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The Science Survey

We've got the news down to a science!

The Science Survey

We've got the news down to a science!

The Science Survey

The Healthcare Catastrophe Running Rampant in America’s Countryside

Uncovering the divide: In rural America, access to healthcare remains elusive for many, revealing deep-seated inequities that demand systemic change.
Dr. Juan Manuel Romero, a cardiologist stationed in an urban center, engages in a pre-op consultation with a patient and her doctor who are 400 miles away, marking the power of telehealth for rural communities. (Photo credit: Intel Free Press, CC BY-SA 2.0 , via Wikimedia Commons)

One in five American citizens are currently suffering at the hands of a healthcare crisis that emerged not from an illness, but rather from geography. An estimated 60 million American citizens live in rural America. Despite this, rural hospitals are grossly underfunded, receiving a mere 2% of the $4.5 trillion the U.S. government spends on hospitals annually.

Government spending inequities in healthcare combined with a workforce shortage in rural America have left rural communities subject to some of the greatest healthcare disparities in the nation that are only growing deadlier each moment the U.S. fails to take action. 

For rural communities, gaining access to even simple health care is no easy feat. Indeed, contracting an illness as ordinary as the common cold is a nuisance for rural residents, who do not possess the privilege of simply walking 10 minutes to the nearest City MD to contact a doctor, as their counterparts in urban centers do. On average, rural residents have to travel a minimum of 20 miles for common services and over 40 miles for specialized treatments, nearly four times the distance an urban resident has to commute. 

Consequently, doing the bare minimum of seeking treatment when ill requires rural residents to embark on extensive commutes, granting them no choice but to take hours off of work at a time. Realistically, the average working-class citizen cannot afford to abandon work for hours on end just to attend a typical 30-minute check-up. As a result, left with no practical means of acquiring medical services, rural residents are often inclined to delay and avoid them whenever possible, which can lead to long-term health issues.

At the surface level, this issue can be attributed to the fact that there is an insufficient number of rural hospitals. Currently, of the 5,139 functioning hospitals in the United States, 65% exist in urban centers, with the other 35% of hospitals being designated to rural and suburban areas. 

Oddly, as opposed to new hospitals being constructed to address the shortage, the scarce ones that exist are being shut down. The closure of rural hospitals has become an all-too-common phenomenon, leaving communities without essential healthcare services and exacerbating the already rampant disparities. Within 11 years, over 136 rural hospitals have collapsed; forced to slam their doors shut in the face of communities who desperately need healthcare. 

Unfortunately, this trend is projected to persist over the course of the next few decades, making the future of rural healthcare appear bleak. Over 30% of rural hospitals are at imminent risk of closing at the hands of the perpetual disparities that plague America’s countryside. 

In the background of the rural hospital shortage, is a deeper-rooted conflict: a chronic resource and staff scarcity. Physicians, nurses, and other healthcare providers are drawn to urban centers, allured by higher salaries, bigger career opportunities, and access to advanced medical facilities.

It certainly doesn’t help that aspiring doctors face the absurd financial burden associated with obtaining a medical education. 73% of medical school graduates have educational debt, with the average graduate owing a shocking $250,995 in total student loan debt. Thus, upon graduation, most doctors are overwhelmed with the daunting task of repaying their loans and look straight past opportunities in underserved areas toward the ones that yield the greatest financial return. Dr.Ken Cordero, a Harvard Medical School graduate and anesthesiologist employed at the North Shore Long Island Jewish Hospital summarizes that “Nobody wants to go out of med-school and owe $500,000 in debt.” 

Due to the lack of financial incentives, rural communities struggle to attract and retain qualified healthcare professionals, explaining the stark difference in the primary care provider-to-patient ratio in rural areas compared to urban areas. The primary care provider-to-patient ratio in rural areas is 40/100,000, as opposed to a notably higher 53/100,000 in urban areas. Simply put, rural hospitals do not have the adequate faculty to keep up with pressing patient demands for treatments, diagnoses, and operations.

It also seems that doctors in rural areas tend to occupy a highly limited array of niches. Dr.Cordero explains that, “people in rural areas usually have doctors that are not trained specialists, as the majority of rural doctors are in primary care.” 

