America is facing a shortage of physicians and other healthcare professionals. In previous articles, we’ve discussed some of the communities already being impacted by a lack of access to care because of doctor shortages, mainly through the lens of low socioeconomic status or historically underserved racial and ethnic communities. In this article, we want to look more closely at the crisis caused by a lack of rural doctors.
Rural communities face a unique set of challenges that contribute to a significant healthcare deficit. This blog post aims to shed light on how widespread the problem is, why it’s happening, and some of the steps medical schools are taking to try to bridge the gaps.
The Scope of the Rural Healthcare Shortage
According to a September 2023 article from STAT News, the United States Health Resources and Services Administration (HRSA) reported that while 15% of Americans lived in a rural area in 2020, only 10% of the nation’s health practitioners were located rurally. As a result, 65% of rural areas have a primary care practitioner shortage.
Furthermore, the American Hospital Association (AHA) reports that 136 rural hospitals closed between 2010 and 2021. This means that, in addition to PCP shortages, rural residents struggle to access specialist services, including home health care, hospice and palliative care, substance abuse disorder treatment, and mental health care.
The need is especially acute in maternity and OB/GYN services: 47% of rural hospitals responding to an AHA survey in 2020 reported that they did not offer obstetric services. In the same year, a March of Dimes survey estimated that 2.2 million rural women of child-bearing age live in a maternity care desert where there are no hospitals, birth centers, or obstetric practitioners of any kind within their county.
Financial Crisis in Rural Hospitals
One of the factors behind the rural healthcare crisis is the difficulty hospitals have in staying afloat financially. Because they are located far from population centers, rural hospitals must pay more to have materials delivered, machines serviced, and to recruit workers. Because they are serving sparsely populated areas, rural hospitals often don’t have the patient volume they need to cover these higher operating costs, especially if they are staffing emergency departments that need to be open 24/7. When hospitals close, residents lose access to medical imaging and laboratory testing as well as emergency departments.
The Kaiser Family Foundation found that, as of 2019, 41% of rural hospitals were operating in the red. The pandemic actually improved the situation somewhat, thanks to relief funding from state and federal governments. However, this funding has begun to expire. The Center for Healthcare Quality and Payment Reform reports that more than 30% of all rural hospitals—about 600 in total—are at risk of closure. Of this group, 300 hospitals are at risk of closure within the next 12 months.
Rural Postings Are Less Attractive to Many Doctors
There’s a myth in the medical profession that rural doctors command much higher salaries than their urban and suburban counterparts, sometimes by as much as 20%–30%. This myth may seem logical based on the idea of the law of supply and demand. However, a New England Journal of Medicine report found that rural doctors generally only see a much more modest salary bump of 5%–10%.
This rise in pay may not compensate for a perceived lack of cultural amenities and local infrastructure in rural areas. It may also not compensate doctors in rural areas for the additional work they often have to take on. A March 2023 ABC News report details how many PCPs in rural areas, for example, have to be capable of dealing with a wide range of health issues, from minor infections to strokes and premature labor, simply because there is nowhere their patients can get to in time for other treatment.
A 2019 NPR report on the difficulty of recruiting rural doctors also notes that some rural PCPs find it even more difficult than urban or suburban PCPs to manage their work-life balance. Because they are the only doctors in their communities, they may need to be on call frequently. They may also need to be prepared to encounter patients with questions when out and about while off-duty.
Rural Residents Struggle to Access Healthcare—Literally
Finally, healthcare is just more difficult to get to for rural residents. The U.S. General Accounting Office (GAO) reports that residents of rural areas are less likely to have health insurance than people living in urban areas. Those that do have health insurance may find that, due to a lack of healthcare facilities in their region, they must travel “out of network” (and thus pay extra) to access treatment that would otherwise be covered.
Rural residents also must travel farther to get to a healthcare facility. This means having to take more time off work and spend more on transportation and fuel costs than other residents. Attending an appointment with an OB-GYN who is 100 miles away, for instance, becomes a half-day journey rather than a simple trip across town.
The GAO also notes that telehealth services, while helpful, are also not the universal solution some people may think they are. This is because 17% of rural residents lack access to high-speed internet access, compared to about 1% of urban and suburban residents.
What Can Be Done?
Addressing the shortage of healthcare professionals in rural areas requires a multi-faceted approach. Policymakers will need to address financial support for rural hospitals and key investments in infrastructure, including high-speed broadband that helps more rural residents access telehealth services.
At the practitioner level, medical schools are beginning to act to encourage more medical students to relocate to—or stay in—rural areas. In 2019, the HRSA began to provide funding for rural medicine residency programs. 39 such programs have opened in the last four years, supporting more than 500 residential spots.
At Tiber Health, we have university partners who offer our Master of Science in Medical Sciences (MSMS) online. This potentially makes graduate health science education—and, ultimately, access to medical school and other health professional programs—more accessible for students located in rural areas. If you’re interested in pursuing your MSMS with us, learn more now!