Do we have the will to fix rural healthcare?
Published February 2, 2023
By Tom Campbell
Rural North Carolina has some of the most beautiful scenery in America, as documented by the growing numbers of tourists. Almost 40 percent of our 10.5 million residents live in the 80 counties considered rural, defined as having a population density of 250 people or fewer per square mile. Demographers tell us rural citizens are older, poorer, more obese, have higher blood pressures, greater instances of diabetes, and a lower life expectancy than state averages.
Why such a gap in health outcomes when our state is known for world class healthcare facilities and schools training care providers?
While rural residents can do much to improve their health, such as getting more exercise, having more regular examinations, stopping smoking and eating better foods, there are some things residents can’t do. Chief among them is having adequate healthcare access. In the vast majority of cases there is limited access to hospitals, clinics and care providers. Many areas lack pharmacies or sufficient options for buying healthy groceries.
Nationwide, 121 rural hospitals have closed since 2010 and another 600 are close to being insolvent. Five North Carolina rural hospitals have closed since 2010 and a handful are teetering. On January 1, the federal government announced a new payment plan to help struggling hospitals. But many question whether the cure may be worse than the disease. Under this plan rural hospitals would become little more than emergency rooms and primary care outpatient clinics, because no patient stay could exceed 24 hours. Any patient requiring longer inpatient care would be transferred elsewhere, providing they could get a room. In accepting these mandates, the Center for Medicaid and Medicare would pay rural hospitals an additional five percent for outpatient services and $3 million a year for a facilities payment.
There are several problems with this payment plan. First, it will likely create staffing shortages, since a nurse or other professional in the emergency department at smaller hospitals typically also works in inpatient care. It’s a triple whammy – the hospital loses revenues from impatient services, resulting in funding shortfalls needed to pay sufficient numbers of nurses and staff and further impedes adequate healthcare access to rural citizens. And what if larger hospitals refuse to accept patient transfers? We’ve heard too many stories of patients waiting in hallways for a bed. Maybe there were good intentions to help struggling rural hospitals, but this plan isn’t the solution.
Then there’s the problem of care provider shortages. Twenty of the 80 rural counties in our state do not have a pediatrician, 26 don’t have an OB-GYN, 32 are without a psychiatrist and finding a dentist in many is like pulling teeth, to use a very bad pun. North Carolina has a sufficient number of doctors we’re told, but too few in rural areas.
Several North Carolina medical schools have placed an emphasis on accepting applicants from rural sections, anticipating they will opt to return home to practice. UNC and Campbell provide targeted training for students, but the ECU Brody School of Medicine has made this their primary focus. From its earliest beginnings in the 1970s, Brody gives admission preferences to North Carolina residents from rural areas. Throughout their four years of med school ECU students work with primary care physicians, frequently in rural areas, so as to learn both the benefits and stresses of rural doctors. Brody ranks in the 90th percentile for graduates practicing in rural areas.
But more primary care physicians are needed. ECU Chancellor Phillip Rogers says one of the university’s primary goals for this General Assembly session is to get additional funding so Brody can increase the number of students they can accept and train. Let’s hope lawmakers respond to this important request.
Leaders in rural sections have an important role to play. Community Care North Carolina has been trained by MIT to establish a new mentoring program. New doctors generally know little about business matters and this mentoring will help them manage their practices. Rural leaders get mentoring to learn what they can do to attract and retain family physicians. Financial assistance in obtaining office space, student debt retirement (typically around $200,000 upon graduation) and other support services will ensure the new physician not only survives but thrives.
To improve rural health, we must have successful rural hospitals and clinics, more primary care physicians, nurses and support staff, and improved partnerships between care providers and rural communities.
I was born and spent much of my life in rural North Carolina and can testify to the great beauty and wonderful way of life in these areas. We often lament the decline in rural populations and once vibrant small towns, but it is a fact that people will not move to and live where they cannot get adequate healthcare. We have a great opportunity to improve rural health. Do we have the will to do so?