5 Specialty Care Shortages in Rural Communities

For the approximately 20% of the US population living in rural areas, having ready and reliable access to health care can be a substantial challenge, especially considering the higher rates of poverty, unemployment, and chronic disease vs the general population; a lack of reliable broadband internet; inadequate public transportation infrastructure; and geographic isolation.^1-4

As recently as January 2024, the Joint Economic Committee put out a report highlighting this disturbing statistic: more than 90% of rural counties are facing a shortage of primary care physicians alone compared with 74% of nonrural communities. However, according to the Health Resources and Services Administration (HRSA), a health professional shortage area extends beyond that specialty to include “geographic areas, populations, or facilities that have a shortage of primary, dental, or mental health care providers.”⁵

Here is more information on these health care provider (HCPs) shortages, as well as 2 additional specialty areas and their providers that rural communities desperately need.

Primary Care

A primary goal of primary care is to be able to achieve a high level of health and well-being through a multidisciplinary approach that can encompass disease prevention, treatment, and management over the long term. These HCPs are often the first point of contact with the health care system,⁶ and this care is often deemed essential.⁷ And yet, 65% or primary care shortages are located in rural areas, and only 9% of US physicians practice in these areas.^8,9

Data also show that, as recently as 2019, rural communities/nonmetropolitan areas had 13 physicians per 10,000 people vs 33 per 10,000 in metropolitan areas, and 7 nurses vs 9, respectively.¹⁰ These providers may also encounter barriers acquiring the health latest technology, and many health systems are pulling out of rural areas for economic reasons.² Between 2005 and 2022 alone, 186 rural hospitals closed.¹¹

Psychiatry/Mental Health

Approximately 5% of rural residents reported serious thoughts of suicide in 2023, and although this number is smaller compared with that for metropolitan areas, experts deem it comparable to that seen among residents of more metropolitan areas. However, these residents face several obstacles to obtaining mental health care services that include the stigma attached to a mental health diagnosis, affordability in an age when many still have to pay out-of-pocket for these services, and availability of mental health care providers.¹²

Drilling down, 2022 data show there are far fewer behavioral health counselors (87.7 vs 131.2 per 100,000 population), psychologists (15.8 vs 39.5), and social workers (57.7 vs 96.4) providing mental health services in rural locations vs more urban areas, despite these practitioners overall increasing in total numbers.^12,13 And data from March show there are 3862 mental health professional shortage areas in rural areas.¹²

Twenty percent of the US population lives in a rural area, making ready access to reliable health care a substantial challenge.| Image Credit: Pixels-stock.adobe.com

Maternal Health

According to the Association of American Medical Colleges, only 50% of counties in the US have an obstetrician-gynecologist physicians, which also means that 50% of counties don’t have these invaluable HCPs.¹ And as recently as 2014, more than half of rural counties in the US were considered maternity care deserts—meaning they have no hospital-based obstetrical services. Further, rural residents have been shown to have worse outcomes vs residents in other areas, including infant mortality and pregnancy complications, postpartum hemorrhage and need for blood transfusions, and severe maternal morbidity and mortality.¹⁴

Also, data show 37.9 pregnancy-related deaths per 100,000 in rural areas vs 31.2 in larger areas; 6.55 infant deaths per 1000 live births in rural counties vs 5.44 in large urban counties; and higher infant mortality rates in rural counties for mothers reporting non-Hispanic White, non-Hispanic Black, and Hispanic race/ethnicity.¹⁵ Pregnant individuals living in rural areas have a higher risk of Intensive Care Unit admission, and recent research shows the overall maternal mortality rate is close to twice as high in rural areas vs urban areas.¹⁶

Dental Care

Periodontal disease, caries, and tooth loss affect rural-dwelling individuals at higher rates, with more potential downstream effects on cardiovascular disease, lung disease, and diabetes. With oral health being a “key indicator of overall health,” the disproportionate effect of oral disease is moreso seen in rural environments, where 40% of residents have not visited a dentist in the past year.¹⁷

Many rural vs suburban residents also say they have poor oral health and more report not having dental insurance compared with suburban residents (34% vs 24% for both).In addition, older age, lower incomes, and lack of dental insurance are more common in rural locales, and serve as indicators of Medicaid and Medicare coverage, which limit dental coverage. Experts are calling for more research on the link between oral health and systemic health, with the most recent State of Oral Health Equity in America survey showing food insecurity remains a significant influence on poor oral health.^18,19

Trauma Care

The American College of Surgeons calls rural trauma a “neglected disease.”²⁰ Mayo Clinic defines it as “trauma care in which patients take longer than 60 minutes to arrive. ”Rural residents also face higher risks of longer wait times after a traumatic injury to when they are found, meaning many miss out on the golden hour involved with traumatic injury—the period of time after a traumatic injury that determines whether someone lives or dies depending on if they receive life-saving care and can be transported.²¹

However, even when there are rural trauma hospitals, adequate resources may still be lacking. Recent research shows a severe lack of air and land ambulances, emergency department (ED) beds, and ED physicians with advanced trauma support certification, as well as higher incident rate ratios (IRRs) from motor vehicle trauma that range from 1.8 to 2.7 per 100,000 person-years; even after adjusting for socioeconomic factors, the RR remains elevated at 1.6.²²

References

1. Stone K. 8 physician specialties that are desperately needed in rural America. CompHealth. September 29, 2022. Accessed September 12, 2024. https://comphealth.com/resources/top-specialties-rural-health

