For small-town residents, there is often a choice between quality of care and convenience of care.
Health care is a major topic of conversation in modern America; oftentimes the conversation revolves around overall health insurance coverage. But the issues go far deeper than that.
There are many who have health care coverage, but coverage can only go so far, and patients often need to travel farther to obtain better quality of care. Brenda Elliott is one such patient. She is a longtime resident of Centerville, Tennessee, a small town located about an hour west of Nashville, and although she lives only about 15 minutes away from local doctors, she decides to go elsewhere.
When asked why this is the case, Elliott said, “From past experiences, the health care in our rural community is not very good. Even if you go to the emergency room, your issues are not addressed.” It is for this reason, and others, that Elliott seeks medical care outside of her hometown.
This is a decision many small-town residents are forced to make, and it is just one of the many problems prevalent in rural health care. According to data profiles from the Health Policy Institute of Georgetown University, rural citizens are usually less well-off than their urban counterparts regarding health. These same profiles find that rural citizens suffer more from chronic conditions, are less likely to be tested for chronic conditions, are less likely to be insured, face higher health care expenditures and face higher rates of access limitations.
Many of these issues are rooted in the socioeconomic standings of individual residents or small towns in general. According to Robin Warsaw of Association of American Medical Colleges.org, a non-profit organization based in Washington D.C., these factors can limit a patient’s access to health care, makes finding solutions extremely difficult and only adds to the problems rural communities already face. So, just what are some of the biggest challenges that rural residents face regarding care? If there are not even enough doctors or specialists in the area, that is certainly one of them.
Kristy Christlieb, a licensed practical nurse in Centerville, said that there are not enough specialists in small towns like her own.
“If you want to see a specialist, it’s a 45-minute drive. And that’s probably at least the minimum for a lot of people in rural communities; a lot of them are driving farther than that,” Christlieb said.
This is true for most rural communities. According to a 2017 report from The National Rural Health Association, there are only 30 specialists per 100,000 people in rural areas as opposed to 263 in urban areas.
With a lack of specialists, residents with a wide range of medical issues likely do not receive the proper care or advice they need. Elliott knows this all too well. She said that the information and advice she received in her hometown only added to her medical issues instead of fixing them.
“I had to receive medication for a health disorder which caused me to have other issues. It caused me to have really brittle bones, and I’ve had six back fractures, and it also caused cataracts. So, I had to have cataract surgery, all from this one medication,” Elliott said.
Seeking medical care outside of one’s hometown is a hard decision to make, and it only brings up another prevalent issue — transportation. Robin Warshaw of AAMC.org said for rural residents who reside on farms or ranches, reaching a health care provider also means traveling long distances, which can entail inconveniences such as days off from work. This can all lead many to decide to simply avoid care altogether.
This is something that Elliott can also attest to, saying that she often must travel an hour away from home to receive her specialized care.
“I have to map out my schedules and try to do more than one visit in a day. Like multiple doctors in one day,” she said.
Aside from time inconveniences, some rural residents do not have the means to make it to their appointments at all.
Wendy Calvert, also a licensed practical nurse in Centerville, said, “Family members are now able to call people to come get them. But yeah, they’ve missed a lot of health care because they couldn’t drive or didn’t have a vehicle.”
Although rural communities already face a great deal of health care challenges, many problems have become exacerbated and new ones have arisen with the onset of the COVID-19 pandemic. Scheduling an appointment is now harder than ever with patients not being able to be seen if infection rates are 10% in the community, Calvert said. Additionally, it is now not only transportation issues that encourage people not to visit the doctor, but also the risk of contracting the virus.
Christlieb said, “So, a lot of people are staying home, you know when they should be seeking medical attention or not going to their follow-up appointments, when they should be. And then you end up with an exacerbation of a chronic condition because they’re too fearful, because catching COVID for a lot of them is indeed a death sentence.”
There are many imperfections with health care in America, and many things that need to be addressed. But rural residents are at the forefront of many of these imperfections and, more often than not, they are suffering more as well.
When asked what she would like to see changed, Elliott said, “I would like to see the physicians in our hometown care more, listen more. It would help a lot if some of the specialist doctors would come to our community and see patients.”
