Dr. Denis Grillo, Ear, Nose & Throat, 01/15/13

Rural areas have always had issues with being underserved as far as medical care goes, and there is not likely any relief in the future with the continuing economic problems and predicted shortage of health care providers.

There are about 50 million Americans who lack access to quality primary care due to their rural settings and shortages of medical providers. Only about 10 percent of America’s doctors practice in rural America, but nearly one-fourth of America’s population resides in a rural area, making the delivery of care a challenge.

Some estimates suggest that there is a need for about 50,000 to 60,000 health care providers needed to resolve this problem; this includes physicians, nurses, and medical assistants.

Challenges to deliver rural medicine can include harsh weather as well as travel and transportation difficulties. Also, some of the difficulties in implementing health care initiatives and reforms are easier to do in a more sophisticated, urban setting.

Newer, younger doctors who are not from a rural setting will reluctantly practice in rural areas because of the fact they are used to being in a more dense doctor population. The training centers typically provide a lot of resources and abundant supplies, and the ability to bounce ideas off of other doctors.

This is difficult to do in a rural setting, particularly if you are the only show in town.

Access to technology is another reason. Doctors prefer to provide the best for their patients, and fear if they move to a rural area they may have to compromise that ideal.

Technology, as we all know, is very expensive and much easier to implement in a larger center where there are multiple doctors using and utilizing the technology. Sometimes in these cases the more complicated medical problems are better suited to be done at a large hospital or teaching center, and that is also the importance of a rural doctor to understand what he can do well, and what more importantly he cannot do well and needs to refer out.

The latest statistics suggest less than 5 percent of medical school graduates plan on living and practicing in a rural or small town. Some ideas have been hatched as a result of this problem, and they include starting medical schools in rural or small communities that have a percentage of seats devoted in each class to students who will commit to returning to smaller rural settings.

Also, choosing candidates from small rural areas will make them more likely to return to those areas and serve the underserved patient population. This is probably more practical with primary care specialties such as family practice: pediatrics, internal medicine, OB/GYN and general surgery.

As the subspecialties become more sophisticated and more technologically driven, they are likely to remain in larger centers. To bridge the gap problem, there may be the ability to utilize computers, as well as telemedicine, and maybe even import a sub-specialist once in a while to address these difficult medical problems and difficult patients.

The U.S. government has looked at several ideas, including seeking international medical school graduates who are accustomed to practicing in rural areas, recruiting them to the United States. The National Health Service Corps is also expanding its programs by providing scholarships and loans to assist medical students who are interested in practicing in underserved areas.

As our population grows, the trend is still to remain around large metropolitan areas, so small towns and rural areas will still be difficult to serve.

Years ago, when there were plenty of health care providers, it only took a few months to fill the shoes of a retiring health care provider. Now it seems like it takes years, and it is much more complicated and difficult to retain someone in these areas.

As a doctor who has practiced in a rural area for more than 25 years, I understand the rigors of practicing in these circumstances, but the benefits are undeniable. You live in a community with nice people who you get to know and see on a regular basis, which cannot be done in a larger center.

Hopefully, these advantages will hit home with some of the younger doctors starting out, and in the future we may not have this problem.

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.