On the Frontier: With a Healthcare Crisis


*On the Frontier is an ongoing series exploring the realities of rural healthcare. If you would like to contribute or have questions, please contact us.

On the frontier, rural healthcare facilities endure experiences that other healthcare facilities don’t. Some are enjoyable aspects of small-town living, such as knowing your patients as friends and neighbors. But more complicated is living with scarcities in resources.  

There are daily financial, clinical, time, and resource-related realities of being a rural healthcare professional that urban and suburban peers might not consider. A harsh statistic rural residents face? From 1999-2019, rural areas suffered the highest age-adjusted mortality rates (AAMRs). In fact, during this time the disparity in mortality between rural and large metro areas tripled.

Why did this occur? A few reasons are most likely. There are far fewer resources available in rural healthcare facilities. There is generally far less money allocated. When patients need specialty care, the facilities they need to be transferred to are spread further apart.

People, including highly skilled people like doctors and other medical professionals, too often leave rural areas in favor of more densely populated regions. This, of course, means that there are fewer highly skilled people available — and even fewer specialists, such as cardiologists, neurosurgeons, or pediatric specialists. Of course, normal circumstances were further exacerbated by rural hospital closures and the COVID-19 pandemic.

The people who decide to stay on the frontier tend to be incredibly resourceful. They are excellent problem solvers and creative thinkers who aren’t shaken by much — essential qualities for rural healthcare.

Tightknit Communities Create a Unique Connection in Hospital Settings

Rural healthcare workers tend to know their patients not only as patients, as might usually happen in more urban areas but as neighbors — sometimes, even as friends and family. The lab tech isn’t just someone you meet at work; he’s your best friend from third grade. Likewise, your patients aren’t just “the hip repair in room 314” or even “Mr. Jones” — that’s Dave, your cousin.

There’s an intimacy in a small town that cannot be duplicated in an urban center. On the frontier, the people you work with are the people you live with.

Every patient doesn’t just have a name — they have a story. You don’t just know their patient profile; you know their families, where they went to school… You might even know how they take their coffee.

Fighting for Access to Resources

Rural healthcare professionals are aware of the challenges — and benefits — in the care they provide. But, despite ample evidence and rationale to provide better care and allocate more resources to rural areas, many pathways, processes, and access to funding are still difficult for many rural areas in America. As a result, even though 19.3% percent of the US population lives in what is considered a rural area, access to equivalent healthcare may remain elusive for them.

For medical professionals within the system, the fight for resources can feel like an uphill battle. Beyond their daily jobs, they are tasked with solving resource problems with many different people, offices, and bureaucracies.

On the Frontier: With Better Access to Quality Healthcare

Rural hospital facilities’ existence is dependent on champions. A person — or people — who will fight for their hospital, their peers, their patients, and their community. Champions who know the challenges and generate excitement about the possibilities. Tireless against pushing back and tireless in pushing forward. To stop — and, hopefully, reverse — the increasing disparities that rural areas face, people involved in healthcare, including researchers, funders, and policymakers, must better appreciate the factors affecting the rural healthcare system. One step forward is to create sustainable standardization of processes and administrative support. By doing this, positive patient outcomes will increase, and rural healthcare facilities will benefit.

Cross SH, Califf RM, Warraich HJ. Rural-Urban Disparity in Mortality in the US From 1999 to 2019. JAMA. 2021;325(22):2312–2314. doi:10.1001/jama.2021.5334

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