The Texas Tribune was on point with the series “No Country for Health Care” which documents the health care challenges for rural Texans. These stories are the more extreme examples of the struggling rural health care system, but they are very real.
Texas is a very urban and very rural state, with little in between. Three million Texans live in rural areas. One hundred seventy-seven of 254 counties are rural; 64 of those are “frontier,” meaning there are less than seven persons per square mile. Twenty-seven counties do not have a single doctor while another 16 counties have only one. The average age of rural physicians is higher, and many are at or beyond retirement age with no replacement in sight. Almost 60 counties do not have a hospital and two dozen counties are without a pharmacy or pharmacist.
As shared in the Tribune series, many rural residents travel far for primary care and even farther for specialty care – sometimes more than 300 miles. Top level trauma care can be hours away, even with a helicopter, meaning rural residents are less likely to survive severe injuries from automobile crashes, gunshots, and other serious accidents.
So why should the 85 percent of Texans in and near urban areas be concerned about the health care needs of the 15 percent who live in rural areas?
There are several compelling reasons. Unless you stay within the confines of the urban city limits, you will eventually travel through a rural stretch of our state – on vacation, hunting, fishing, or just traveling through to another urban area. Should you become the unfortunate victim of a major traffic accident, you will suddenly be very concerned about the rural health care system.
Another reason to worry about the health care of rural Texans is because they provide your food, fuel and fiber. Vegetables do not grow in the back room of your favorite grocery store, nor does the gasoline for your car mysteriously appear at the corner convenience store. And many of the clothes on your back came from cotton grown in West Texas fields. Without a rural workforce with access to health care, urbanites could find themselves without that food, fuel, and fiber.
So how do we improve rural health care? There are no easy answers. To start with, the Texas Legislature and community leaders need to make it a priority to support existing rural hospitals, clinics and health providers. The rural health care system has done an incredible job with limited resources, but you can only hang on for so long.
There must also be a concerted effort by the Legislature, community leaders and our state medical schools to see that new doctors and other health care workers are standing in the wings to replace our aging rural health care workforce. That means finding the right students, directing them to rural health care and providing them the support and incentives to make it happen.
Finally, some laws need to be changed and state regulatory agencies must realize that the rural health care system is different. Texas remains one of the few states with an antiquated law that prohibits physicians from being an “employee” of a hospital. Yet, many of the new physicians want the financial stability of a regular employee paycheck and benefits. Many will not take on the financial risk of being self-employed and setting up their own practice in a rural area with higher levels of uninsured and underinsured patients. Further, the health industry is already the most regulated industry in this country and regulatory agencies need to find the balance between patient safety and not strangling our rural providers to the point they can no longer afford to stay open.
The Texas rural health system impacts every Texan and working together it can be saved ... and improved.
McBeath is the director of advocacy for the Texas Organization of Rural & Community Hospitals, and is the former director of rural health and telemedicine for Texas Tech University Health Sciences Center