Doctors in specialized fields in rural areas are few and far between, compelled to seek employment in urban landscapes to maximize profit and career opportunities. Without trained specialists, logistically it is impossible for rural hospitals to sustain specialized departments, drastically restricting the services available to rural patients. Certain departments have been hit particularly hard by this calamity, notably obstetric care. 

Female patient communities have been shoved to the forefront of understaffing issues, with there being a concerning absence of obstetric services in rural areas. In 2020, 47% of rural county hospitals did not provide obstetric services. The American Health Association has coined these counties as “maternity care deserts, not having a singular hospital in the vicinity that offers obstetric care. 36% of U.S. counties have been classified as ‘maternity care deserts,’ entailing that for over 7,000,000 rural women becoming pregnant is an inherent danger. 

To no surprise, similarly to the rest of the predicaments in rural healthcare, this issue is only expected to grow in severity. By 2030, the anticipated supply of OB/GYNs is expected to meet only 50% of the demand in rural areas. Given little to work with in regard to certified obstetricians and resources, rural hospitals have been placed in a situation void of an apparent solution except for simply shutting down obstetric units. Between 2014 and 2018 alone, 2.7% of rural counties lost hospital maternity services, with their local hospital failing to maintain the necessary treatments.

It is no wonder that pregnancy-related mortality is strikingly high among rural populations; there are 26.1 pregnancy-related deaths per 100,000 in rural areas compared to 21.8 deaths per 100,000 in urban areas. 

It’s incorrect to construe the false narrative that nothing is being done to combat the rural healthcare conundrum. Indeed, there has been a diverse range of solutions implemented to fight the issue, but all of them generally fall in the realm of the two main existing ones: telehealth and debt relief programs.

Ostensibly, the root of all discrepancies in rural healthcare is the distribution of hospitals and transportation barriers. Consequently, many rural communities have opted for telehealth services, which minimize commutes, allowing patients to contact doctors without having to travel hours just to be within sight of a county that has a healthcare facility. Telehealth is exactly what it sounds like, permitting doctors to confer with patients via video call as opposed to in-person. 

Although telehealth is a seemingly cheap and convenient fix, it may miss the mark on taking into account the nuance of the rural landscape. As telehealth is naturally contingent upon adequate internet service, rural communities are still placed at a unique disadvantage. Internet access is yet another area where there is a piercing divide between rural and urban regions, with over 17% of rural residents lacking broadband internet access. It appears that to constructively address the crux of the issue, technological solutions alone are not enough. 

This is where debt relief programs seem promising. Loan forgiveness and debt relief programs aim to tackle the problem from a different angle, going slightly deeper by targeting the workforce shortage and developing a profit incentive for rising doctors to work in underserved areas.

These initiatives, including the NHSC Rural Community Loan Repayment Program, Nurse Corps Scholarship Program, and NHSC Scholarship, all offer graduating med-students a form of student loan forgiveness in exchange for an agreement to work in a HPSA (health professional shortage area). The prospect of graduating nearly debt-free is endlessly enticing, being a concept that is generally unheard of for young med-school graduates. 

Dr. Codero emphasizes how constructive economic motivations could be in combating this crisis, noting that, “if you give enough of a financial incentive, doctors would willingly work anywhere.” 

As the nation grapples with steeply escalating healthcare inequities in rural America, access to quality care should remain a cornerstone of healthcare reform efforts. By fundamentally acknowledging and prioritizing the medical needs of rural residents, hopefully, America can start constructing a path toward a healthier future for all Americans, regardless of region.

Within 11 years, over 136 rural hospitals have collapsed; forced to slam their doors shut in the face of communities who desperately need healthcare. 

About the Contributor
Simone Ginsberg, Staff Reporter
Simone Ginsberg is a Spotlight Editor for ‘The Science Survey.' She enjoys composing editorial pieces and prioritizes strong rhetoric and statistics in her writing. However, she also appreciates hard news stories. In addition, Simone thoroughly enjoys writing about foreign affairs and world issues, covering unique angles on global politics. She appreciates journalism that includes a plethora of unique, loaded quotes, strongly believing that quotes are one of the most effective ways to cover a diverse range of perspectives while maintaining journalistic objectivity. Another aspect of journalism she greatly values is photography. Good photography should contribute vitally to the article as opposed to simply supporting it. Beyond journalism and academics, Simone enjoys traveling, shopping, and debating, all of which play a key role in inspiring her writing. Although much of her future remains undecided, she aspires to study economics or foreign affairs in college.