med_moneyThe steady decline in rural health care access can take a toll on patients’ health. But it can also impact the economic well-being of rural communities. When health care providers leave a geographic area — either by choice or by retirement — the surrounding community loses a significant portion of its tax base.

For the past several months, The Iowa Independent has documented the health costs associated with provider shortages in rural areas. Without sufficient providers, some rural residents are forced to travel significant distances for general health, mental health, dentistry and pharmaceutical services.

According to a 2007 study by the National Center for Rural Health Works at Oklahoma State University, one full-time primary care physician generates, on average, approximately $1.5 million in revenue, $900,000 in payroll and creates 23 jobs. The relatively large impact is created through clinic employment, inpatient services, outpatient activities and the multiplier effect of these contributions, and it does not include potential benefits to local pharmacies.

The study also documents another important factor: If primary health care services are not available in a rural town, residents will often travel to the nearest urban centers to meet their needs. Because such urban centers often provide expanded shopping and specialty service opportunities, the traveling patients will often make other purchases out of town that may have otherwise been made locally.

In many ways, a general practitioner’s economic contributions are as important to a community as her medical contributions.

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The National Center for Rural Health Works estimates that a rural community with a shortage as low as one-half of one full-time physician stands to lose $236,565 from clinic visits and $451,169 net revenue at a local hospital for in-patient and out-patient activity. When those figures are adjusted for indirect multipliers — for example, services purchased by the physician, the clinic and employees — the total impact of the shortage was 13.8 jobs and $533,493 in income.

Despite all the evidence, few rural areas currently target medical professionals as a part of their routine economic development efforts.

“Some of our larger communities struggle to attract health care providers to those communities, and I know that it gets very competitive as far as what they need to do in order to draw physicians, physician assistants, nurse practitioners, primary care providers and the whole gamut of health care providers,” said Tom Newton, director of the Iowa Department of Public Health. “It is gets very competitive to draw those individuals to your community. But when you look at the rural communities, the people (i.e., providers) just not willing to go out there and work.

“Somehow we need to re-invigorate those communities and show the benefits that they have and what they can offer to providers who are willing to go out there and work.”

It is typically only when a primary care physician leaves a community or retires that residents and local leaders understand the impact of that business on the local economy. And, unfortunately, creating a medical practice from scratch instead of transitioning from one physician to another is a much more formidable task.

There are, however, promising approaches rural communities could take to reduce the decline of medical professionals, but none is in widespread use.

Some rural communities are taking a “grow your own” approach, whereby community groups attempt to identify young adults — even as young as middle school or junior high students — who might have an interest in attending medical school. Through scholarships and other incentives, they pay for a student’s medical training in exchange for a promise to return to the community and practice medicine there.

Although most rural communities have been slow to adopt this approach, it is gaining momentum as smaller communities are faced with aging medical providers and few prospects to fill those potential voids in service. According to Newton, such approaches to provider shortages have been “the most effective” in bringing providers into rural areas.

“It is much easier for a young person to go back into a rural community if that’s where they grew up, and if that is where they raised, because they understand the benefits of living in those rural communities” he said.

Another, somewhat more popular method of training physicians and other health care providers for service in smaller communities is the implementation of rural residency programs. Not only do programs such as the Smoky Hill Family Medicine Residency Program in Kansas and the Durant Family Medicine Residency Program in Oklahoma prepare physicians for work in smaller communities and rural areas, but they also provide a boost to local communities where they operate.

“I think we also need to do a better job of selling what we have in Iowa. We don’t do that. We make a lot out of the fact that we don’t have oceans and we don’t have mountains, and everyone is under the assumption that is what attracts young people today. Well, to some degree it does. But, eventually those young people get married, have kids and have other priorities that begin to take precedent in their lives,” Newton said. “If they understand that there are safe communities, that have good schools, that have short commutes — ones in which there is a sense of community and they know their neighbors, and their patients and they can have a real relationship with them — there are aspects of that which are very appealing to people.”

As the recession takes its toll and small town populations continue to age, health care providers will become an increasingly important part of rural economic development. Doctors are an important component of the rural economy, improving conditions far beyond the walls of an examination room.