Imagine driving an hour for a colonoscopy. Because of limited access to health care, that’s the harsh reality for many people living in rural communities, said Leslie Griffin, M.D., program director of family medicine residency at the University of Tennessee College of Medicine Chattanooga, during the “How to build a rural health pipeline” panel at AHCJ’s Rural Health Workshop 2022 in Chattanooga, Tenn.
During the talk, moderated by AHCJ core topic leader on mental health Katti Gray, Griffin explained to journalists how she’s using her platform to encourage more medical students and physicians to train and practice in rural communities.
Other featured panelists included Ashoke “Bappa” Mukherji, chief executive officer of the Java Medical Group — which has been buying and reopening rural hospitals — and Lisa Beasley, D.N.P., A. P.R.N., N.P.-C., R.N., a nurse practitioner, assistant professor at the University of Tennessee Health Science Center and president of the Tennessee Nurses Association.
During the panel, speakers emphasized the dire need to address the physician and nurse practitioner shortage in rural America, discussed barriers to recruitment in these areas, offered solutions to providing more health care access to rural communities and presented story ideas for journalists to explore.
High demand but no supply
The World Health Organization has estimated that because of increasing health care demand, 18 million health care workers will be needed in rural areas by 2030. But fewer younger physicians are entering rural practice, and rural hospitals are closing at alarming rates.
According to a recent report from the Center for Healthcare Quality and Payment Reform, more than 30% of all rural hospitals in the United States are at risk of closing soon because of persistent financial losses on patient services and low financial reserves.
So, what’s the solution? Attract more physicians to rural communities, said Mukherji, who knows firsthand the impact rural physicians have on improving health care access. He grew up in a small town in Midville, Tennessee where for a while, his dad was the only surgeon in the area. Inspired by the impact his father had on the community, he bought his first rural hospital in 2002 and has spent over 15 years in the health care industry working to acquire rural hospitals and clinics. In 2021, his firm reopened a hospital in Marks, Miss., that had closed five years ago. Still, he said, adequately staffing has been a struggle.
Without enough physicians, however, these hospitals can’t stay afloat, he explained, citing four key reasons why so few physicians work in rural communities.
- Rural hospitals rarely have residency programs.
- Less than 5% of new medical students are from rural communities.
- Most new primary care graduates want to be employed, not start their practice.
- Providers and their spouses are often educated and trained in urban areas.
He added that there is also a bias that larger hospitals provide better care. They “provide more diverse and acute care,” he said, adding that people can still get high-quality care at rural hospitals.
To help combat these barriers, the University of Tennessee College of Medicine Chattanooga and Erlanger Health System have expanded their family medicine residency program to Bledsoe County.
The goal was to improve access to health care in a county plagued with higher rates of smoking, obesity, sexually transmitted infections, teen births, diabetes, heart disease, and suicide, among other health concerns, and produce more physicians willing to stay and serve in rural areas. Griffin believes training and retaining family physicians is crucial to improving health care access issues in rural America.
“Family physicians are the way to go for the rural health track because we do a lot more than a lot of the communities realize. Yes, we do adult care. We do the geriatrics, but we also take care of kids. I still deliver babies … Family physicians are staffing a lot of the rural emergency medicine departments,” Griffin said.
“So, we’re using residents, students, interns — people who need to get their hours for their training — and we’re bringing them into our patient population. And we want to grow that and take that to Bledsoe County as well so that you have people that maybe are from Bledsoe County and have to come to UTC to train.”
Griffin said she hopes that when these students spend time in these rural communities and build relationships with families, they’ll be inspired to practice and stay in these rural areas.
Nurse practitioners are also helping to fill in gaps in health care in rural areas and represent one in four providers in rural practices, according to the American Association of Nurse Practitioners. A 2018 study also concluded that “well-qualified and high-performing ARNPs (advanced registered nurse practitioners) may positively contribute to access and utilization of primary care services in rural areas.”
Beasley, one of the three panelists, shared what the University of Tennessee Health Science Center College of Nursing is doing to expand the rural health care pipeline.
“So, some of the undergraduate nursing student clinical experiences are in our population health nursing concepts course and these students go to these [rural] communities,” she said, adding that the nursing students assess the needs of the community, including at health fairs, and develop a plan to educate and care for residents.
Story ideas panelists encouraged journalists to explore
- Opioid misuse and abuse in rural communities.
- New funding and grants available to rural hospitals.
- Recruiting medical and nursing students from rural areas.
- OB/GYN shortages in rural areas and how midwives are helping to fill the gaps.