Recruiting Providers to a Rural Community


January 2014

An Opinion Piece by CEO Linnea Hunter

As I think about what really matters to the health of our community, one of the most important elements is our health care providers: doctors, dentists, therapists, nurse practitioners, physician assistants, midwives, and others. While that may sound like a really obvious statement, figuring out how to recruit and retain these providers to our community is anything but obvious.

The National Rural Health Association shares some startling facts from a report called “Rural Healthy People 2010,” which was funded by the Office of Rural Health Policy.

  • About ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas. 
  • Rural residents are less likely to have employer-provided health care coverage or prescription drug coverage, and the rural poor are less likely to be covered by Medicaid benefits than their urban counterparts.
  • Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads.
  • Rural residents are nearly twice as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents. Rural residents are also at a significantly higher risk of death by gunshot than urban residents.
  • Abuse of alcohol and use of smokeless tobacco is a significant problem among rural youth. The rate of DUI arrests is significantly greater in non-urban counties. Forty percent of rural 12th graders reported using alcohol while driving compared to 25 percent of their urban counterparts. Rural eighth graders are twice as likely to smoke cigarettes (26.1 percent versus 12.7 percent in large metro areas.)
  • 57 to 90 percent of first responders in rural areas are volunteers.
  • There are 60 dentists per 100,000 population in urban areas versus 40 per 100,000 in rural areas.
  • Twenty percent of nonmetropolitan counties lack mental health services versus five percent of metropolitan counties.
  • The suicide rate among rural men is significantly higher than in urban areas. The suicide rate among rural women is escalating rapidly and is approaching that of men.
  • Medicare payments to rural hospitals and physicians are dramatically less than those to their urban counterparts for equivalent services. This correlates closely with the fact that more than 470 rural hospitals have closed in the past 25 years.
  • Rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.
  • Death and serious injury accidents account for 60 percent of total rural accidents versus only 48 percent of urban. One reason for this increased rate of morbidity and mortality is that in rural areas, prolonged delays can occur between a crash, the call for EMS, and the arrival of an EMS provider. Many of these delays are related to increased travel distances in rural areas and personnel distribution across the response area. National average response times from motor vehicle accident to EMS arrival in rural areas was 18 minutes, or eight minutes greater than in urban areas.

Recruiting additional providers won’t solve all of these problems, but it’s a good start. So what do we do? We tackle the problem together, as a community. We work together (businesses, individuals, non-profit organizations) to recruit providers, working hard to find meaningful work for the health care provider’s spouse, if need be. We highlight the wonderful attributes of inland Mendocino County and Western Lake County, with outdoor activities from hiking to biking to water sports. We share how easy the drive is to San Francisco, and how great it is to come home where there’s no traffic and clean air. We let people know they can choose from lots of quality schools for their children, public and private. And we remind them that if the downtown merchants can’t help them, it’s only 52 minutes to Macy’s in Santa Rosa.

Once we recruit physicians, we need to retain them. Working as a team, health care providers can coordinate care across a broad spectrum of services, which makes the provider feel less isolated, and allows the patient to get better care.

Lots to think about. With the Affordable Care Act helping thousands more people in Mendocino County get health insurance; we could use some more primary care doctors right about now. Let’s work together to recruit them.

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