Hello you all, my name is Tony Vo, and I am a first-year student at UNC Chapel Hill. In this presentation we will take a look at healthcare access disparities in rural communities of North Carolina. If anyone has ever been to rural North Carolina, they will notice little towns spread out all around the state. While this may sound charming, it comes at a big cost – healthcare access. Many of these towns lack healthcare access, with the people who live in these regions sometimes having to drive long distances to get basic physicals. Even with initiatives to bring healthcare to these small communities, they have not been extremely effective at the time of this presentation. Gathering secondary research, I am here to find the causes of this gap in access and explain how these gaps affect the health of the communities as a whole. I will also give possible solutions to bring healthcare to these communities to better these communities’ futures.
Firstly, before moving into North Carolinian rural issues, I would like to talk a little about some healthcare barriers that occur in the rural United States in general, as many of these communities face similar challenges in accessing proper healthcare. In a study conducted by Nathan Douhit in 2017, the author found that there were issues not only with the absence of doctors in these regions, but also with difficulty in getting to clinics. In a study of rural North Carolinian counties, it was found that people with driver’s licenses were twice as likely to attend appointments than those without (Douhit, 2015, p 614), meaning mobility played an important role in being able to access proper healthcare. This is compounded by the fact that hospitals and clinics are not easily found in these communities, with only twenty-four percent of rural populations having a trauma center within a ten-mile radius, compared to seventy-one percent in urban areas. Douthit also found that “Rural residents had less comprehensive insurance coverage and, as a result, were less likely to seek and receive eyecare in order to avoid paying out-of-pocket expenses” (Douthit, 2015). Coupled with differing insurance coverages in rural communities, this meant that many rural residents preferred to not seek treatment in order to save money, prioritizing scarce financial resources at the expense of their health.
In addition to the above, Douhit was able to find that differences between rural and urban culture played a role in preventing many from seeking treatment. The author found that the culture of rural areas tended to emphasize self-reliance in the community, keeping many sick patients from seeking treatment on the notion of being independent. This is especially true when talking about mental health, where an extra existing stigma prevented people from getting help in an attempt to not be ostracized by the community. When a local man was asked about mental health, he responded: “We have our ways. We’re from a ranch… We don’t use medical. We fix ourselves here” (Williging, 2006, qtd in Douthit, 2015, p. 614). This reinforces the culture of self-reliance, since people would rather find treatments at home than get professional help.
All these issues plague rural communities all over the US and the world; however, North Carolina specifically faces its own set of challenges, especially regarding the distribution of healthcare in the state. North Carolinians living in urban metropolitan areas have almost three times the relative supply of physicians than most rural counties. The rapid growth of metro areas and faster growth of physicians has led to an increase in relative supply in metro areas, even though the rate in rural regions is still relatively similar to the past (Holmes, 2018, p. 372). This shows that the main issue in North Carolina lies in the distribution of healthcare – the state has enough doctors to go around, but the problem is getting the doctors to practice in rural regions. Moreover, many who graduate in-state choose to avoid rural areas, leading to only three percent of the state’s residency graduates practicing in rural areas five years after graduating. For many of these doctors, their reluctance to move to these regions arise from concerns of limited career opportunities for their spouses, limited educational and recreational opportunities for their children, and limited continuing education (Myhre, 2015, p. 6). Additionally, the doctors may feel that community is isolated from the world, since many rural communities are remote, with the nearest city being a few hours away.
While all of the issues above prevent equal distribution of doctors in the state, there are solutions that could benefit the state in the present and future. Currently, North Carolinian medical schools offer loan forgiveness incentives for students in exchange for them working in rural, underserved counties for a few years (UNC School of Medicine). Although this may be a good short-term solution, it does not prevent physicians from leaving after a few years in the community, leaving broken bonds and distrust in communities. Better strategies may involve recruiting more students from rural regions of the state in addition to creating and maintaining NC medical school to NC residency tracks. A study conducted by MacQueen (2018) found that growing up in a rural location was the strongest predictor of choosing a rural practice location. Moreover, around thirty to fifty-two percent of providers from rural backgrounds entered rural practice, showing that a large portion of rural-raised physicians want to work in and improve rural communities. Rural students can be exposed to the health field in school to cultivate interest from a young age, and hands-on activities can be done to help rural students better understand health sciences. Although this may take a few decades to pay off, given the time needed for schoolchildren to finish school and graduate (Holmes, 2018, p. 374), by recruiting rural students and providing them paths to work in rural North Carolinian communities, the shortage will decrease and more rural areas will have better access to healthcare.
In addition to recruiting rural doctors, medical students can also be educated on rural culture to cultivate interest in serving rural communities (Thatch, 2018). This would help familiarize students to the rural lifestyle, decrease culture shock, and can help the students build closer bonds with the community, something that is typical of most rural towns.
Overall, many gaps in healthcare access exist in rural areas of the state due to a lack of doctors present in the area, doctors’ disinterest in moving to these communities, long travel distances, and a self-reliant culture. All these factors lead to rural communities having fewer doctors than metropolitan areas. However, many solutions can be taken to address these gaps, including recruiting more rural doctors and educating them from youth and increasing rural awareness for urban-raised doctors to familiarize them with rural life. Using these techniques, rural communities in North Carolina may be able to get the healthcare they need to grow and thrive, helping build a better, healthier future for everyone involved.
Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6), 611–620.https://doi.org/10.1016/j.puhe.2015.04.001
Holmes, M. (2018). The sufficiency of health care professional supply in rural north carolina. North Carolina Medical Journal, 79(6), 372–377. https://doi.org/10.18043/ncm.79.6.372
MacQueen, I. T., Maggard-Gibbons, M., Capra, G., Raaen, L., Ulloa, J. G., Shekelle, P. G., Miake-Lye, I., Beroes, J. M., & Hempel, S. (2018). Recruiting rural healthcare providers today: A systematic review of training program success and determinants of geographic choices. Journal of General Internal Medicine, 33(2), 191–199. https://doi.org/10.1007/s11606-017-4210-z
Myhre, D. L., Bajaj, S., & Jackson, W. (2015). Determinants of an urban origin student choosing rural practice: a scoping review. Rural and remote health, 15(3), 3483.
University of North Carolina at Chapel Hill School of Medicine. (2021). Loans with service components. https://www.med.unc.edu/ome/finaid/loans/medical-school-loans/loans-with-service-components/
Thach, S. B., Hodge, B., Cox, M., Parlier-Ahmad, A. B., & Galvin, S. L. (2018). Cultivating country doctors: Preparing learners for rural life and community leadership. Family Medicine, 50(9), 685–690. https://doi.org/10.22454/FamMed.2018.972692
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