I shadowed a fantastic doctor today — the kind that makes me hopeful for going into medical school. He works at a clinic whose primary client base is underserved or uninsured Central Texans (the same clinic I’ve volunteered with — and adored — for a year and a half now). When my rural, 20-miles-from-a-hospital upbringing came up, he told me about how his experiences working in rural settings outside of Bombay made him realize that a lot of the problems faced by those communities are also faced by many communities in America.
He said that we like to talk about America as if it is Boston, San Francisco, Houston, Chicago, Miami, etc. — but our cities only make up a small portion of the fabric of America. The rest is a patchwork quilt of tiny, underserved communities like my own, but we don’t talk about them when we talk about healthcare in the US. I will further add that our cities, too, are patchworks of areas with access and areas without.
Sure, the majority of our population lives in urban areas. As of 2010, nearly 80% lived in the city or the suburbs, leaving only 20% in rural areas. From these numbers alone, it makes sense that cities, although they make up a tiny geographic portion of the US, get the largest portion of healthcare services. The problem is that rural populations still get a relatively meager portion of services, even once you consider population differences — 20% of the US population might live in rural areas, sure, but only 10% of doctors practice there.
And only a portion of the problems are addressed. We have an RN moving to a community 10 miles from my hometown. She’ll be able to provide a HUGE number of services to people who are used to driving 20 miles or more to receive them — immunizations, stitches, casts, antibiotics, and more. I was incredibly excited when I first heard the news, even though I haven’t lived at home in years.
The truth is, though, it disturbs me how excited I was. It disturbs me how excited I can be about a situation in which there is a single medical professional in a 15 mile radius containing over 1500 people. RNs and other primary care professionals are an important part of delivering healthcare to an area — but they are still only a part. What about mental health services? A 45 minute drive. Specialty GI care, like I had to have? 3 hours. A neurologist that could recognize Tourette syndrome, like my friend had to search for months to find? 3 hours.
The only way you can be excited about this situation is if you know what it’s like to have 0 healthcare professionals in your area. Meager portions? That barely even describes it.
For me, one reason I want to tackle this problem from the healthcare side and not the advocacy side (besides the fact that medicine suits my personality, as I wrote about here, The Beginning of my Gap Year) is empathy. For someone who has grown up in the suburbs their entire life — who’s used to quick access to restaurants, cultural sites, and people who look and think like them — can I really tell them that they should give all that up to help communities like mine? And, considering how much bias plays a part in the doctor-patient reaction, can I really expect them to go in with the skills and live experiences required to not think of my gun-touting, flag-waving neighbors as dumb, backwards hillbillies? (I exaggerated a bit there — but not as much as you’d think :))
And can I really tell a physician with a spouse, two kids, two cars, and a mortgage that they should stop practicing in their top-notch hospital to work at the county medical center? No. No, I can’t.
To me, a large part of the solution is finding more people who grew up in these communities and want to serve them in some way. This doesn’t just include rural healthcare, either — for example, black or African American patients, who are disproportionately affected by disease burdens (as I wrote about in The Differential Rates of Survival), report better outcomes and satisfaction when seen by a physician of the same race. We don’t need the typical medical student to “sacrifice” and work with underserved populations. We need more medical students (and nurses, and PAs, and techs) from these underserved communities who want to work with populations they already know and care for.
In other words, it’s not enough that we denounce the meager portions of healthcare that underserved (rural AND urban) get. We need to start serving them a bigger portion — and that begins, in part, with the people who’d actually be doing the serving.