparities even starker, putting rural communities in a frightening position.
Rural medicine is lacking, but the medical industry can lead the way to make the necessary changes and ensure every person has the healthcare they need.
A Lack of Rural Medicine
Many small, out of the way towns across America don’t have anywhere near the medical resources as can be found in a city. Although more than 50 million people live in rural areas, less than 10% of physicians practice in these communities.
In Wheeler County, Oregon, there is no doctor, psychiatrist, or dentist, according to Joy Anderson, a community health center leader. She says that people have to travel 70 miles or more to reach a physician.
Other areas, such as in Alaska, it would take thousands more doctors and dentists to remedy the shortage of medical support.
Not all rural communities face the same dearth of medical support, but these examples show how dire the situation is for many people. In cities and their surrounding communities, residents can find providers to care for a broken collar bone, pregnancy, chemotherapy, or a life-threatening injury in minutes, while everything beyond first-aid maybe out of reach for others.
The Risks of Not Having Rural Medicine
A study by the CDC shows that residents in rural areas are more likely to struggle with health problems or encounter dangerous activities.
Some of these issues include lack of regular health screenings and insurance, higher levels of smoking, and physical hazardous jobs.
Besides limited access to healthcare, the populations in rural places tend to be older. These factors combined to make COVID-19 a serious threat to less populated counties.
With fewer doctors, it has been difficult to reach residents in these counties. Although the virus is frightening in larger groups, it might be even worse in these communities where hospitals are miles, even days away. COVID-19 has shed more light on how the number of doctors in rural areas is dangerously low.
This shortage of physicians in rural America is not something to downplay or overlook. However, by examining the causal factors, it may be possible to come up with solutions.
Why Is There a Shortage of Rural Physicians?
The shortage of rural physicians is mainly because doctors usually practice in urban areas. Often, physicians practice where they train, and they rarely branch out after earning their degree.
Not Enough Medical Schools
The fundamental problem is a lack of medical schools in rural counties. Medical facilities are usually in areas with higher population density because it appears that’s where the most demand is.
More Urban Equals More Money
Dr. Vikas Saini, president of the Lown Institute, says that physician “training systems are biased towards cities and big urban centers.” Physicians near cities tend to make more, especially those in specialty fields. Therefore, these physicians make more money and they support the best medical schools where they train next up-and-coming physicians.
This bias leads to urban areas having higher-paid doctors and their hospitals supporting local medical universities to provide training. In rural areas, it’s less common to find hospitals financially supporting or training young doctors. The result is that fewer new doctors are likely to stay in these smaller communities.
Not Enough Rural Medicine Students
Too few rural students apply to medical school, so even if they decide to return home to open a practice, there are never enough of these upcoming physicians to supply the great demand for rural doctors.
These young doctors may worry they will earn less if they aren’t in a city, and with student loans hanging over their heads, it is harder to pass up a high paycheck from a city job.
Is There a Solution?
It is possible to alleviate these problems, but it won’t be easy.
Pay Rural Physicians More
One of the biggest grievances right now is that doctors who practice in rural communities are at a disadvantage. This conception means that there is a significant social risk both for doctors and residents.
With this in mind, one solution would be to pay doctors for the care they perform, not how many patients they see. Physicians should always practice quality over quantity.
Thankfully, the National Academy of Sciences, Engineering, and Medicine reported on how social factors could play a more significant role in physician payment. Doctors of rural areas might receive bonus paymentswhen they treat disadvantaged patients, such as those with lower income in rural communities. This way, the doctors will not be at a disadvantage, and they will receive pay based on the quality of service.
Provide Scholarships and Recruiting
All efforts to find and make doctors must focus on the source: the students. Some universities conduct outreach programs to attract students from rural counties who are interested in the medical field. Recruiters then encourage them to practice medicine in their home communities.
It would take federal and state action to ensure that rural health care services and schools have adequate funds and support, just like urban cities. It takes a village, so to speak, to provide the resources for recruitment and scholarships for these students.
It must be all hands-on deck for the medical community to solve these pressing issues for rural medicine. Everyone deserves access to healthcare when they need it, whether they live in an apartment in the city or a farm out on the plains.
While there are only so many options to bring hospitals and doctors to these rural places, every patient is worth the effort. Whether we provide a hospital that’s 20 minutes closer to a family or a team of house-call doctors to visit homes, any care will be great care, indeed.