The rural healthcare crisis is not new, but it is particularly pronounced in the South.
Rural areas are less likely to have enough primary care physicians. Rural residents also tend to be poorer, according to the National Rural Health Association.
More than half the nation’s rural hospital closures since 2010 were in the South. Many of those are clustered in states that didn’t expand Medicaid under the Affordable Care Act, according to the Sheps Center for Health Services Research at the University of North Carolina.
Most of the states that have not expanded Medicaid under the Affordable Care Act are in the South, leaving thousands of Southerners uninsured or underinsured.
A plethora of policy solutions have been put forward by politicians and policymakers over the years. But who better to develop solutions to these problems than the health-care providers on the ground working with patients every day?
Reckon talked with doctors who live and work in rural communities across the South, asking them what they think are the biggest problems facing rural healthcare in the South, and how they’d fix those problems if they had unlimited resources. Below is the first in our series. Read what our other docs have to say in Alabama and Mississippi.
If you know a young doctor with smart ideas on tackling the health care crisis, email firstname.lastname@example.org.
Dr. Amanda Finley, Henry County, Tenn.
In 2018, the hospital in Amanda Finley’s rural hometown of McKenzie, Tenn., closed.
“It was harder and harder for my family to get care at home,” she said. That spurred her decision to leave rural Mississippi, where she’d been on faculty at a hospital there, and move back to Northwest Tennesse.
Now Finley works on staff at Henry County Medical Center in Paris, Tenn., located in the northwest corner of the state, about two hours west of Nashville. There she practices internal medicine and teaches medical students. The hospital serves patients from the surrounding five or six counties, most of whom come from rural communities and have difficulty accessing and affording adequate healthcare.
Many of her patients have chronic conditions like diabetes, she said, and a significant number need treatment for mental illnesses and substance use disorders. But much of the hospital’s coverage area is federally designated as “medically underserved,” meaning it has too few physicians and/or high rates of poverty.
“It’s very difficult for many of our patients to get follow–up care, especially if they need specialists, because they aren’t able to drive to Memphis or Nashville,” she said.
“They have trouble finding resources as simple as diabetes supplies or transportation, or sometimes even having running water is an issue.”
Finley believes one of the biggest problems facing rural healthcare is a lack of available medical workforce.
“It’s hard to recruit (doctors) who didn’t grow up in a rural community, to feel like they could be comfortable and to thrive there,” she said. “You almost have to grow up in a rural community to be happy practicing in one and to be able to understand the dynamics and the lifestyle.”
Finley believes in building or improving pipelines for generating more rural doctors and nurses, starting with encouraging rural high schoolers to consider STEM and medical fields.
“Sometimes you don’t see a lot of high achievers in rural communities beyond the teachers and maybe some business people, so (as a student) you don’t really know what the possibilities are,” she said. “It’s exciting when I get to interact with youth in the high schools or college. Maybe I help break down some barriers, so they can look at me and say, ‘She became a doctor, and maybe I can pursue that.’”
She would also improve programs to help medical students afford and succeed in college, from financial aid supports to loan repayment assistance. The cost of medical education can run into six figures.
And finally, she wants to see more medical residencies that focus on bringing future doctors into rural communities and showing them how to succeed there.
To that end, Finley and her colleagues recently applied for a federal grant to open a rural medical training program that would train medical residents to work in rural areas as primary care doctors or specialists. They’re currently pursuing accreditation and hope to have their first set of residents in 2023.
“It’s a rigorous thing to undertake,” she said. “And one of our goals is that our trainees will be so comfortable practicing in a rural setting that they stay there when they graduate.”