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Shortage of specialists negatively impacting patients in rural areas

Medicare recipients with chronic conditions such as heart failure or diabetes who live in rural locations have higher death and hospitalization rates

Jeff Lagasse, Associate Editor

Residents of rural areas are more likely to be hospitalized and to die than those who live in cities primarily because they lack access to specialists, recent research has found.

The study, led by Dr. Kenton Johnston, assistant professor of health management and policy at Saint Louis University College for Public Health and Social Justice, looked at data from Medicare patients who have chronic health problems. The paper was published in the December 2019 issue of Health Affairs.

It found that Medicare recipients with chronic conditions such as heart failure or diabetes who live in rural locations have higher death and hospitalization rates than those living in more urban settings. Lack of access to specialists, such as cardiologists and endocrinologists, was the primary reason.

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Johnston and his coauthors suggest targeted innovations to bring more specialists to these underserved areas. Among the strategies they suggest are expanding telemedicine in key areas, such as cardiology, to provide routine specialty care visits through technologies such as video conferencing.

They also suggest adding incentives for physicians to practice in rural areas, such as loan forgiveness; considering differential payment rates that offer specialists who practice in rural areas more money; incentivizing rural and urban hospitals partnerships; and bringing urban specialists into rural health systems on certain days of the week.


Researchers examined 2006-2013 data from Medicare claims of patients in rural and urban areas who have heart disease, diabetes and other complex chronic conditions.

They linked the claims to health care supply data from hospitals that was provided by the Dartmouth Institute for Health Policy and Clinical Practice and determined rural-urban classifications using a Health Resources and Services Administration database.

The researchers defined a rural area as any town with fewer than 10,000 people, and found that 10% of Medicare beneficiaries lived in such areas.

Patients who saw a specialist at least once in addition to a primary care provider compared to those who saw only a primary care provider were 15.9% less likely to be hospitalized for a preventable cause and 16.6% less likely to die.

Preventable hospitalizations were highest in rural areas and lowest in metropolitan areas. Residents of rural areas had 40% higher rates of preventable hospitalizations and 23% higher mortality rates than their metropolitan counterparts.


Hospitals, medical groups and other healthcare facilities are seeking more medical specialists and fewer primary care physicians, according to an annual report tracking physician starting salaries and other physician recruiting trends.

Prepared by Merritt Hawkins, a company of AMN Healthcare, the 2019 Review of Physician and Advanced Practitioner Recruiting Incentives tracks a sample of 3,131 physician and advanced practitioner recruiting engagements the firm conducted from April 1, 2018, to March 31, 2019.

Now in its 26th year, the report shows Merritt Hawkins is conducting a growing number of search engagements for medical specialists while conducting fewer searches for primary care physicians relative to recent years.

Twitter: @JELagasse

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