2. Health in rural America: connecting to care. News in Health. March 2022. Accessed September 12, 2024. https://newsinhealth.nih.gov/2022/03/health-rural-america#:~:text=This%20is%20critical%20for%20certain,to%20medicine%20and%20health%20care.%E2%80%9D

3. Mattina C. 5 underrecognized social determinants of health. AJMC®.

September 6, 2024. Accessed September 12, 2024. https://www.ajmc.com/view/5-underrecognized-social-determinants-of-health

4. Focus areas for rural community health programs. Rural Health Information Hub. 2023. Accessed September 12, 2024. https://www.ruralhealthinfo.org/toolkits/rural-toolkit/1/rural-issues#:~:text=Aging%20in%20place,Unintentional%20injury%20prevention

5. Addressing rural health worker shortages will improve population health and create job opportunities. Joint Economic Committee Democrats. January 30, 2024. Accessed September 12, 2024. https://www.jec.senate.gov/public/index.cfm/democrats/2024/1/addressing-rural-health-worker-shortages-will-improve-population-health-and-create-job-opportunities#:~:text=The%20demand%20for%20physicians%20is,insufficient%20supply%20of%20medical%20professionals

6. Primary health care. World Health Organization. Accessed September 12, 2024. https://www.who.int/health-topics/primary-health-care#tab=tab_1

7. Primary health care. Exemplars. December 2021. Accessed September 12, 2024. https://www.exemplars.health/topics/primary-health-care

8. Empinado H. Treating rural America: the last doctor in town. Stat News. September 25, 2023. Accessed September 12, 2024. https://www.statnews.com/2023/09/25/rural-health-doctor-shortage-physicians/#:~:text=In%202023%2C%2065%25%20of%20rural,Health%20Resources%20and%20Services%20Administration

9. Rosenblatt RA, Hart LG. Physicians and rural America. West J Med. 2000;173(5):348-351. doi:10.1136/ewjm.173.5.348

10. Mantz A. 8 statistics that explain the rural doctor shortage. Incredible Health. February 8, 2023. Accessed September 12, 2024. https://www.incrediblehealth.com/blog/8-statistics-that-explain-the-rural-doctor-shortage/

11. Ostmo P. Rural health research recap: rural hospital closures: 2023 update. Rural Health Research Gateway. June 2023. Accessed September 12, 2024. https://www.ruralhealthresearch.org/assets/5299-24183/hospital-closures-2023-recap.pdf

12. Rural mental health. Rural Health Information Hub. Updated August 2, 2024. Accessed September 12, 2024. https://www.ruralhealthinfo.org/topics/mental-health

13. Andrilla CHA, Woolcock SC, Garberson LA, Patterson DG. Changes in the supply and rural-urban distribution of selected behavioral health providers. WWAMI Rural Health Research Center/University of Washington. October 2022. Accessed September 12, 2024. https://familymedicine.uw.edu/rhrc/publications/changes-in-the-supply-and-rural-urban-distribution-of-selected-behavioral-health-providers/

14. Hostetter M, Klein S. Restoring access to maternity care in rural America. The Commonwealth Fund. September 30, 2021. Accessed September 12, 2024. https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america

15. Ely DM, Driscoll AK, Mathews TJ. Infant mortality rates in rural and urban areas in the United States, 2014. CDC. September 2017. Accessed September 12, 2024. https://www.cdc.gov/nchs/data/databriefs/db285.pdf

16. Harrington KA, Cameron NA, Culler K, Grobman WA, Khan SS. Rural–urban disparities in adverse maternal outcomes in the United States, 2016–2019. Am J Public Health. 2023;113(2):224-227. doi:10.2105/AJPH.2022.307134

17. Still searching: meeting oral health needs in rural settings. CareQuest Institute for Oral Health. November 14, 2023. Accessed September 12, 2024. https://www.carequest.org/resource-library/still-searching-meeting-oral-health-needs-rural-settings?utm_campaign=november_newsletter2&utm_medium=email&_hsmi=282655146&_hsenc=p2ANqtz-_SbZZDL8H2clMhZygh34NSLX_lpDqMlTccOrJH7S4aNA0XR-45D0U713u6GaUIJgqRtuR6cQAuermz7nW02VW2PaeAEdJuqIQwnbufJ45DNG2zzzM&utm_source=newsletter

18. State of oral health equity in America. CareQuest Institute for Oral Health. Accessed September 12, 2024. https://www.carequest.org/content/state-oral-health-equity-america-2023

19. Henderson-Frost J, Deutchman M. Eight ways to mitigate us rural health inequity. AMA J Ethics. 2022;24(1):E73-E79. doi:10.1001/amajethics.2022.73

20. Trauma education: rural trauma team development course. American College of Surgeons. Accessed September 12, 2024. https://www.facs.org/quality-programs/trauma/education/rural-trauma-team-development-course/

21. Overcoming barriers to improve time to definitive care after rural traumatic injury. Mayo Clinic. May 7, 2022. Accessed September 12, 2024. https://www.mayoclinic.org/medical-professionals/trauma/news/overcoming-barriers-to-improve-time-to-definitive-care-after-rural-traumatic-injury/mac-20531716

22. Rural trauma. Eastern Association for the Surgery of Trauma. March 2021. Accessed September 12, 2024. https://www.east.org/education-resources/east-monthly-literature-reviews/march-2021-rural-trauma