Healthcare Career Blog, Physician Blogs

What is the Most Likely Reason Rural Communities have Physician Shortages?

Author Healthcare Career Blogger | 04.13.2009

If we were on the popular tv game show Family Feud (now hosted by John O’Hurley, of Seinfeld fame), the question might be put to us this way:

Name a reason that big cities tend to have more doctors than rural communities:

Would you name either of these two reasons?

• Affluent areas pay higher salaries than rural areas
• Physicians tend to settle down near the place they were trained

And the Survey Says …

Both! Affluent communities in and around big cities are where the majority of medical schools and teaching hospitals are located. As doctors leave school and move forward with their careers in physician residency jobs, they tend to settle near the large teaching hospitals where they trained.

For example, San Francisco and Washington DC are loaded with medical schools, as well as high-income residents:

• San Francisco, California, had 117 primary care doctors per 100,000 residents.
• Washington, D.C., had 102 primary care doctors per 100,000 residents

Whereas, in these more rural communities with fewer medical schools and lower household income:

• McAllen, Texas, had just 45 primary care doctors per 100,000 residents
• El Paso, Texas, had 47 primary care doctors per 100,000 residents

Who were the researchers that did the study?

The nonprofit group that conducted the survey was The Dartmouth Atlas, funded by The Robert Wood Johnson Foundation. The purpose of this group is to provide research, information and analysis about hospitals, doctors and healthcare markets.

For the research, the nonprofit group evaluated 306 regions nationwide, using data from the government, the American Medical Association, and the American Hospital Association.

The study also found that areas with more doctors tend to have a decreasing amount of hospital beds. But some rural areas have far more beds per capita than more heavily populated areas. For example:

• San Francisco suburb of San Mateo had 1.45 hospital beds per 1,000 residents
• While Mississippi’s Jackson and Gulfport both had 4.44 beds per 1,000 residents

What does this all mean for consumers and registered voters who are looking for healthcare reform?

Dr. David Goodman, a professor of pediatrics and community and family medicine at The Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, which publishes the Atlas had these suggestions:

• Congress should require the federal Centers for Medicare and Medicaid Services to use its payment policies to try to limit hospital growth in regions that have too many beds.
• National healthcare reform, should it be implemented, should set up a national commission to direct training dollars to high-need specialties such as primary care physicians

And what is the recommendation for communities that need to attract high quality physicians for staff openings? First, they start by attracting locum tenens in hopes that these physicians may choose to settle in their areas permanently. Once a physician has had a chance to live in a new place, and experienced the alternative to the fast-paced, busy metropolitan lifestyle, they may be more inclined to make the move a permanent one.

What else does it take? Great pay and benefits, less stressful work environments, and a desire to try something new are the top motivators to change for medical doctor jobs in specialties like OB/GYN and Orthopedic Surgery.