Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Can rural health care be saved?

Edward Hoffer, MD
Physician
December 4, 2019
38 Shares
Share
Tweet
Share

There are many disparities in health care. Black mothers have a much higher rate of maternal death than do white women. All women are less likely to get guideline-advised cardiac care than do men. Among the many such examples, perhaps the hardest disparity to solve is that of the poorer access to health care faced by rural communities. People living in rural counties have higher death rates from cancer and heart disease than their urban counterparts, and there are more deaths from opioid overdose. Rural hospitals are closing every week, leaving their communities with less local access to needed services. Physicians practicing in rural communities are older and are not being replaced as they retire.

To keep small hospitals open, the federal government created the Critical Access Hospital program in 1997 that pays more to small (25 or fewer beds) and isolated (at least 35 miles from another hospital) hospitals. A friend who is an experienced nurse once told me she thought this was akin to the Chrysler bail-out, and these hospitals provided poor care and should be allowed to close. Many studies have documented poorer processes of care at small hospitals compared to larger ones. It is certainly true that small rural hospitals do not provide the same level of service as do larger hospitals. They have few specialists and rarely have anything close to a critical care unit for truly sick patients.

I remember an experience from many years ago. I was moonlighting in the emergency department of a small isolated hospital when a patient came in with an obvious acute appendicitis that looked about to rupture. Unfortunately, the only surgeon on staff was quite inebriated after a night of partying and clearly in no shape to even drive to the hospital, never mind operate. The weather was foul, and getting the patient to another hospital was going to be dangerous, so the nursing staff convinced me, a cardiology fellow, to operate. Luckily the OR nurses knew more about the procedure than I did, and I had assisted on a few appendectomies in medical school, so the patient survived, but at a larger hospital, this dilemma would never have arisen.

What can be done? Better transportation would help. In truly isolated areas, air ambulances may be needed. Under our current system, these are often exorbitantly expensive and a common source of “surprise medical bills” that run $10,000+ for non-Medicare patients. State governments and/or referral hospitals should establish fairly-priced air ambulance services if they cannot get commercial providers to bring down their prices. More use of telemedicine would help, both in providing specialty consultation to the small hospitals and in allowing patients to avoid long drives. It has been found that pre-hospital personnel, EMTs and paramedics, can often avoid taking a patient to the hospital if they have telephone back-up at the scene. Consolidation of rural hospitals to provide more of a critical mass of physicians might require longer drive times but would provide better care in return. Medical schools should recruit more students from small communities, as graduates are much more likely to serve their own or similar communities than are students from an urban background.

In the meantime, if you are contemplating a move to the bucolic countryside after retirement, look carefully at the medical resources that would be available when you need them.

Edward Hoffer is an internal medicine physician and author of Prescription for Bankruptcy: A doctor’s perspective on America’s failing health care system and how we can fix it. He blogs at What’s wrong with health care in America?

Image credit: Shutterstock.com

Prev

There is a profound lack of self-esteem in the medical profession

December 4, 2019 Kevin 2
…
Next

There’s no place like labor and delivery for the holidays

December 5, 2019 Kevin 0
…

Tagged as: Emergency Medicine, Hospital-Based Medicine

Post navigation

< Previous Post
There is a profound lack of self-esteem in the medical profession
Next Post >
There’s no place like labor and delivery for the holidays

More by Edward Hoffer, MD

  • Gun crisis in America: Youth fatalities on the rise

    Edward Hoffer, MD
  • One person’s wasteful medical spending is another person’s income

    Edward Hoffer, MD
  • How to make the most out of your doctor’s visit

    Edward Hoffer, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • The rural health care crisis and medical education

    Nick Richwagen, Evan Chen, and Jacob Riegler
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Health care needs more physician CEOs

    Alexi Nazem, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA

More in Physician

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Can rural health care be saved?
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...