The Solution To Rural Health Crisis May Take More Than Sheer Physician Incentives.
Illumination Curated initially published this article on Medium!
Improving health disparity has been at the top of the conversations among healthcare leaders for quite some time. Among many, we all see factors such as geographic location, access to education, and socioeconomic prosperity that would help us achieve health equity. Some nations have been prosperous in addressing some of those factors; others are still struggling to do their part. Nonetheless, I can not point out any society that has been able to create one hundred percent health equity for all its constituents and probably will never do for decades to come.
Amongst all variables that we must handle towards achieving health equity, yet clearly sacrificed by the modern healthcare trends, is the topic of "Rural Healthcare."
Rural healthcare in the United States has always been under strain. However, for the last two decades, many rural residents have suffered discrepancies in health outcomes. Even after the Affordable Care Act and Medicaid expansion, they have had insufficient access to physicians.
Although the rural healthcare crisis is not solely the American problem, it is ironically mind-boggling that despite coverage expansion and draining billions of dollars, we still can't provide quality healthcare to those in rural neighborhoods.
Some blame the cause of rural health inequity on the lack of primary care physicians and others on the lack of incentives for medical professionals.
Current Solutions For Solving Rural Physician Shortage
In the recent past, we have seen many proposed solutions to rural health problems, including:
- Engaging community health workers
- Opening federally qualified health centers
- Promoting higher education financial incentives for health professionals serving underserved areas
- Offering pastoral training in medical education, including school dental programs
- Telemedicine and Telemental health services
All solutions offered so far may have been partially effective, if at all. In fact, according to the March edition of NIH News in Health, 20% of Americans live in rural neighborhoods yet have more risk of dying from the leading causes of death, such as heart disease, cancer, lung disease, and stroke. They have higher rates of obesity and diabetes. Rural Americans are at higher risk of fatal car crashes, suicide, and drug overdoses than their urban counterparts.
The Rural Health Crisis Is Beyond Mere Physician Shortage.
According to a recent survey done by Jackson Physician Search, 40% of babyboomer physicians consider retiring within the following decade. It projects that this rate will be even higher in rural areas. In addition, 43% of the surveyed physicians stated they were contemplating early retirement, whereas 46% intended to leave their independent practice for a new healthcare employer.
On top of already retiring rural physicians, the study finds a significant reduction in rural-raised medical students, even though overall medical school enrollment has increased.
A 2019 survey saw that fewer than 5% of incoming medical school students were rural area natives. That is significant because those living in rural areas are most likely to return home after graduation.
Based on a recent survey of 1,311 physicians, 169 administrators, and 158 advanced practice providers, the medical practice Management Association (MGMA) sees a market transition in rural physician practice. Accordingly, 90% of surveyed physicians allude to some openness to rural practice. Yet still, the majority willing to relocate to the rural neighborhood are baby boomers. Incentives include work/life balance (46%), higher compensation (44%), affordable living expenses (42%), more time to spend with patients (28%), flexible schedules (27%), and family priorities(26%).
With the emergence of Healthcare management organizations and the takeover of the healthcare system by large corporations on the one hand and the introduction of administrative mandates and value-based physician reimbursement schemes on the other independent medical practices lost their incentives to stay open in the rural communities.
Large organizations like managed care entities could handle the wave of reforms, however, at the expense of small medical practices. Furthermore, there is a lack of financial incentives, and the exercise of lean operations to conserve money for larger systems hardly, if ever, restores the already lost independent clinics. That, inevitably, forced rural citizens into health inequity.
Reestablishing Independent Medical Practices Is The Recent Cure To The Rural Healthcare Crisis.
“The survival of independent physician practice is vital to the sovereignty of our rural communities” — Adam Tabriz, MD
Independent physician practices are the cornerstone of rural healthcare. Besides, those physician students who take on the medical profession will most likely return to practice at home. And most likely, those who return would have to practice independently to maintain true flexibility and engage their patients in their health. And indeed, incentivizing physicians to practice in a rural area can hardly be through the shackles of corporate employment. Instead, it requires a reinvigorated, robust logistic healthcare delivery infrastructure.
The system that will meet the expectations of physicians and patients in the rural area is the scenario where every stakeholder in healthcare, irrespective of their geographic and socioeconomic standing, can search, find, realize, and exchange every service and product. It is a hybrid interactive, collaborative Cyber-Physical-Human System(CPHS) where in-person and virtual experiences transpire in tandem. The system will use workflow automation as well as human collaboration in balance to minimize physician administrative burden. It will enhance remote patient care and expert contribution to the care of rural patients. Most of all, it will meet patients' expectations where they are and not where they must be!