Family Matters

In Rural Areas, There May Be No Doctors to Tend to Your Sick Kid

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Nearly 1 million American children living mostly in rural areas have no doctor to call if they get a get a sore throat or an ear infection. Meanwhile, some metropolitan areas are crawling with family physicians and pediatricians — about one doctor for every 140 kids in some places. As a result, children in more urban areas have better access to health care, reports a new study published online this week in the journal Pediatrics.

It’s not that there aren’t enough child physicians to go around. Their numbers increased pretty dramatically between 1996 and 2006; the number of pediatricians grew by 51% and family physicians jumped by 35%.

“We are training enough doctors, but they are not choosing to go to areas where they are most needed,” says Scott Shipman, an assistant professor of pediatrics at Dartmouth Medical School. (More on Time.com: Elmo at the White House? Monster Plugs School Lunch Bill)

There are plenty of policy implications inherent in the study, but for parents, it comes down to this: you either have a doctor you can take your child to, or you don’t.

The new research shows there are essentially equal numbers of kids who live in areas of abundant supply or undersupply. There are 15 million children — 20% of kids in the U.S. — who live in areas where child health care is plentiful. But another 15 million live in enclaves in nearly every state where the ratio of pediatricians and family physicians is 22 for every 100,000 kids. That’s a patient load of more than 4,500 kids per doctor.

On average in the U.S., there are 1,420 kids per doctor, though every state has its own maldistributions, with low-supply and high-supply areas.

Overall, Washington, D.C., has the highest per-capita supply of doctors — 443 kids per doctor, or 100% of children in high-supply areas, defined as fewer than 1,000 children per doctor. Next in line is Vermont at 933 kids per doctor. (More on Time.comHouse Calls: A New Pediatric Model?)

Nevada is at the opposite extreme, with 2,151 kids per doctor. Mississippi — where 42% of children live in undersupplied areas, defined as more than 3,000 children per doctor — claims the highest proportion of kids in low-supply areas.

It’s concerning enough to Shipman that he’s calling for incentives to lure doctors to underserved areas. During training, primary care doctors should be encouraged to consider setting up shop in more rural areas. There are benefits, after all, like a distinct lack of competition, plus gratitude from parents who’ve long had to drive far away for medical care.

Why the disparities? There are several factors at play. Research has shown that doctors who grew up in rural areas are more likely to return to practice there, yet rural medical school applicants are on the decline. As Shipman notes, “If you grow up in Manhattan, it’s not likely you’re going to go to rural Nebraska to practice.”

He suggests medical schools could look more specifically for qualified rural applicants and minorities, because numerous studies have shown that minorities are more likely to serve the underserved.

The training environment in medical school — largely urban hospitals — could also stand to be updated. “Once you get indoctrinated into medicine, if you haven’t experienced medicine in a rural environment, the likelihood you will seek out a rural hospital is unlikely,” he says. (More on Time.comNot Just Your Imagination: Kids Really Are More Allergic)

Finally, money talks. Much as Teach for America has attracted scores of bright, energetic college graduates to downtrodden schools, the decades-old National Health Service Corps could lure new doctors to areas where they’re most needed. With a recently expanded program, the Corps could provide incentives to doctors to practice in rural areas. It helps to repay medical school loans for doctors who do so. In addition to altruism, what greater incentive could a young doc saddled with med-school loans need?

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