Rural healthcare in trouble

[MillCreek]

https://www.bloombergquint.com/businessweek/the-state-with-the-highest-suicide-rate-desperately-needs-shrinks

https://www.sfgate.com/business/article/A-catastrophic-trend-in-Maine-A-shortage-of-14305176.php

Two interesting stories in my newsfeed this morning: Montana needs mental health care and Maine needs workers for elder care.  These sort of stories are happening a lot in rural America.

[Jocassee]

Great write up.

Wish I had something to add.

I do enjoy living close to good health care, opportunities, and a community. Would be hard doing without those things.

[MechAg94]

What they really need are more insurance and medical administrators to soak up health care funding and tell them what they can't afford. 

[Brad Johnson]

Rural health care has heen "in trouble" for decades. My small home town's hospital closed when I was in jr. high school, the result of an insufficient tax base. Most of the surrounding communities suffered the same fate at about the same time. The result was a 45 mile drive to the nearest thing that could reasonably be called an emergency room, though the term was used loosely as most were little more than a lightly modernized community clinic. The nearest real emergency centers were, and still are, over an hour away. At best, the community ER's are there to stabilize you enough to maybe survive the longer drive. Air ambulance services have made big inroads but they are still a 30 min flight to scene.

In short, if you are critically injured in that part of the country you are SOL. You might as well write off that Golden Hour because you don't get one.

Brad

[makattak]

Gee, I wonder what the problem is:

Care workers in Maine were paid about $11.37 an hour in 2017, according to an AARP report, with a 2019 minimum wage of $11 an hour.

Note the private sector:

With private help now bid up to $50 an hour

You can't find enough people to fill a job (a hard, messy, at times DANGEROUS job) for just over minimum wage. Fancy that.

[Ben]

Rural health care has heen "in trouble" for decades. My small home town's hospital closed when I was in jr. high school, the result of an insufficient tax base. Most of the surrounding communities suffered the same fate at about the same time. The result was a 45 mile drive to the nearest thing that could reasonably be called an emergency room, though the term was used loosely as most "emergency rooms" were little more than a lightly modernized community clinic. The nearest real emergency centers were, and still are, over an hour away. At best, the community ER's are there to stabilize you enough to maybe survive the longer drive. Air ambulance services have made big inroads but they are still a 30 min flight to scene.

In short, if you are critically injured in that part of the country you are SOL. You might as well write off that Golden Hour because you don't get one.

Brad

Similar to where I am. The local clinic is staffed part time by a PA, who does the "daily illness" stuff, minor injuries, and even physicals, and a doctor might stop by once a week. For ER type stuff, I'm gonna have to rely on the local paramedics to get me to the hospital. Where I AM lucky is that there are three huge hospitals about 30 minutes away by ambulance - one in Oregon and two in Idaho.

Weirdly for dental, one of the most popular dental offices in the valley is only 10 minutes away.

[MillCreek]

You can't find enough people to fill a job (a hard, messy, at times DANGEROUS job) for just over minimum wage. Fancy that.

Because of course people bitch about the cost of healthcare and healthcare insurance.  Everyone thinks their healthcare and insurance is way too expensive and wants healthcare to cut costs.  When reimbursements decline, we have to cut costs to stay in business.  Now facilities are closing, headcount is being cut, services are being reduced and people are surprised how this could possibly happen.

[MechAg94]

Because of course people bitch about the cost of healthcare and healthcare insurance.  Everyone thinks their healthcare and insurance is way too expensive and wants healthcare to cut costs.  When reimbursements decline, we have to cut costs to stay in business.  Now facilities are closing, headcount is being cut, services are being reduced and people are surprised how this could possibly happen.

I would be curious what percentage of the health insurance premium goes to reimbursements and how much covers the overhead of the insurance company. 

[DittoHead]

My small home town's hospital closed when I was in jr. high school, the result of an insufficient tax base. Most of the surrounding communities suffered the same fate at about the same time. The result was a 45 mile drive to the nearest thing that could reasonably be called an emergency room, though the term was used loosely as most "emergency rooms" were little more than a lightly modernized community clinic.

Yeah, same experience where I'm from. This doesn't seem like some new problem to me, it's just how it always was.
There are positives and negative to rural life and this is just one of the negatives. You also can't get sushi delivered.

[MillCreek]

Approximately 80 cents on the dollar of your private healthcare insurance premium goes to healthcare costs, about 17 cents goes to administrative overhead at the insurance plan, and about 3 cents goes to profit.  These costs may vary a cent or two depending on which data source you quote.

https://www.ahip.org/health-care-dollar/

https://www.ahip.org/wp-content/uploads/2017/03/HealthCareDollar_FINAL.pdf

Compare this to Medicare, where only two cents goes to administrative overhead.

