As members of Congress work to solve the coming physician shortage, a lack of healthcare professionals could mean rural residents will have more trouble accessing care, experts said.
According to a 2021 Association of American Medical Colleges (AAMC) study, America could see a shortage of between 37,800 and 124,000 physicians by 2034. The study said that if rural residents had the same access to healthcare as their urban counterparts, rural areas would need an additional 180,000 doctors.
James Jordan, professor of health care and biotechnology at Carnegie Mellon University’s Heinz College, said rural residents will feel the shortage sooner than the rest of the country.
Already, rural areas are seeing physician shortages. Jordan said that while rural populations account for 20% of the country’s population, only 11% of the country’s physicians live there. According to the AAMC, three out of five federally designated health professional shortage areas are in rural regions.
Because rural residents tend to be older, poorer, and sicker, those areas need more physicians now and in the future, he said.
“Older people have two and three co-morbidities, so it’s not just about the simple math of how many doctors per patient do you need,” Jordan said in an interview with the Daily Yonder. “It’s about how Mrs. Jones has three diseases and that math would represent three patients, which adds to the problem.”
Also adding to the problem are the numbers of healthcare workers leaving the workforce.
On February 16, the U.S. Senate Committee on Health, Education, Labor and Pensions held a hearing on “Examining Health Care Workforce Shortages”. Chaired by U.S. Senator Bernie Sanders (I-Vermont), the committee heard testimony about what Congress can do to address the situation.
James Herbert, president of the University of New England in Biddeford, Maine, testified about the physician shortage in his state.
“Maine’s population is the oldest in the nation and is tied with Vermont as being the most rural state,” he told the senators at the hearing. “Our healthcare workers are also among the oldest in the country, with many practitioners approaching, or even practicing beyond, retirement age. The challenges we face are in some sense harbingers of what the rest of the country will increasingly confront as our nation ages not only in our cities, but also in our vast remote rural areas.”
In fact, a 2019 AAMC study found that nearly 25% fewer rural physicians will be practicing by 2030. At the same time, the number of medical students from rural areas (who are most likely to practice in rural regions) fell by 28% between 2002 and 2017. Rural students accounted for just 4.3% of medical students in 2019, the study said.
Additionally, stress from the pandemic has increased the number of healthcare professionals leaving the workforce. Before the pandemic, between 35% and 54% of healthcare professionals in the U.S. reported being burned out. Since then, a 2021 survey from the Kaiser Family Foundation-Washington Post found that nearly 60% of health care workers reported declining mental health, and nearly 30% considered leaving their profession.
Herbert said the country needs to increase the number of people entering the healthcare workforce pipeline as well as educate more healthcare professionals across the board. And those healthcare workers must look like the communities in which they will serve, he said.
“It is well established that individuals from underrepresented groups are more likely to seek out practitioners who share their identities and backgrounds,” he said in written testimony. “Studies have found that minority patients who are treated by (minority) clinicians are more likely to use needed health services and are less likely to delay seeking care.”
The problem, Jordan said, is not just creating more healthcare professionals, but getting them to locate in rural areas.
“There’s a perception of lower reimbursement (for physicians in rural areas),” he said. “There’s a perception of having limited support services, which means they are on call more. And there’s a perception that geographic isolation will limit their ability for career advancement.”
While those perceptions don’t necessarily jibe with reality, he said, they do present barriers to attracting healthcare professionals to rural areas.
What will be the likely outcome, he said, is a greater reliance on telehealth, on foreign-born healthcare professionals, and on non-physician healthcare providers.
“What came out of Covid was an opening of these codes (for telehealth)… and I think that is improving access to health care services, reducing health care costs, and making patients happier,” Jordan said. “It’s also becoming very attractive to healthcare providers who can take a day at home and practice (via telemedicine).”
Jordan said he sees rural doctors becoming more “team leaders” to higher skilled support staff. And, with a greater reliance on new technologies, those healthcare teams can provide more services.
Committee members said they would work on strategies to address the crisis, including supporting a National Health Service Corps. That program would provide scholarships and loan repayments for physicians who practice in underserved areas, like rural communities.