Journal Article

Physicians and rural America

Hart, L Gary, Rosenblatt, Roger A

2000

Overview

Summary points There is a relative shortage of physicians in rural areas of America The more highly specialized the physician, the less likely he or she will settle in a rural area The preference of women for urban practice may pose a problem for the future recruitment of rural physicians Although managed care systems can recruit physicians to rural areas, systems are growing slowly in rural areas and their doctors may be of little use to the working poor who have neither Medicaid nor conventional health insurance Possible solutions to the problem of physician shortages in rural areas include changing the medical education system so that it trains more physicians who choose rural practice, changing the reimbursement strategies of Medicare and Medicaid, and changing the existing federal and state programs EFFECT OF SPECIALTY CHOICE AND DISTRIBUTION Nothing affects the location decision of physicians more than specialty. INFLUENCE OF MANAGED CARE Managed care is a major emerging influence on the delivery of rural health care.\\n 8 , Table 1 Key factors in improving the delivery of telemedicine to rural areas Resolution of the professional licensure regulations, allowing physicians in metropolitan areas to make their expertise available to remote rural areas, even across state lines Clear protocols for a unified technologic infrastructure to reduce costs and to allow rural providers to have the option of communicating with multiple providers of these distant services without being captives of any single information provider Reasonable reimbursement by third-party payers for providing medical services at a distance Given the realities of the current system, future efforts should concentrate on improving the fit between need and services, enhanced coordination--and reduced duplication--of services provided, better identification of students to ultimately serve in the NHSC and state programs, and improved effectiveness and efficiency of governmentally sponsored health care services, including those of rural health clinics. 9 The wide variety of programs available--and the natural variability in the way they are organized and administered--leads to enormous complexity in the provision of services.

• Publisher: Copyright 2000 BMJ publishing Group,BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Demographic aspects / Female / Health care policy / Humans / Medicaid / Medical care / Medical personnel / Medical professions / Medically Underserved Area / Physicians / Physicians - supply & distribution / Physicians, Women - supply & distribution / Population / Rural areas / Rural health care / Rural Health Services / Shortages / Telemedicine / United States / Urban areas / Utilization