The COVID-19 pandemic has laid bare many inequities in the foundations of our healthcare system, including factors causing disparate access to care for rural areas of the country. Since 2005, there have been 181 rural hospital closures — and the pace of closure has only quickened during the pandemic. Moreover, it has never been easy to entice physicians and staff to leave major cities and establish careers caring for patients in rural regions. Fewer opportunities for working spouses, lower-resourced schools, and oftentimes lower wages are just a few of the reasons. Now, COVID-19 has exacerbated those inequities.
When providers leave rural communities behind for cities and suburbs, they weaken the community as a whole, dissuading other providers from taking their place. However, it is more important than ever that physicians consider the opportunities that come with providing care in these settings.
The Task at Hand
When rural hospitals and health systems close, they take radiology services with them, making it harder for rural patients to access lifesaving screenings and procedures. Recent data shows that 83% of urban patients live within a 30-minute drive of a lung cancer screening center, compared to only 22% of rural patients. This disparity is just one example with rippling effects across imaging services for a wide range of diseases. There are also striking disparities in the likelihood of women receiving mammography and cervical cancer screenings in urban versus rural settings, with the difference growing each year.
These disparities have devastating consequences. Lower screening rates lead to higher mortality rates long-term, which is why tackling health and radiology inequities in underserved rural communities must be made a priority.
Growing up in northeastern North Carolina, I saw first-hand the correlation between our community’s location and family and friends foregoing critical screenings and vital care. I ultimately decided to go into radiology, in part, to solve this growing problem, and to ensure patients do not have to drive three hours for quality care. Developing more integrated care networks across rural regions can help address this.
Closing the Gap
Resolving this crisis in the delivery of radiology services to rural markets must begin with a renewed commitment to rural healthcare by medical schools, providers, and policymakers alike. Practicing care in a rural setting offers a unique opportunity for healthcare professionals to immerse themselves in a community and build relationships with others dedicated to preserving local healthcare. It offers a chance to spend greater time with a smaller cohort of patients. And, for patients, it helps close the care gap that drives inequitable health outcomes. Despite these factors, many medical students still resist practicing rural medicine. Medical schools that have begun requiring their students to practice rural care as part of their rotations can help expose more students to this critical area of care — more should follow their lead.
But we must do more than just renew our commitment to rural healthcare. We must show how new innovations like teleradiology can expand access and improve quality. The COVID-19 pandemic has forced many practitioners, hospitals, and health systems to accelerate their use of teleradiology, a development we should continue to nurture. It simultaneously meets patients where they’re at and reduces the burden on rural healthcare providers, freeing up valuable time and resources.
Despite the challenges, I remain optimistic about the future of radiology, especially in communities like my own. New attention to health disparities and social determinants of health are driving much-needed policy change that supports rural providers and residents. New medical school programming is pushing students towards rural care, and new technology is making it easier than ever to reach patients across the nation. Optimism alone will not close the urban-rural healthcare gap, but so long as we remain hopeful and continue to push for practices that tackle rural health inequities, significant strides are possible.
Catherine Everett, MD, MBA, is a general, musculoskeletal, and breast radiologist, and she is the Practice President and a managing partner for Coastal Radiology in New Bern, North Carolina. She also serves as associate chief medical officer for Practice Analytics for Radiology Partners, and is a member of the American College of Radiology’s board of chancellors.
Last Updated October 25, 2021