Rural Missourians face a set of challenges in obtaining health care that can be unknown to city dwellers. Difficulties such as lengthier distances to travel, understaffing of health care facilities and lack of internet all contribute to health outcomes that are far worse for rural citizens than the average American.
The Missouri Hospitals Association has announced a set of policy recommendations to improve Missouri’s rural health care as a part of the Reimagine Rural Health Initiative, an effort for which it is partnering with Gov. Mike Parson. The recommendations are aimed at tackling problems with infrastructure, workforce and access.
In December 2018, a rural health summit was held in Bolivar, where a core of rural health solutions for 2019 were identified. Parson then recommended these changes as a part of his budget, and a significant number of them were eventually approved by the legislature. This year’s plan serves as a follow-up to the partnership that began at the summit, and the ideas serve to compliment the progress made this past year.
Last year’s initiatives, to be implemented in 2020, included additional investments in behavioral health, substance abuse treatment and finding primary care doctors to work in underserved areas. Attention was given to the treatment of the developmentally disabled, with nearly $100 million directed specifically at that population.
This year’s suggestions follow a similar trend but include a specific focus on solving the understaffing that plagues rural medicine in much of the country. These ideas include giving nurses the power to make more decisions and joining the Interstate Medical Licensure Compact, a group of states that have agreed to share licensing for physicians so it’s easier for doctors to move between different states.
Jeffrey Davis is a family practitioner at the Scotland County Hospital in Memphis, Mo., near the Iowa border. He grew up in the area and knew he wanted to come back to practice. Smith described trying to find a residency program for family medicine that was broader than normal because a rural physician is forced to wear far more hats than their metropolitan counterparts.
“I knew if I was going to practice in a rural community, I would need to be able to take care of people in the emergency department, in the hospital, deliver babies and take care of nursing home patients,” he said.
“Rural residencies for physicians are something that needs to be funded,” said Kathleen Quinn, associate dean for Rural Health at the MU School of Medicine. She and Davis both stressed the importance of improving access to broadband, and the opportunities telemedicine presents.
Scotland County Hospital is a designated critical-access hospital, meaning it is more than 35 miles from any other hospital and has fewer than 25 acute inpatient beds, yet Davis estimates it serves up to 30,000 individuals.
More than 46 million Americans live in rural areas, per the Census Bureau, and they suffer in higher numbers from a multitude of health risks. According to a 2014 report from the Health Reform Policy Research Center, rural Americans suffer higher rates of obesity, addiction, heart disease, infant mortality, suicide, car crash and accident-related death.
It is a population that is statistically older and less wealthy than those of urban areas, and a dearth of doctors means each physician must treat far more patients than one working in a city.
Dave Dillon, spokesperson for the MHA, said, “What we’re trying to do with Reimagine Rural Health is define the issues and be transformative for rural health care in Missouri and put them out front on the agenda because many of them are not extremely hard to do or extremely expensive to do. But they take a different type of thinking.”
Davis stresses why the effort is worthwhile.
“I honestly like taking care of people that I know. I like taking care of people in my office that I know teach my children at the school. I like taking care of people in my office that I do business with at the bank or the grocery store. I wouldn’t enjoy what I do as much if I didn’t know the people I’m taking care of,” he said.
Supervising editor is Mark Horvit.