Fewer staff, longer delays and fewer options: Rural America faces a health care crisis

More than 40,000 graduating medical students learned Friday where they will spend the next three to seven years of their medical training.

As the United States grapples with a simultaneous shortage of primary care physicians and a rural health care crisis, many of the graduating students are poised to enter the front lines of the nation’s health care shortage.

At least 136 rural hospitals and health systems closed between 2010 and 2021, and over 40% of rural hospitals operate with negative profit margins. Despite billions of dollars in healthcare investment, hospitals across the United States face the possibility of closing.

“I would say this is probably the worst time for health care that we’ve ever experienced,” Joanne Conroy, CEO and president of Dartmouth Health, told ABC News. She noted that increased costs, inflation, limited housing and labor shortages have made managing rural hospitals more challenging.

“We know what to do if we face another pandemic,” Conroy said. “The question is whether we have the financial sustainability to see it through.”

Many hospitals that remain open have cut costs to survive by offering fewer services and beds.

In 2020, 47% of rural community hospitals did not provide midwifery services, with 89 midwifery units closed between 2015 and 2019. Seven million women live in counties with limited or no access to maternity services, affecting half a million newborns per year.

According to Conroy, patients are already feeling the impact of the crisis, noting that some women in New Hampshire have to drive two hours to deliver their babies. Other effects include fewer emergency room beds, delays for elective surgery and longer wait times for prescriptions or ambulance pickups.

For new medical professionals entering their residency, especially those joining rural systems, the circumstances of struggling health systems are beyond their control.

“It’s not my job to solve all the problems for an entire community, that’s impossible. When you feel like it’s your responsibility, burnout is basically inevitable,” said Katie Stevenson, a medical student at Tufts. “When you feel like your goal is to do the best you can with the resources you have, you’re able to adjust your expectations a little bit.”

An increasing number of students are entering medical school programs that focus on rural medicine. In 2019, the Health Resources and Services Administration issued grants to establish 32 newly accredited rural residency programs to complement existing programs.

This year, Tufts School of Medicine will graduate its tenth class of students from its Maine Track MD program, a partnership with Maine Medical Center that allows students to follow a community-based curriculum and receive financial incentives to promote primary care specialties. medical assistance.

Graduating approximately 40 students a year, 27 percent of Maine Track students were matched to programs in Maine and 47 percent were matched to primary care programs, according to Dena Whitesell, assistant dean for students at Tufts and a psychiatrist at Maine Medical Center .

“We know that students and residents who live in an area [and] who practice in a field are more likely to practice in that field in the future,” Whitesell said.

Liv Faure, a Tufts student who is in charge of a residency program at the University of Vermont, grew up in rural New Hampshire and said she feels motivated to work in a community like this where she can positively impact local residents.

“I think for me, my purpose is to live and work in the community that I serve,” she said. “So I’m really in a place where I go home or go to the grocery store and see my patients all the time because that’s the world I live in and work in.”

While rural hospitals are closing in record numbers, PCPs — medical professionals that patients regularly use for checkups and other routine care — face additional challenges, especially in rural areas, experts say.

Greg Savin, a PCP who has practiced in Massachusetts and Maine as well as a professor at Duke University School of Medicine, said he worries that the goals of primary and long-term preventive care can sometimes be at odds with larger health care systems. .

“We get paid to do things for people. We are not being paid to keep the population healthy,” he said.

Additionally, he believes that the costs associated with medical school—including the high cost, the likelihood of incurring debt, and the significantly higher pay for pursuing competing specialties such as orthopedic surgery or dermatology, for example—disincentivize primary care options such as family or internal medicine.

“It can be very attractive to want to go into a major where you’re guaranteed to make more money and pay off that debt more easily,” Stevenson said.

Owen Foster lives in rural Vermont and has felt the impact of the reduced number of PCPs available, spending six months trying to get an appointment. Living in a rural area, Foster shares his dilemma with the millions of rural Americans affected by the shortage of PCPs.

“You need essentials at certain intervals in your life,” he told ABC News. “If you don’t have a primary care provider, you can’t get one and you can’t get the referrals you need, so it’s really, really hard.”

What makes Foster’s experience unique is its position as the state of Vermont’s top health care regulator. As chairman of Vermont’s Green Mountain Care Board, he oversees the quality and costs of the state’s health care system.

Learning of the shortage of primary care physicians in Vermont, Foster decided to use the opportunity to find a PCP as a chance to explore the market as a “mystery shopper.”

“What I found was that I was completely unable to find a doctor,” he said. “I called eight places and the best I got was an indefinite waiting list that never materialized.”

Rural areas make up about two-thirds of primary care physician shortage areas nationwide, even though only 20% of Americans live in rural areas.

The problem is also likely to worsen over time. Projections indicate that the United States will likely suffer from a shortage of between 17,800 and 48,000 PCPs by 2034.

In addition, health care professionals believe that a shortage of PCPs can make other elements of health care more expensive and worsen overall patient outcomes. Savin gave the example of a person who gets strep throat. Without a PCP, the person may go to the local hospital emergency room, which is significantly more expensive than other treatment options.

“In terms of the disparity of resources, you know, a kid with strep throat showing up in the emergency room is like cutting butter with a chainsaw,” Savin said.

Foster added that primary care providers are “critically important to controlling health care system costs” because of their role in early identification of problems, their ability to diagnose mental health problems and their approach to preventive medicine.

However, PCPs in rural areas struggle to find and retain staff, negotiate with insurance companies and prevent burnout, according to Foster. The shortage of PCPs combined with the increased health care needs of an aging rural population creates a troubling combination.

Despite those problems, Foster said he’s optimistic about some approaches to making primary care more financially feasible, including adding a floor on PCP costs within health plans and government involvement in setting rates. .

A new generation of students graduating from rural rail programs also has the potential to turn the tide on rural PCP shortages, with 571 additional primary care matches this year. Stevenson, for example, coincided with the Cherry Hill Swedish Country Program in Washington state.

“I think we have an opportunity in this country to do a much better job of taking care of our patients if we do a better job of funding primary care and preventive care and creating a healthy environment,” Stevenson said.

Leave a Comment

Your email address will not be published. Required fields are marked *