Our nation seems to expect that health outcomes will be worse —a lot worse—for people living in small towns, farming and ranching communities, and other places far from city lights and suburban sprawl. Rather than accept this status quo, the AMA is working on multiple fronts to reduce these inequities, promote greater access to care, and significantly improve the health of people regardless of zip code.
The health trends in rural America are admittedly alarming. Research has shown that people in rural communities experience disproportionately higher rates of cardiovascular disease, stroke, cancer, diabetes and respiratory illness. In addition, the death rate from unintentional injuries in rural areas is 50% higher than in urban centers, according to Centers for Disease Control and Prevention data.
Some 46 million people live in rural sections of our nation. That is 15% of the U.S. population, a contingent larger than the combined number of people residing in our 20 largest cities. Our policymakers should understand that rural health is America’s health, and that our solutions to fix our health care system must ensure that everyone has access to meaningful care.
Factors driving the differential
So why is the age-adjusted death rate in rural America 20% higher than that in urban centers? The reasons are varied. Wages are typically lower and jobs can be harder to find and keep; that increases economic pressures as well as mental and physical stress. A higher percentage of rural residents live at or below the poverty line, leading to the twin issues of greater food insecurity and limited access to vegetables, fresh fruit, dairy and other components of a nutritionally balanced diet.
Poorer health outcomes among rural residents are also tied to higher rates of tobacco use, obesity and hypertension. The ability to obtain care for these and other health issues is complicated by scarce medical facilities, and the fact fewer rural residents are covered by health insurance than their urban counterparts. Suicide rates, motor vehicle crashes and drug overdoses also contribute to a grim health outlook for those living in rural areas.
Identifying and implementing solutions
The ongoing physician shortage is part of that grim outlook, but the good news here is that the AMA is working tirelessly to correct the systemic issues that drive physician burnout and prompt many doctors to opt for early retirement. The AMA is active on multiple fronts to grow the physician workforce, including advocacy to secure expanded residency slots and incentivizing physicians to practice in rural communities.
Fixing the broken Medicare physician payment system remains a top priority, because private practice physicians are the backbone of rural health care. Medicare physician reimbursement rates have plummeted by nearly 30% since 2001, adjusted for inflation. Meanwhile, the cost of keeping independent practices open continues to soar.
Without action, the viability of our system and health care for tens of millions of patients in every setting is needlessly put at risk, and the risk is heightened for seniors and those with low incomes in rural areas. Please visit FixMedicareNow.org to add your voice to the call for providing a rational Medicare payment system that safeguards access to high-quality care.
Maximizing telehealth
We learned during the pandemic that telehealth and remote patient care were essential tools in caring for patients who lacked the ability to travel to a physician’s office. For those patients, particularly for many in rural settings, telehealth is a literal lifeline.
The AMA championed the use of telehealth and remote patient care long before COVID-19. Our mission is to help provide physicians with the tools, resources and support to seamlessly integrate telehealth into their practices without financial risk or penalty, while giving patients the opportunity to access telehealth services from the comfort and privacy of their homes, wherever they live.
The AMA won an important victory with the passage of legislation extending pandemic-related telehealth flexibilities through the end of 2024, ensuring that patients could continue to receive remote care regardless of whether they lived. And we continue to work with Congress and the Department of Health and Human Services to make these changes permanent.
There are other legislative fixes as well that could help solve rural health challenges. The AMA strongly supports legislation pending in Congress that seeks to expand residency training options, provide greater student loan support, and create smoother pathways for foreign-trained physicians, who already comprise about one-quarter of our nation’s physician workforce. This work is particularly important in addressing shortages in rural and medically underserved areas of the country.
Priming the physician pipeline
Maintaining the status quo in rural health care is not an option. That’s why the AMA is leading the charge to bolster the physician workforce by increasing the number of residency slots, especially in primary care and in rural areas of our nation. We continue to advocate for legislation to increase incentives for physicians to work in rural and underserved markets, while also seeking expanded loan forgiveness for medical education.
The AMA supports the Conrad State 30 and Physician Access Reauthorization Act (H.R. 4942/S. 665). This bipartisan measure would improve the J-1 visa waiver programs to address physician shortages, especially in rural and underserved areas, and also promote a more diversified workforce. We also strongly support the Healthcare Workforce Resilience Act (H.R. 6205/S. 3211) which would recapture 15,000 unused employment-based visas for physicians.
The AMA also supports expanded roles for international medical graduates, as nearly 21 million people live in areas of the U.S. where foreign-trained physicians account for at least half of all physicians. Working to establish a physician workforce that better reflects the diversity of our nation is an important step towards eliminating health inequities.
Unfortunately, there is no single solution to the complex issues confronting rural health care. But the answer starts with ensuring access to care for patients, and strengthening a physician workforce besieged by excessive administrative hassles while bearing the brunt of a broken Medicare payment system. Solutions to fix these and other challenges are within our grasp—we just need to find the political will to make them happen.
