Geographic Maldistribution Case Study

Healthcare access and delivery in rural area has been challenging not only within the U.S., but also in many developed countries. Many issues seem to be common to this maldistribution of physicians and other HCPs. According to Weinhold and Gurtner1, ” [c]ommunities have become progressively disempowered by the continuous centralization of services and the dismantling of infrastructure.” Rural populations tend to be at

There are 2,157 Health Professional Shortage Areas (HPSA’s) in rural and frontier areas of all states and US territories compared to 910 in urban areas.**

Another threat is the current state of rural hospitals nationwide. According to the case study, about 25% of Americans live in rural areas and only about 10% of physicians actually practice in rural areas. There is a 15% gap in the ratio of rural citizens to available practicing physicians. This is a threat to ELH’s need to attract and hire more physicians. In relation to rural hospitals, citizens have longer drive times to their medical facilities. This causes them to delay routine visits which subsequently exacerbates

Rural health professionals represent a diverse set of individuals seeking to meet the main goals of public health. Their desire to promote health and prevent disease is blocked by many barriers, due to the geographical position of their target population; yet they still persevere to serve their specified communities. Approximately twenty percent of America is rural, and rural counties are more likely to report fair to poor health. This particular population cannot be compared to its urban counterparts due the sheer amount of obstacles health care providers and patients face. Rural Americans are shaped by geography and tradition which creates a combination of factors that create disparities.

The poor areas have many less doctors than the wealthy spots, even though the rural areas suffer from much harsher diseases on a larger scale. The countries either provide medical training for their own citizens or fund their training from somewhere else, but once the students have the skills to save lives, they move to different places for higher pay. This issue lies not only in South Africa, but in the entire continent. For example, for every Liberian doctor working in Liberia, there are two working abroad. Not only is there a shortage of doctors in general (averaging about 1.15 doctors for every 1,000 people in sub-Saharan Africa) but a shortage of nurses and midwives. Over two-thirds of mothers in Africa have no health professionals to guide them through hardships regarding pregnancy and childbirth, causing Africa alone to be responsible for over one half of the world’s infant and maternal

One observation that seems to be common for both rural and urban underserved areas is the relatively low physician to patient ratio. Accessing care is often difficult when there are few doctors to be seen. These physicians are often overworked and burned out. Finding an empathetic doctor willing to take the time to listen is not easy. This often leads to mistrust or resentment toward doctors. The second common thread is the lack of education the community experiences as a whole. Many members of these communities often have no college education and many times little or no high school education. This has a two-fold effect, high unemployment and little understanding of complex medical jargon. With likely little or no medical coverage, even less purchasing power, and little ability to make sense of prescribed treatment you can see how the odd are not in anyone’s favor. Last, but certainly not least, are the hours in which the clinic operates. Often, clinics are open during normal working hours. If a person was fortunate enough to be employed, they

Communities across America face a shortage of doctors. At only 2.56 physicians per 1000 people, America ranks 23rd out of 28 nations reporting data on practicing physicians (Carroll). This shortage is expected to increase as the aging Baby Boomer generation is expected to contribute to a doctor shortage of up to 90,000 physicians by the year 2025 (Carroll). This shortage is most evident in rural areas and cities that are less popular to live in. As the need for doctors continues to increase, America is also producing fewer medical graduates. Out of 35 nations that report data on graduation rates in the medical field America ranks 30th (Carroll). The effect that doctor shortages will have on the health of American citizens will be detrimental. America cannot meet its demand for doctors without looking beyond its borders. The Good Neighbor Nextdoor program will bring the needed doctors in to communities in desperate need of medical

Annotated Bibliography "General Practitioners and Family Physicians. " Government of Canada, Employment and Social Development Canada. Government of Canada. Web. 27 Jan. 2016.

The social issue that I am addressing is that certain populations in the United States are not able to receive the treatment they need. This has a lot to do with accessibility and affordability. “…residents of metropolitan areas have better geographic access to physicians.” (Newhouse) We are seeing an uneven distribution of available physicians in rural and urban areas. There is an abundance of doctors in the urban areas, but they aren’t branching out to the rural areas. This is known as a paradox of the United States health system: “shortage amid surplus”. (COGME)

An underlying problem in today’s medical world that is often overlooked is the lack of available medical treatment in underserved rural areas. An example of such is the community I grew up in, where there is not even a facility that is equipped to handle child birthing. There are no physicians that are able to treat endocrinology, nephrology, neurology, pediatric, or even so much as general health issues. Rising physicians seeking out residencies are drawn to areas that are innovative hubs for medicine, but often remain in these areas after their residency has been completed. This has led to the vast shortage of medical care available to rural and underserved communities. The result is that only those with enough money to drive at minimum an

Canada being one of the largest countries in the world, faces a unique challenge of geographic distribution of doctors. The remote and rural areas have low population density and because the FFS mechanism relies on volume of patients that a doctor attends to, it influences their distribution with a higher number settled in high density areas.

One would think that rural areas would not receive the proper health care due to the location, but those minimal differences have started to disappear thanks to the SERUMS plan which is meant to keep health care workers in the furthest places from the urban areas, so that everyone can properly live healthy lives. The SERUMS plan in currently in effect to bring a broader health plan to many. One of the main reasons this was even thought of was due to an increase from various places for medical specialists over the past decade. They are in the final phases 4 and 5 of the country coordination and facilitation in Peru which means they have to have an open dialogue on how their health care worker retention plan will benefit everyone and various other details associated to the CCF. Even though there was a minimal difference between rural and urban health care availabilities it is still a big difference in giving everyone an equal chance to see a physician and get the treatment they

Rosenthal et al (2015) reported the Council on Graduate Medical Education (COGME), in 1988, identified geographic maldistribution as an area of concern stating that it is “one of the most persistent characteristics of the American health care system”.

The shortage of qualified human resources in the health sector is a major challenge India is currently facing. 18% of the primary health centers are without a doctor and out of the 52% sanctioned posts for specialists at CHCs that remain vacant, 55% are for surgeons, 48% are for obstetricians and gynecologists, 55% are for physicians and about 47% for pediatricians (Rao et al. 2011). As a consequence, the worst hit are the people from the rural sections and other marginalized communities. Although the proportions may be different in the case of Kerala, the reality is not quite promising either. The shortage of MBBS graduates to serve under the National Health Mission on contract in government hospitals is an issue of concern for the NHM authorities in Kerala (The Hindu 2015). The reluctance of the doctors to serve in the rural areas is also evident.

Misfortune in Rural Health Care..............................................................................4 Physician Shortages...................................................................................4 Increasing Professional and Technological Resources..........................................5 Geographic Barriers...................................................................................5 Culture Obstruction...................................................................................6