I've always been sort of interested in the rural countryside. Things happen out there that are very strange to city dwellers - John Sandford
If hit television shows like Grey's Anatomy are to be believed, the average American doctor is gorgeous, well-paid, brilliant, and resides in some gorgeous and spacious loft in some gorgeous and spacious city, where she or he spends most days contemplating romance and a perfect wardrobe. Reality, of course, is very different. In real life, doctors are exhausted, overworked, frequently underpaid, and, sadly, have very little time for life's little idle pleasures. But one part of the stereotype is true: They probably do live in cities.
Slightly over a century ago, more than half of all Americans lived in rural areas, and more than 40 percent of their doctors did as well. Americans have since moved out of the country and into the city -- by the 1960s, two out of every three Americans were residing in urban communities -- and their doctors moved even faster. While states like Massachusetts boast 414 physicians for every 100,000 Americans, in more rural stats that ratio is sometimes as dismal as 176 doctors for every 100,000 residents. This means that unless you live in a big city, your community is 2.5 times more likely to be facing a severe shortage of primary care physicians.
To a certain extent, that's understandable. Doctors, like everyone else, are not immune to business considerations, and from a strictly business standpoint, it seems sensible to want to set up shop where you're likely to attract the greatest possible number of potential clients.
It seems sensible, but, increasingly, it isn't. The future of American medicine, from both an economic and a professional standpoint, isn't in New York or Seattle or Chicago; it's in Vidalia, Reidsville, and Statesboro. And it's not only because rural areas have greater demand, and therefore save young doctors from the cutthroat over-saturation of any large market. It's mainly because the life of a rural doctor, ironically, is much closer to the glamorous ideal you see on TV.
It sounds like a strange statement, but consider the evidence. Down where we are, in southeast Georgia, we live in the communities we care for, and the communities aren't large. This means that we attend church with our patients, see them in the local diner and at the annual charity auction, know them from the PTA and the town's 4th of July picnic. When they end up in our care, then, we never treat them with the same detached manner as an urban doctor who sees hundreds if not thousands of strangers each week.
I'm not suggesting, of course, that physicians in large metropolitan areas give their patients anything but the most excellent care possible. I am suggesting, however, that when the patient sitting in your office isn't just a name and a case history, but a neighbor and a friend the atmosphere is very different.
All these warm, fuzzy feelings, however, have clinical advantages as well:
Because we get to know our clients so intimately, we get to offer them both the kind of diagnosis and the sort of care that is specialized to their own needs. Even when the volume of patients is high -- and it often is -- we don't believe in the industrial approach to patient management. Whether with spinal injuries, joint problems, or physical therapy patients, we do what one does with folks one cherishes: We take the time to listen, comfort, and heal.
And learn: Because advances in medicine often depend on close and careful observation of causes, conditions, and permutations, it pays off to have a clinical environment free of the rush and the hustle of big city life. Peace of mind is essential in our line of work; we have it in spades in our small rural towns, and it gives us rural doctors the luxury of being as slow and thorough as we need to be.
So while downtown Statesboro may not be as cinematic as the sweeping, rain-soaked metropolis you see on Grey's Anatomy, if you're looking for the moving, dramatic, and intimate hospital environment you see on TV, and for the passion and commitment that make doctors such great subjects for hit shows, forget about big cities and their grind, and head down south. We'll treat you not only as a patient, but as a friend.
Source: Don G. Aaron, Jr. MD, To Save American Medicine, Look to Rural Doctors, The Blog, Huff Post, May 05, 2014.
Even before the pandemic, the health care systems that serve rural Americans were in decline: rural hospitals were closing their doors, and the medical workforce was shrinking. This year, as the coronavirus outbreak has made its way from major cities to rural America, threats to the rural health care infrastructure have only increased.
Living in rural America certainly comes with a number of benefits. There is less crime, access to the outdoors, and lower costs of living.
Yet, not everything is rosy outside the city limits. Rural communities face growing infrastructure problems like decaying water systems. And they have more limited access to amenities ranging from grocery stores to movie theaters, lower quality schools, and less access to high-speed internet.
Yet perhaps most daunting are the tremendous health disparities rural Americans face, in terms of both their own health and accessing care.
Presidential candidates and other politicians have talked about the rural health crisis in the U.S., but they are not telling rural Americans anything new. Rural Americans know all too well what it feels like to have no hospital and emergency care when they break a leg, go into early labor, or have progressive chronic diseases, such as diabetes and congestive heart failure.
The health care situation in rural America has gotten worse since my childhood. Rural Americans face serious health disparities because of the shortage of physicians and the resulting lack of access to care.
There's a changing of the guard going on in the health care industry, and its effects may be most apparent in rural America. As baby boomer doctors retire, independent family practices are closing, especially in small towns. Only 1% of doctors in their final year of medical school say they want to live in communities under 10,000; only 2% were wanted to live in towns of 25,000 or fewer.
If not for telehealth, Marcin says, the costs of getting what should be routine care "are significant barriers for those living in rural communities."
In some parts of central Appalachia, doctors are few and far between, and so is the money to pay for them. That leaves a weekend-long annual medical event as some people's only way to get treatment.
Adopting m-health would allow doctors to reach out through mobile phones and tablet apps to conduct examinations while such patients remain at home; track exercise, blood pressure or other metrics; send reminders to take a walk or take a pill; or deliver information to help manage chronic ailments. But spotty cellular networks in the southern Sierra create problems for people using mobile apps.
As these data demonstrate, there is a lot of conflicting information regarding the degree of shortage of rural surgeons. It can be difficult to draw conclusions and come up with a real answer to the question of how many rural surgeons are needed now and in the future.
The simple fact of where you live can have a huge impact on your health.
The rugged lifestyle has its appeal, just not for physicians.
If you're looking for the moving, dramatic, and intimate hospital environment you see on TV, and for the passion and commitment that make doctors such great subjects for hit shows, forget about big cities and their grind, and head down south.
Welcome to the Rural Health Research Gateway. This site provides access to publications and projects funded through the federal Office of Rural Health Policy (ORHP) as part of the Rural Health Research Centers and Analysis Initiatives grant program.
Welcome to 3RNet, the National Rural Recruitment and Retention Network. 3RNet members are non-profit organizations helping health professionals find jobs in rural and underserved areas throughout the country. 3RNet members are eager to talk with you about jobs and opportunities that are available in their locations.
The Canadian Rural Health Research Society offers the opportunity for researchers and their collaborators to network with new and established researchers of many disciplines engaged in rural, remote and northern health research.
The international electronic journal of rural and remote health research, education, practice and policy. Rural and Remote Health was initiated in 1998 by a grant to Deakin University from the Department of Human Services, Rural health Division, Victoria, Australia. The initial vision was to serve rural and remote communities throughout the world by providing a community forum and specific health-related information.