Rural Health Care - who's out there?

20% of Americans or approximately 60 million people live in rural America. Those who live in rural communities are older, poorer and have more chronic diseases than the typical city dweller. The problem: few doctors choose to practice in rural America. And the doctors who are out there are getting older themselves and are close to retirement.



Medical schools, with few exceptions, are located in urban areas. What, you may ask, about medical students who we recruit from rural areas? Are they more likely to go back?



Take a typical 18-year old female raised on a farm in Nebraska. She goes to college in a city, stays for medical school in a city and then marries an aerospace engineer. Is she likely to go back to her home town? Hmm... probably not. On a positive note, studies do report that those from rural areas are more likely to return there... but not enough of them do.



Who are the doctors out in rural areas now? They are mostly family doctors. Family physicians are the only specialty that's evenly distributed across all settings - inner city, large rural and frontier, isolated rural. Other specialties (as seen in the graph below) cluster themselves in cities, where they can actually sustain a practice. BUT, we've had fewer people entering family medicine over the 10 years (exception of this year) and, as such, the rural doctor pipeline is drying up.

Figure: Physicians per 100,000 people

To ensure the health of rural Americans, we need to have more doctors practicing in rural areas. From studies, we know the type of doctors who are likely to end up in rural areas:

• doctors in family medicine (not pediatricians or general internal medicine doctors... and definitely not sub-specialists)
  
  
• doctors with rural origins
• doctors who are married when they graduate medical school
• male doctors (not being sexist - this is a statistically proven fact)
• doctors who have rural experiences during medical school and/or residency
  
  

So what do we need to do? We need to support more residency and medical school experiences in rural communities. Possibilities include rural elective opportunities, expanding rural residency training programs or rural training tracks.



We also need to talk about rural medicine as an exciting opportunity! In rural settings, family doctors get to do everything - from deliveries to surgeries to colonoscopies... a family doctor gets to call all the shots (unless the patient's condition is really serious). A family doctor gets to practice his or her full scope of training.



Doctors, especially family physicians, are needed now in rural areas! Otherwise, in a generation's time, we may not have rural communities and rural America!