Rural health: Scope for improvement in return on investment

A significant proportion of the U.S. population live in rural areas with lower population density. Although rural residents tend to be older with more chronic diseases requiring specialists and nursing home care, they have less access to healthcare services. More than half of non-metropolitan counties are considered Primary Care Health Professional Shortage Areas (HPSAs). Although Federally Qualified Health Centers (FQHCs) with government funding mostly provide primary care services in underserved areas, they operate under a narrow profit margin, leading to difficulty in recruiting and retaining healthcare providers. Furthermore, lower population density in rural areas leads to a lower total number of visits in rural clinics. Physician shortage is increasing; doctors have preferentially moved toward cities for better career opportunities, higher pay, and urban amenities. FQHC funding, creating a rural track in medical education, and student loan repayment programs have facilitated improving the physician shortage in HPSA regions. Studies have suggested that these programs support physicians working in rural regions. Still, a significant care gap exists between rural and urban health. Further policy changes should be inculcated for care gap closure. To decrease healthcare provider attrition, part of the funds may be directly invested at primary provider levels by providing tax credits for those who work part-time in rural HPSAs, which would indirectly translate to better salaries without affecting access to urban amenities. Policy changes could support providers to remain in the role for a longer period and motivate older physicians to remain in practice part-time, especially during semi-retirement. In addition, providing telemedicine specialist services to patients from rural HPSA regions could be incentivized by adding a modifier for rural regions that could nearly bring the reimbursement to the cost of in-person visits. Subsequently, this has allowed more specialist clinics to pursue telemedicine to cover rural areas. National medical organizations could provide additional training and support for rural providers through dedicated rural medicine-based conferences and continuing medical education programs. This two-pronged approach to increase primary provider part-time out-migration to rural communities and to increase specialist telehealth access may improve rural health.