While the physician shortage is affecting the entire country, rural areas are being hit especially hard. A shortage of physicians who are willing to work in the more remote parts of the U.S. has led to major staffing problems for rural hospitals, exacerbating an already fragile healthcare environment. Findings from last week’s study published in the BMJ (formerly the British Medical Journal) also revealed that the physician shortage at rural hospitals could be adversely affecting patient outcomes.

In part two of our series looking at America’s rural healthcare crisis, we take a closer look at the staffing challenges these hospitals are facing as well.

A recruiting challenge in rural areas

According to a report from the American Hospital Association (AHA), although 23 percent of Americans live in rural areas, only about 10 percent of physicians practice there—and 10 percent of rural counties do not have a single primary care physician. Specialists such as surgeons, cardiologists, neurologists, rheumatologists, pediatricians, obstetricians/gynecologists, psychiatrists and general internists are in especially short supply compared with urban regions.

A recent study from the Centers for Disease Control and Prevention (CDC) revealed that Americans living in rural areas are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke than those in urban areas—more than 70,000 of these deaths were potentially preventable. Furthermore, Americans in these areas are often poorer, sicker, older, less likely to have health insurance and the most in need of health intervention, yet, without an adequate number of physicians to treat them, the least likely to have access to it.

Many factors play a role into why rural areas experience such drastic physician droughts. An article in The Atlantic reported that some feel the disparity starts with medical education. There aren’t enough applicants from rural areas applying to medical school and those that do often don’t want to return after graduation. Additionally, most of the prestigious medical schools are located in big cities and are less likely to enroll rural students. A lack of cultural offerings in remote areas can also factor in, as well as individuals graduating from medical school staring down enormous amounts of student debt—a more lucrative practice in a metropolitan area can seem a better alternative.

How rural hospitals are adapting

Hospitals adapt where they can. For example, some states have amended their scope-of-practice laws allowing for nurse practitioners and other midlevel health professionals to expand their care roles, taking on elevated responsibilities. Programs have also been developed aimed at enticing more physicians to practice in rural areas. Under the Affordable Care Act (ACA) funds were expanded and allocated to the National Health Service Corps to support scholarships and loan repayments for primary care practitioners who work in Health Professional Shortage Areas (HPSAs). Yet, given the likelihood of an ACA repeal, it’s uncertain whether a similar provision under the new administration would address the dearth of physicians in these deficient areas.

Foreign-born doctors also shoulder much of the responsibility, filling the wide gaps in care created by a lack of physiciansparticularly in rural and underserved areas where doctors are most gravely needed. “One way foreign medical graduates can negotiate to stay in the U.S. after their residency is through a visa waiver under which they agree to practice in underserved areas for several years,” the Atlantic reported. For many regions in this country, foreign-born physicians are the lifeblood for these communities who would otherwise have little to no access to basic healthcare.

Dr. Chalak Berzingi, a cardiologist and Iraqi immigrant recently profiled by STAT, understands the dire needs of a community with little to no access to healthcare. Dr. Berzingi had already earned his US citizenship when he chose to practice in Elkins—a small town in West Virginia with a vastly medically underserved population, explaining, “I wanted to be in a place where I felt I was needed. In Elkins, I was really needed.”

A Growing Healthcare Crisis in need of Solutions

As policy leaders and the healthcare community continue to grapple with how best to recruit more physicians to rural areas, demand is also growing for more innovative solutions to address this crisis. Increasingly, evidence seems to point to technology as being promising and effective in helping this problem.

Next week, in the conclusion to our series on rural healthcare in America, we will look at how technology can help alleviate some of these burdens communities are facing by enabling remote care, and also incentivizing primary physicians to practice in these rural pockets while better supporting the ones who already do.