Of course, no story on an issue this broad is complete without the good, the bad and the ugly. The bad and the ugly in this story are as hard to swallow as a multivitamin:
- Traumatic injuries are more common in rural areas.
- Nearly half of rural residents have at least one major chronic illness.
- The rural mortality rate for residents under 24 is 20% higher than the national average. This is in part because motor vehicle accident mortality rates are 50% higher in rural areas.
- Rural residents are less likely to be insured. And though that statistic doesn't hold true for farmers and ranchers, they do pay more for health insurance that covers less.
- Twenty percent of Americans live in rural areas, but only 10% of America's physicians practice there.
Sounds like a negative diagnosis. But then there are people like Deanna Munson. She credits her local rural hospital's care with saving her father's life. After being hospitalized in Topeka, Kan., with a bleeding ulcer, the retired farmer was given a slim chance of recovery, she says.
Deanna moved her father 86 miles from his home to Geary Community Hospital in Junction City. "The minute he got there he was treated like royalty. He started to thrive within two weeks," says Deanna. "The rehab unit is the only reason he's alive today."
Alan Morgan, chief executive officer of the National Rural Health Association (NRHA), says stories like Deanna's are common, but don't make news often enough. "The fact is, most people are looking for primary care. And if you look at that, across the board, rural performs better then urban," he says.
There's research to back that up too. The Institute of Medicine's study "Quality Through Collaboration: The Future of Rural Health" saw higher levels of quality outcomes and patient satisfaction among rural health providers. Meanwhile, other research that targets health indicators such as cancer, diabetes and heart disease often see little or no difference between rural and urban residents.
The oft-reported disparities still exist (see much more about that at www.progressivefarmer.com/bestplaces). But community and volunteer spirit—along with technology—are helping more and more to bridge the gap.
(MORE NEXT PAGE)
[PAGEBREAK]
Long-distance house calls
The lack of specialists is one of those disparities. The bridge over that particular gap is a virtual one.
Telehealth is not a new technology by any stretch. It has been used to treat astronauts in space since the 1960s. But in the past few years telehealth has gained great strides serving rural areas where specialists are scarce.
Dr. Robert Skinner works in the University of Tennessee Health Science Center's immensely successful telehealth program, used at 85 sites across Tennessee, Arkansas and Mississippi. "I see patients one afternoon a week," says Skinner, a dermatologist. "Sometimes as many as eight to 15 patients (via telehealth)."
Billy Taylor is one of those.
"My general practitioner couldn't figure out what was wrong with me, and he referred me to a telehealth doctor," says the 61-year-old, who lives on 450 acres outside Dyersburg and is suffering from skin rashes. "The drive to Memphis would eat up an entire day, but with telehealth, I can be back home in less than an hour and a half."
Taylor simply drives to the local hospital, checks in, and his telehealth nurse takes him to an exam room. There, two monitors and a camera are set up. "On one monitor I can see Dr. Skinner, and on the other I can see what he's seeing," Taylor explains.
The exams are done over a secure web link, allowing the patient and doctor to converse normally. "The cameras are so good that the images the doctor receives are better than what you'd see in person," says Taylor, who's still working with Skinner to figure out a diagnosis. And the best part, he laughs, is there's no waiting room.
COMING HOME TO PRACTICE
In many parts of the country, telehealth is still the wave of the future—a potentially distant one for those not served by high-bandwidth networks necessary for the job.
NRHA's Morgan says it's in those places that recruiting and retaining physicians become vital to the success of a rural clinic or hospital.
That's because the shortage of health care workers—from doctors to nurses to even trained clerical staff—is one of the most pronounced differences between urban and rural hospitals and clinics.
It helps when caregivers know what they're getting into by moving to a rural area. Sometimes that's even a draw, says Todd Wiltsie, who directs physician recruitment for LifePoint hospitals, one of the nation's largest rural hospital chains. "A good fit is a doctor who likes to hunt or fish. Some candidates like to farm or raise cattle. And someone who was born and raised in a certain area is most preferred," he says. That approach helps keep LifePoint's turnover rate low.
(MORE NEXT PAGE)
[PAGEBREAK]
It's a good approach, says NRHA's Morgan. "What you see often is these rural training tracks approach kids with the highest scores that grew up in urban areas, train in urban areas and then end up in a rural area where they're unhappy, so they don't stay," he explains.
Now, some rural hospitals even reach out to elementary schools to get kids interested in health care early, since data shows that rural kids in rural tracks tend to stay around and practice. "You'll get returns that way, but it's long-term," he says.
VOLUNTEER SPIRIT
Still, it's not surprising that long-term involvement in a community leads to more stability. That's perhaps most true on the volunteer level, where most rural emergency service takes place.
"EMS is an afterthought on the federal level," says Morgan. As a result, it's vastly more underfunded than hospitals and clinics, who at least have the opportunity to receive grant money and government support.
That leaves much of the burden on residents. "This is a good way to give back to the community," says Lou Hubbs, who farms winter wheat and rents 2,000 acres of pasture.
Hubbs is also captain of the sparsely populated community's ambulance and fire service in unincorporated Hawk Springs, Wyo. Hubbs, whose emergency services leadership roles are also voluntary, works part-time for pay in neighboring Cheyenne County, Neb., for their ambulance service.
But another trend may be emerging—a partnering of rural emergency services that will allow more volunteer paramedics and EMTs to take on those roles as a full-time job.
This can happen, according to health care planners, because workers can provide much-needed assistance in the community or at local hospitals while not responding to ambulance calls.
"Paramedics might conduct follow-up home visits for heart attack patients, deliver and administer medications, provide immunizations at schools or car seat clinics—a variety of public health kinds of tasks," says Gary Wingrove, director of government relations and strategic affairs for the Mayo Clinic Medical Transport.
The reality, according to Wingrove and others, is that many rural areas are overserved by volunteer ambulance services while other duties at hospitals and in the community go wanting. The present system is largely a victim of its own success, with rural communities making it a point of civic pride to have enough trained volunteers and a well-equipped ambulance. "We believe there is a ready-made work force that is already part of the community," says Wingrove. "Many of them would rather be full-time."
Even in rural areas where full-time staff is possible, volunteers like Hubbs will still provide valuable help when needed. "We care about the community," he says. "You either have to like it or not."
(MORE NEXT PAGE)
[PAGEBREAK]
STICK TOGETHER
Collaboration at every level, says NRHA's Morgan, is critical to the future of rural health care. "In the best rural hospitals, you see it," he says. "It's the ability to link up, use state hospital associations, state offices of rural health, state universities—all sharing knowledge."
And then there's that sense of community—of connection—that often transcends what others might view as a disparity.
"It's a clinically proven fact," says Morgan, "that a tight community plays a role in the healing process." While farmers like Hubbs help prove that point on a volunteer level, it's true of doctors too. "You see your patients at the store, at school functions, at church—it makes a difference in how you care for them," says Morgan.
It also plays a role in the success of a small hospital or clinic. Morgan says to think of a health care establishment the same way you'd think of a school—as something like the center of your town. "Utilize it, donate to it, volunteer for it, rally around it," he says. Those are things farmers and rural residents know well how to do—things that play a huge role in stabilizing even the most critical patient.