The shortage of doctors in rural areas and medical schools’ attempt to fill this gap

The United States has a serious shortage of doctors, and rural areas are hit harder than most places. According to the U.S. Department of Health and Human Services, there are 6,100 federally designated health professional shortage areas in the United States. Urban areas have approximately 84 primary care doctors per 100,000 people. However, rural areas have only 68 primary care doctors per 100,000 people. To put these numbers into perspective, approximately 20% of the population lives in rural areas, while only 9% of doctors practice there. The future looks even bleaker; the Association of American Medical Colleges warned that by 2020, the United States will have a shortfall of 45,000 primary care physicians and 46,000 surgeons and medical specialists.

If medical school applicants are increasing, then why is the severe shortage of doctors in rural areas? Dr. Howard Rabinowitz, professor of family and community medicine at Thomas Jefferson University's Medical College, has studied this issue for over 30 years and cites several reasons. For current doctors, commonly cited reasons for leaving rural areas include insufficient insurance payments, administrative hassles regarding insurance claims, and rising business and malpractice insurance expenses. Additionally, fewer people from rural areas are applying to medical schools, and approximately half of the students from rural areas want to practice in metropolitan areas instead of returning to their rural communities.

 

When a rural area loses a doctor, the consequences can be particularly problematic for the community because that doctor may be the only one around within an hour (or more!) drive. For a family, that means not only time spent driving to the doctor, but also the gas expense and lost wages if one must take time off of work to go to the doctor. 

Medicare and medical schools have taken steps to try to control the shortage. Medicare gives a 10% bonus to doctors who serve communities with physician shortages. From 2011-2015, these doctors are eligible for additional bonuses depending on the type of care they provide. Medical schools are thinking even more proactively by influencing students during the educational stages of becoming a doctor. For example, the University of Missouri School of Medicine’s Rural Track Pipeline Program targets students who want to practice in rural areas and offers repeat exposure to these areas. More than 450 medical students have participated in the program, and more than 57% of students practice in rural areas both inside and outside Missouri. The University of Colorado School of Medicine’s Rural Track program helps students understand the benefits of practicing medicine in a rural environment. Applicants are up from 62 in 2006 to 190 in 2010. Lastly, Kansas, a state that has five counties without any doctors, opened a medical school devoted to rural medicine. (See this blog post on the University of Kansas and this blog post describing other similar programs).

Medical schools’ rural track programs offer a better solution by developing students’ interest in rural areas early on. Research shows that only 3-4% of medical school graduates plan to practice in rural areas, while schools with rural track programs, such as University of Missouri School of Medicine, show more than 50% of matriculates work in rural areas. This outcome is quite promising.

Will legislative and medical school efforts be enough? For current doctors, especially those with families, the bonuses may not be enough to draw them to a rural area. Uprooting a family often means the spouse finding another job, children having to start new schools, and leaving family and friends – essentially leaving an established life. For many, moving to a rural area may not be worth the effort. Additionally, many of these doctors likely did their residency in metropolitan area hospitals and became accustomed to certain aspects of urban areas, such as more extensive cultural or educational opportunities. Arguably, medical schools' rural track programs offer a better solution by beginning students on a rural track before residency. Although the current number of rural track programs is limited, hopefully other medical schools begin to adopt this idea so we can begin solving a problem before it's too late.

Postscript:  On a medical school on the Cherokee nation, from Dec. 2023.