What’s the news: With a recent report from the Centers for Disease Control and Prevention (CDC) showing that rural residents often live sicker and die younger than do their urban counterparts, the AMA has proposed five strategies the nation should take to improve rural health care access.
Physician private practices are the backbone of rural health care for 46 million patients, but administrative burdens such as prior authorization and declining physician payment from Medicare and commercial insurers are exacerbating the challenges that these practices have in keep their doors open, AMA President-elect Bruce A. Scott, MD, said in conjunction with remarks he made at the National Rural Health Association Annual Conference in New Orleans.
The challenges are also leading to physician burnout that results in early retirement—including potential physician practice closures—and leaving rural communities underserved. A study by researchers at the Mayo Clinic found that one in five physicians hopes to retire or leave clinical practice in the next two years. One in three physicians hope to reduce their clinical hours. It’s projected that the nation will be short as many as 87,000 physicians by 2036.
On top of that, fewer college graduates from rural areas—who are the students most likely to practice in rural areas after graduation—are applying to attend medical school.
“All of this compounds the access problem, particularly in rural areas,” Dr. Scott said during a news briefing. “The American Medical Association is deeply concerned about the ever-widening health disparities between urban and rural communities.”
Dr. Scott proposed five strategies that could help turn things around:
- Fix the Medicare payment system. Adjusted for inflation, Medicare physician payment has fallen 29% since 2001 (JPG).
- Address workforce burdens that drive burnout and early retirements. This includes the two hours physicians waste on administrative burdens such as prior authorization for every one hour they spend face to face with patients.
- Enact legislative fixes to grow the physician workforce, including expanding residency and graduate medical education slots, incentivizing physicians to work in rural communities and supporting an expanded role of international medical graduates (IMGs).
- Permanently remove telehealth restrictions. The pandemic showed that removing restrictions is an essential tool to providing care, especially in rural areas where transportation can be challenging.
- Tackle chronic disease head-on. This includes bolstering health outreach and education to rebuild trust in science and medical institutions.
“We need Congress, we need the media, to understand that rural health care is American health care and we need to fix the situation before it’s too late,” said Dr. Scott, an otolaryngologist and head-and-neck surgeon in private practice in Louisville, Kentucky.
Why it’s important: While physicians across the country face declining pay rates and are retiring earlier because of burnout, the impact of these challenges are far greater for patients in rural areas.
When a physician retires early or stops accepting new Medicare patients, or doesn’t take any Medicare patients, rural patients often don’t have other physicians they can turn to. While urban areas have 263 specialists for every 100,000 residents, Dr. Scott said, there are about just 30 specialists for every 100,000 rural residents. Consider also that:
- 136 rural hospitals shuttered their doors between 2010 and 2021.
- About 65% of rural areas have a shortage of primary care physicians.
- There was a 28% decline in graduates from medical school in rural areas between 2002 and 2017.
- Just 4%–5% of incoming medical students are from rural areas.
And statistics like these are having a real impact on patients’ lives. The CDC data shows that in 2022, many early deaths among rural residents could have been prevented. That includes:
- 17,000 from heart disease.
- 6,000 from chronic lower respiratory disease.
- 6,000 from cancer.
- 2,800 from stroke.
The CDC says that health risks can be reduced by screening patients for high blood pressure, increasing cancer prevention and early detection, encouraging physical activity and healthy eating, promoting smoking cessation, and treating opioid use disorder—all things that physicians can make a difference and save lives.
Learn more: Find out how the AMA is rebuilding critical components of the U.S. medical profession, in rural areas and beyond, by:
- Leading the charge to reform Medicare pay.
- Fixing prior authorization.
- Fighting scope creep.
- Reducing physician burnout.
- Transforming digital health.
The AMA already has achieved a number of big wins in these five critical areas. Get the details on the AMA’s success with these advocacy efforts (PDF).
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