Hospitals and clinics in rural America are closing down for a lot of different reasons – economic, in general. According to Rural Health Information Hub (RHIHub), rural non-profit hospitals shut down mainly because of low reimbursement rates as a result of government healthcare regulations, decrease in the volume of patients, and even uncompensated care. However, since most of these hospitals are government-owned and non-profit, they should be able to raise capital funding from public grants, private donations, and loans.
Taking a closer look, it appears that rural hospitals have a bigger problem than economic challenges and mismanagement. Finding doctors who genuinely have the heart for the underserved can save rural hospitals from closing down. The best way to find out who they are is by using a talent search app like DocDelta.
Current situation of rural hospitals in the U.S.
Out of the 50 states in the United States, 26 have seen at least one rural hospital close since January 2010. According to Chartis Center for Rural Health, from 2010 until just last month, 83 rural hospitals have already closed down. As if that was not bad news enough, it looks like the trend is not changing anytime soon. Last year, it was projected that 670 other rural hospitals would close. Eighty-three is not even half of this projection.
According to Khazan as revealed in her article in The Atlantic, if urban areas have 1 doctor for every 1200 people, a doctor in a rural area should be ready to serve about 1600 people. There is obviously a shortage of primary care doctors in rural areas in the United States. To think that these people are the ones who need healthcare the most because of their vulnerabilities, the constant decline in the number of rural hospitals is like a series of unfortunate events.
Rural hospitals shutting down does not only affect the status of healthcare in an area. This occurrence also has an impact on the economy of the community. According to Hart, Pirani, and Rosenblatt, 90 percent of mayors thought that the closure of the only hospital in town “substantially impaired the community’s economy”. In a separate research, Holmes and colleagues revealed that the closing of the sole community hospital decreased per-capita income, and increased unemployment rate.
Survival strategies for rural hospitals
As National Rural Health Association (NRHA) Vice-President for Government Affairs Maggie Elehwany describes the situation, these rural hospitals are “hanging on by their fingernails”. Nevertheless, there are a number of interrelated survival strategies that hospital administrators may employ depending on the need of their institution. The main goal would be to face and adapt to new market realities.
This involves increasing or reducing the list of services being offered while maintaining its classification as a general hospital and maximizing the use of the community’s income-generating properties to fund this diversification of services. As aforementioned, rural hospitals can apply for government grants, low-interest loans, and even do fundraising activities.
There had also been instances wherein petitions were able to save community hospitals from closing down.
For instance, there was the case of the Teaching Health Center Graduate Medical Education (THCGME) program that produces graduates who eventually practice medicine in rural communities and underserved areas. This program was supposed to stop receiving federal funding on December 2017 as per Public Health Service Act. This would definitely result to the closure of many rural hospitals because of lack of doctors. However, due to the efforts of the whole medical education community, particularly the Council on Graduate Medical Education (COGME), to lobby for the extension of providing federal funding for the said program, the Congress came up with the Teaching Health Centers Graduate Medical Education Extension Act of 2017. This bill extends and expands the said federal funding through 2020.
However, the even such programs still cannot guarantee that all of its graduates would stay in rural hospitals.
Why doctors do not stay in rural hospitals
THCGME is one example of the measures taken by the government to encourage doctors to work in rural hospitals after they graduate. There are various scholarships and grants offered for students to train and study as primary care doctors. Most of these offers come with an agreement to work for rural hospitals for a certain number of years after finishing the degree. According to Khazan, the state of Kansas even opened a medical school that focuses on rural healthcare.
However, no matter how enticing these opportunities are, some of these doctors do not stay in rural hospitals for long.
Based on case studies, the main reasons why doctors, especially those who did not enroll with scholarships and grants, do not stay in rural hospitals are mainly economic in nature. Most of these graduates have hundreds thousands of dollars’ worth of student loans that they have to pay off. Working in a rural hospital does not allow them to maximize their potential to earn. Patients in rural areas are more likely to have and use Medicaid and Medicare that have lower reimbursement rates than private insurance.
For instance, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) are only allowed to bill Medicare for Chronic Care Management (CCM) Code 99490, whereas urban counterparts can bill for all other CCM codes. This kind of regulation further challenges doctors economically since the aging population does not only reside in urban areas. They are providing almost the same amount and quality of care via telehealth, but only getting less than 25 percent of what their urban counterparts are eligible for.
It’s not all about the money
However, doctors do not only leave a rural hospital or clinic for financial reasons. According to a poll conducted in 2014 through Sermo, the main reason why doctors do not last long in rural areas is because of inadequate cultural opportunities. Remember, these doctors are not only going to work in the community; they are also going to live in the community.
Inconsequential as it may seem, but not having a lot of food choices in the rural area is one of the main non-financial reasons why doctors do not stay. According to a report from Sermo, there was one rural doctor who needed to go to the city once a month to eat “good food”, watch a movie, get some food for the rest of the month, and just simply get out of the place.
Other doctors reportedly experienced gender and cultural discrimination against them and their families. Some patients would not communicate with them because of language and emotional barriers. A number of people in these areas do not trust doctors because they do not think they are one of them. Doctors who have tried working for these hospitals ended up hating their patients.
Lastly, because of the scarcity of doctors in rural areas, they do not get to have a day off and they are usually on call 24/7. This inevitably results in burnout, which prompts the doctors to decide to leave the institution for good.
However, all these challenges would have been overcome or would not have surfaced if these hospitals are able to find doctors that would be cultural, emotionally, and psychologically fit to work in these areas…and the best and easiest way to find doctors that would best match a specific cultural setting is by using a talent search app such as DocDelta.