POLICY
THE GROWING DIVIDE
THE CONSEQUENCES OF FEWER RURAL PHYSICIANS
By
HELEN KESSLER ABHIJIT RAMAPRASAD (Editor)
As the population in the United States continues to increase and grow older, more physicians are needed to keep the population healthy. Currently, there are almost 7,000 areas around the country with an inadequate number of primary-care providers, and with the current pace of population growth, the country could be short 95,000 doctors within the next decade. However, the lack of physicians is unevenly distributed across the country, impacting rural America the most. America is becoming more industrialized, but 97% of its land is still considered rural, and although 19.3% of the population live in rural areas, only 9% of physicians do. Nearly
half of rural populations do not have adequate access to medical services. There are several trends driving these statistics, one of which is the flow of physicians from rural to urban areas. The physicians leaving rural practice are usually relatively young (aged 45 or younger) and predominantly female. Other populations contributing to the exodus of rural physicians include international medical graduates, those not born in rural settings, and those working in a community far from metropolitan areas. There are numerous additional challenges encountered by physicians working in rural areas, including lower reimbursements for services,
clinician lifestyle considerations, spousal career needs, and school quality. It was once believed that the lower socioeconomic status of rural areas was a direct cause for the drain of physicians, as rural populations tend to be poorer, older, and sicker than their metropolitan or suburban counterparts. This, however, was not supported by a study completed by the American Academy of Family Physicians, which has shown that economic demographics of served populations does not affect physicians’ decisions to leave rural areas. Two major reasons for leaving, as quoted by physicians, included lack of a nearby hospital and low population. Interestingly, the decision by one physician to leave also caused nearby healthcare workers to also consider leaving, causing an exponential drain in access to health care. The ability to retain rural physicians in remote communities that lack hospitals remains one of the biggest obstacles to expanding access to care. There is a promising statistic for rural communities: 68% of physicians stay in the place they complete their residency. Despite the draining of doctors from rural areas, it is advantageous to entice
autumn 2018 || 21
