{"id":18309,"date":"2019-04-04T08:18:42","date_gmt":"2019-04-04T16:18:42","guid":{"rendered":"https:\/\/www.pbs.org\/independentlens\/?post_type=blog&p=18309"},"modified":"2023-10-02T11:37:46","modified_gmt":"2023-10-02T18:37:46","slug":"new-efforts-to-improve-rural-healthcare-crisis","status":"publish","type":"blog","link":"https:\/\/www.pbs.org\/independentlens\/blog\/new-efforts-to-improve-rural-healthcare-crisis\/","title":{"rendered":"New Efforts to Improve Rural Healthcare Crisis"},"content":{"rendered":"

By Suzanne Gordon<\/strong><\/p>\n

The three caregivers we meet in <\/span>The Providers<\/i><\/b><\/a> face daunting challenges as they try to deliver medical and mental healthcare to patients in rural New Mexico. Sadly, their struggles are reproduced all over America because for decades the nation has failed to address the problem of delivering healthcare outside of urban and suburban areas. Even though 60 million \u2013 or 19.3% \u00a0\u2013 of Americans live in rural areas, they can\u2019t get the healthcare services they desperately need. It\u2019s therefore not surprising that, <\/span>in 2016, five of the ten states with the highest rates of deaths<\/span>\u00a0due to opioid abuse were rural (interestingly New Mexico is not one of them).<\/span><\/p>\n

Whether it’s finding someone who will treat opioid addiction, scheduling a routine primary care visit, making an appointment with a cardiologist, oncologist, psychologist or psychiatrist, rural Americans are often out of luck. <\/span><\/p>\n

The nation has been plagued by a persistent shortage of primary care physicians (PCPs). A <\/span>study<\/span> by the American Association of Medical Colleges (AAMC) warns that the U.S. will need <\/span>52,000 more<\/span> PCPs by 2025. The problem is worse in rural areas, which is why <\/span>the Health Resources and Services Administration<\/span> has designated many as <\/span>primary care shortage areas<\/span>. In spite of documented need, not enough physicians in training are <\/span>choosing<\/span> to enter primary care<\/span>. \u00a0<\/span><\/p>\n\n

Indeed, only 4% of medical school graduates surveyed in 2016 would consider practicing in a small community, whether as primary care or specialty providers.<\/span><\/p>\n

Rural residents also have trouble getting care \u2013 whether for elective surgery or an acute care crisis \u2013 in a conveniently located hospital. Between 2010 and 2019, <\/span>102 rural <\/span>hospitals<\/span> have closed<\/span> and it is <\/span>estimated<\/span> that another 700 will close in the next decade.<\/span><\/p>\n

When it comes to mental health treatment, the situation is even direr. The Substance Abuse and Mental Health Services Administration (<\/span>SAMSHA<\/span>) found that 77 percent of U.S. counties face a severe shortage of practicing psychiatrists, psychologists, or social workers; 55 percent of U.S. counties \u2013 all rural \u2013 have no mental health professionals at all. According to studies by the National Institute of Mental Health, 40 percent of people with schizophrenia and 51 percent of people with bipolar disorder go untreated in any given year. \u00a0Many of them live in rural areas.<\/span><\/p>\n

So what is being done to address this problem? \u00a0<\/strong><\/p>\n

Not enough, but there are some shining examples of efforts to improve rural healthcare. \u00a0A number of medical schools are trying to attract medical students who actually want to practice in rural areas and will do so when they graduate and finish residency programs. Over the past four decades the program has trained about 400 graduates. 40 percent of them have actually gone into\u2014and stayed in\u2014practice in rural areas.<\/pullquote><\/span><\/p>\n

Among these are the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) program at the University of Washington Medical School, and North Carolina’s Area Health Education Center, which are trying to increase the number of primary care physicians who will work in underserved areas. \u00a0One of the most successful programs — the <\/span>Physician Shortage Area Program (PSAP), at the Sidney Kimmel School of Medicine at Thomas Jefferson University in Philadelphia <\/b>— has been operating since 1974. \u00a0<\/span><\/p>\n

As family medicine physician Howard Rabinowitz, co-director of the PSAP, told me, over the past four decades the program has trained about 400 graduates. 40 percent of them have actually gone into\u2014and stayed in\u2014practice in rural areas. \u00a0By partnering with local undergraduate programs, the PSAP identifies future medical school students who come from rural areas and want to return to work there. Students are encouraged to apply to the PSAP. If accepted, they form a cohort of about ten students a year\u2014about 270\u2014and are mentored through medical school by program faculty. \u00a0\u00a0\u00a0<\/span><\/p>\n

The program helps them to resist the inevitable peer pressure they may encounter from medical students or faculty who look down on both primary care and rural practice. The program\u2019s success, Rabinowitz says, is directly due to the fact that it eschews the traditional model used to entice medical students into rural practice. \u201cWe identify people who <\/span>want to<\/span><\/i> do this as opposed to going to people who don\u2019t want to do it but will \u2013 at least temporarily \u2013 because they get loan repayments or scholarships.\u201d<\/span><\/p>\n