“Medical schools expanded significantly over the last 15 to 20 years, but residency programs were not expanded,” Fincher explained. “So we have a lot more medical students and not enough residency spots.”

The cost of a medical degree also would tend to lead new doctors away from a rural practice, Fincher added.

“The average medical educational debt coming out of medical school for most medical students is now over $251,000,” Fincher said.

       Telemedicine had been expected to alleviate some of the health care shortfalls in rural areas, but technological hurdles hamper access to even remote care, Fincher noted.

Broadband internet has been slow to expand across rural America, delaying access to the video and audio feeds needed for a good telehealth visit, Fincher said.

Also, older folks might not necessarily have the technology needed for telehealth.

“Our older population doesn’t necessarily have a smartphone or a computer on which to do a telehealth visit,” Fincher added.

Efforts are being made to expand residency programs into rural areas, which could help bring young doctors to the people who need them, she said.

For example, one rural region in Appalachia last year built a family medicine residency program from scratch, recruiting doctors-in-training to work in western North Carolina and eastern Tennessee.

That area’s health professions training center, MAHEC, is accepting four to six residents for training at a hospital and clinic in Boone, N.C. The program is partially funded by a three-year $750,000 grant from the U.S. Health Resources and Services Administration’s Rural Residency Planning and Development Program, one of 27 grants handed out in 2019.

“We need to change the way we recruit physicians into medical schools to get the types of workforce out of our physicians that our country needs. And we need to work to make those medical students more exposed to rural environments and those types of areas that will make them feel much more comfortable about going to the rural areas,” Fincher said.

         More information
       

The U.S. Health Resources and Services Administration has more about rural residency resources.

SOURCES: Jacqueline Fincher, MD, president, American College of Physicians; Health Affairs, 2019; Rick Pollack, president and CEO, American Hospital Association; Association of American Medical Colleges, report, 2020