Friday, May 16, 2008

Rural Health Care: A Few Thoughts

Having just interviewed for a position with a home health agency whose territory covers a large swath of rural countryside, I am appreciating the challenges and difficulties of delivering care in such a setting. Whereas the city---where I currently provide home health care---finds patients in an area of high population density and relatively close geographic proximity, serving patients who live in mostly single family homes in far-flung sections of the countryside is an entirely different story.

When considering such matters, I recall how Dr. Paul Farmer, the founder of Partners in Health (recently featured on "60 Minutes"), created teams of trained lay outreach workers to bring care to patients living in rural isolation.

Native American reservations face great challenges when it comes to the delivery of home health care. The Center for Rural Health at the University of North Dakota School of Medicine use their resources to drive policy and develop care models vis-a-vis rural health and the delivery of medical care in rural areas.

Even the Health Resources and Services Administration of the U.S. Department of Health and Human Services has an Office of Rural Health Policy that strives to improve rural health care around the country.

It is now an accepted fact that physicians are leaving primary care and family practice in droves as specialization becomes the ultimate goal. More and more medical students choose specialties other than primary care as the cost of medical school skyrockets and the subsequent debt after graduation becomes even more astronomical.

While much is written about a nursing shortage which is feared to be worsening by the day, a physician shortage--especially of primary care physicians---is also taking hold, and one can easily extrapolate that any nurse or physician shortage is bound to have a devastating effect on rural health around the country. Many articles recount how doctors are in high demand, and strategies to lure health care workers to rural areas are discussed in stories and reports from Australia, Norway, and elsewhere.

Rural health is a subject which has never captured my imagination, yet today's interview and a few clicks of the mouse were enough to make me dig just a little deeper. While strategies and policies to offset the growing national shortage of nurses and doctors are developed and implemented, those living in rural areas are sure to be hoping that they don't get left in the proverbial dust.


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