Why Poverty Is Making Doctor Shortages Worse
You can’t talk about health today without someone mentioning the phrase “social determinants of health.” These include regional factors like access to healthy food, exposure to pollution, poverty, and other variables that people often have little control over. Because the majority of Americans live in urban or suburban areas, though, the health issues facing rural populations are often overlooked. In recent years, these communities have experienced significant health issues. Poverty has compounded the shortage of doctors in rural areas, but there are several changes that could help.
Evaluating Rural Medical Access
Across the country, about 20% of Americans live in rural counties, but only 10% of doctors practice in these areas. That can lead to circumstances like the one Texas physician Ed Garner faces each day – until a young doctor came to town recently, he was the only doctor covering 11,000 square miles. And it’s not just that doctors don’t want to practice in remote areas, though this is sometimes the case. No, one of the major reasons for the access crisis stems from hospital mergers and closings in rural areas.
Care Where Care is Needed
How do we get young doctors to move into rural areas where physicians are most in demand? This question hinges on the reasons that people go into medicine in the first place. Among these reasons, two common interests that medical students cite include wanting to build meaningful relationships and a desire for a variable and exciting workday. A quick glance at the Washington Post’s profile of Ed Garner reveals that the senior physician experiences both; he knows the locals on a personal level and, with few additional staff and no other doctors, he does a bit of everything.
Of course, convincing young doctors that rural areas are where they can do the most good is more challenging than describing the communities or the needs they have. Doctors also need to be prepared to practice in those areas and urban residencies often fail to provide that support. When doctors are trained in advanced, well-staffed hospitals, they may feel ill-equipped to be the primary care provider, ER doctor, plastic surgeon, and more in a rural facility. To this end, several rural hospitals are developing fellowships designed to prepare new physicians to take over for them. The goal is not just to encourage young doctors to enter rural medicine, but to stay for the long term.
Fixing The Funding Crisis
In addition to developing rural medicine fellowships, another way that hospitals are trying to attract new doctors is by offering higher salaries than those doctors could earn elsewhere, and in areas with a lower cost of living. This may strike some as strange; most of these rural hospitals are operating at deficit, which is why so many have shut down in recent years. By paying more, these towns hope to attract and retain good doctors and compensate them for the immense responsibilities they’ll take on once they arrive.
Since 2010, 119 rural hospitals have closed and many more have gone through mergers, creating local monopolies, and both act to leave patients in these areas at risk. Even when they can get basic healthcare, there are no specialists and patients that experience serious emergencies often need to be transported hundreds of miles to the closest city. Those injured while far from both city and rural hospitals may not get help in time.
Bringing more doctors to rural areas will help improve conditions, but those areas need more medical centers, better equipment, and doctors who understand the unique factors that shape their health. In other words, rural areas need doctors who come from rural areas, in addition to an influx of funding. This is about the health of one-fifth of Americans who deserve better.