Edited to add: Medicaid has somewhat higher administrative overhead, around six cents, I believe, because so many private healthcare insurance plans have contracts to administer Medicaid benefits. Medicaid caps the amount of administrative overhead to those plans.

[MillCreek]

As a side note, I have been peripherally involved from time to time in physician recruitment.  Especially in rural areas, finding a physician suffers from the 'spouse problem'. You may well be able to put together a nice job package for a physician you are trying to recruit, but if the spouse/significant other cannot find a suitable job in the area, the physician will likely turn down the offer.  This is an important reason why rural small hospitals and clinics are closing due to lack of physician staffing.  It can be difficult finding both the physician and spouse who are willing to leave the cultural, social and employment offerings of the big city.

[makattak]

As a side note, I have been peripherally involved from time to time in physician recruitment.  Especially in rural areas, finding a physician suffers from the 'spouse problem'. You may well be able to put together a nice job package for a physician you are trying to recruit, but if the spouse/significant other cannot find a suitable job in the area, the physician will likely turn down the offer.  This is an important reason why rural small hospitals and clinics are closing due to lack of physician staffing.  It can be difficult finding both the physician and spouse who are willing to leave the cultural, social and employment offerings of the big city.

Looks like we need to start encouraging single income families...

[brimic]

Looks like we need to start encouraging single income families...

THAT.
I remember 25-odd years ago when I was in college, there was a big push to get Pre-Med students to go the PA route to staff small town clinics. They were speaking to the right audience at the time, as the college was in a very rural part of the state, which attracted mainly rural students.

[RoadKingLarry]

As a side note, I have been peripherally involved from time to time in physician recruitment.  Especially in rural areas, finding a physician suffers from the 'spouse problem'. You may well be able to put together a nice job package for a physician you are trying to recruit, but if the spouse/significant other cannot find a suitable job in the area, the physician will likely turn down the offer.  This is an important reason why rural small hospitals and clinics are closing due to lack of physician staffing.  It can be difficult finding both the physician and spouse who are willing to leave the cultural, social and employment offerings of the big city.

Need more of.the Northern Exposure premise stuff. Get your school paid for in exchange for a specified number of years in a remote/rural location.

I.kind of thought the Joel character was a bit of a loser. A place like that would have been a dream location for me at.that age.

[makattak]

Need more of.the Northern Exposure premise stuff. Get your school paid for in exchange for a specified number of years in a remote/rural location.

I.kind of thought the Joel character was a bit of a loser. A place like that would have been a dream location for me at.that age.

The "rural" area I grew up in has a deal like that. Agree to work in the town hospital (which isn't great, but at least there is one to go to) after Med School and have it paid for. (Some doctors will work long enough to pay off the rest of their loans and leave, but at least they get some doctors in town that way.)

[BobR]

Need more of.the Northern Exposure premise stuff. Get your school paid for in exchange for a specified number of years in a remote/rural location.

I.kind of thought the Joel character was a bit of a loser. A place like that would have been a dream location for me at.that age.

That sounds like a good plan but often doesn't work out. The US Government will pay money to certain providers in exchange for service. Indian Health Service is a good example, they used to pay 20K per year toward school loans as long as you would work in one of their areas, usually rural and poor. It sounds nice but they are still (the gov) are still bound by salary limitations and can't come close to matching the salary they could make in the "big city".

Even the VA where I work had to limit our hours in the ER and turn it into an Urgent Care Center because we could not hire enough docs at the government salary level to maintain adequate staffing. Presently we do not have other specialties we should have because the grass IS greener on the other side of thew fence and no one wants to take a huge pay cut to work for the VA.

bob

[MillCreek]

https://www.npr.org/sections/health-shots/2019/08/15/747023263/creative-recruiting-helps-rural-hospitals-overcome-doctor-shortages?utm_medium=social&utm_source=facebook.com&utm_campaign=npr&utm_term=nprnews&fbclid=IwAR1FfXFXD-KY6LyiQCwJQdK3qNlDacIZGzesiAhaVtvr2NKTZKVZZo9TTrk

The things you have to do in order to recruit physicians to rural hospitals.

[sumpnz]

Rural areas generally have a dearth of just about every kind of services.  Not just medical.  At my house I can't get anything better than crappy DSL internet service.  Equivalent to the best you could get ca. 2002. 

[T.O.M.]

I work in a city that is about an hour outside of a major city (top 15 in the US).  It has a branch of a major university, and a nearby small liberal arts university.  The area is having difficulty attracting young professionals of any type.  Doctors, lawyers, nurses, teachers, etc.  The big city is paying so much more in salary, the small city can't compete, even with lower cost of living, less competition,  etc.  Some people blame the student loan level, which they say pushes young professionals to the higher salaries.  Others say the young professionals want the life and attractions that come with the big city.   Don't k ow the answer to this one.