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September 2, 2014

Why rural America doesn't attract doctors

Daily Briefing

Despite the vast need for primary care physicians (PCPs) to practice in rural areas, they often pass on such jobs because they like the amenities of more urban areas and the predictable flow of patients, Olga Khazan writes in The Atlantic.

More hospitals are closing—and it's creating medical deserts

There are about 6,000 federally designated areas of the United States with a shortage of PCPs, according to HHS. In rural areas, there are about 68 PCPs per 100,000 residents, compared with 84 PCPs in more urban areas. In five counties in Kansas, there are no PCPs at all.

"Put another way, about a fifth of Americans live in rural areas, but barely a tenth of physicians practice there," Khazan notes.

Although the Affordable Care Act (ACA) created grants for training PCPs to work in rural locations, it would take thousands more to alleviate the shortfall, according to health experts.

Does location matter? Rural patients skip nearby hospitals in favor of urban facilities

How did this happen?

The inequalities between urban and rural areas begins with medical school applicants—there are too few applicants from rural areas to begin with, says Howard Rabinowitz, professor of family medicine at Thomas Jefferson University's Medical College. Medical students with rural roots are more likely to return to their communities to practice, but still only 50% do, Rabinowitz says.

Moreover, residents are more likely to practice near where they train, and most of the prominent medical schools are in large cities. And when rural-born students go to medical school in a big city, they may not want to go home.

"[Providers] may graduate from a big school, and they realize they like the ballet," says Lyle McClellan, an Oregon dentist, adding, "They don't necessarily want to go out on the tundra."

A lack of cultural opportunities topped the list of reasons why physicians did not want to practice in rural areas, according to a poll by Sermo, a social network for physicians.

Rural hospitals under more pressure than ever

"It might be the lack of diversity of food options," says Christian Rubio, Sermo's community director, adding, "One rural doctor said he goes once a month with his wife to a big city to get food and go to movies and just get out."

Even when PCPs do choose to practice in rural areas, they may find that there are not enough patients to support their practice or that most patients are Medicaid beneficiaries. Rural physicians may find that being the only provider in town means they never get a day off.

"Country doctors doing family practice is kind of a 24/7 job," says Dave Jones, board president of the California State Rural Health Association.

How one rural hospital plans to lure urban patients

Physicians in the Sermo survey also reported that they were deterred from practicing in the country because they heard their rural colleagues got burned out quickly—some even came to resent their patients.

"To stick with it, they really have to have the heart for it and that has to come from within," says Seattle dentist Ji Choi who grew up in a small town (Khazan, The Atlantic, 8/28).

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