Fewer staff, long delays and fewer options: Rural America faces a health care crisis.

More than 40,000 graduating medical students learned Friday where they will spend the next three to seven years of medical school.

As the United States simultaneously struggles with a shortage of primary care physicians and a rural health care crisis, many of its graduates are poised to join the front lines of the nation’s health care crisis.

At least 136 rural hospitals and health systems closed Between 2010 and 2021, and more than 40% of rural hospitals will operate Negative profit margin. Despite billions of dollars of investment in health care, hospitals across the United States face the prospect of closing.

“I would say it’s the worst time we’ve ever seen for health care,” Joanne Conroy, CEO and president of Dartmouth Health, told ABC News. She said that rising costs, inflation, limited housing and lack of manpower have made managing rural hospitals a challenge.

“If we have another outbreak, we know what to do,” Conroy said. “The question is whether or not we have the financial capacity to survive it.”

Many hospitals that remain open have cut costs to survive, offering fewer services and beds.

By 2020, 47% of rural community hospitals did not offer maternity services, 89 Maternity rooms It will be closed between 2015 and 2019. Seven million women are limited or live in the county There is no access To maternity care, affects half a million newborns every year.

According to Conroy, patients can already feel the effects of the problem, noting that some women in New Hampshire have to drive two hours to deliver their babies. Other impacts include fewer emergency room beds, delays in elective surgery and longer wait times for prescriptions or ambulance pickups.

For new medical professionals entering their homes, especially those joining rural systems, struggling health systems are out of control.

“It’s not my job to fix all the problems for the whole community, that’s impossible. When you feel like that’s your responsibility, burnout is basically inevitable,” said Tufts medical student Kathy Stevenson. “When you feel like your goal is to do the best you can with the resources you have, you can adjust your expectations a little.”

More and more students are entering medical school programs that specialize in rural medicine. In 2019, Management of health resources and services Provides funding to create 32 newly accredited rural residency programs to supplement existing programs.

This year, Tufts School of Medicine will graduate its tenth class of students from the Maine Track MD program – a partnership with Maine Medical Center that provides financial incentives to encourage students to pursue a community-based curriculum and become primary care specialists.

Graduating about 40 students a year, 27 percent of Maine track students are affiliated with programs in Maine and 47 percent are affiliated with primary care programs, said Dena Whitesell, assistant dean of students at Tufts and a psychiatrist at Maine Medical Center.

“We know students and residents living in the area [and] “Those who train in one area are more likely to practice in that area in the future,” Whites said.

Liv Fauver, a Tufts student affiliated with Vermont’s residency program, grew up in rural New Hampshire and said she was inspired to work in a similar community that had a positive impact on local residents.

“I think my goal is to live and work in the community I serve,” she said. “So I’m really in a position where I can go home or go to the grocery store and see my patients all the time, because that’s the world I live in and work in.”

While rural hospitals are closing in record numbers, PCPs — medical professionals who patients routinely use for exams and other routine care — face more challenges, especially in rural areas, experts say.

Greg Sawin, a professor at Duke University School of Medicine in Massachusetts and Maine, said PCPP worries that the goals of primary and long-term preventive care can sometimes conflict with larger health care systems.

“We pay people to do things. We don’t pay people to keep people healthy,” he said.

What’s more, he believes the costs associated with medical school — including high costs, the possibility of going into debt and high fees — to pursue competitive specialties like orthopedic surgery or dermatology, for example — can dwarf primary care options like family or internal medicine.

“It can be very attractive to want to go into a specialty where you’re guaranteed to make more money and pay off that debt more easily,” Stevenson said.

Owen Foster lives in rural Vermont and has been affected by the decline in the number of PCPs available, taking six months to get an appointment with a doctor. Foster, who lives in a rural area, shares the plight of millions of Americans in rural areas due to PCP shortages.

“At certain points in your life, you need the basics,” he told ABC News. “If you don’t have a primary care provider, you can’t get that and you can’t get the referrals you need, so it’s really hard.”

What makes Foster’s experience unique is his position as Vermont’s top health care regulator. As chairman of Vermont’s Green Mountain Care Board, he oversees the quality and cost of the state’s health care system.

Learning about the shortage of primary care physicians in Vermont, Foster decided to explore the market as a “mystery shopper” for the opportunity to find a PCP.

“What I found was that I couldn’t find a doctor at all.” “I called eight places and the best thing I got was on an indefinite waiting list, which never happened.”

Rural areas include about two-thirds of primary care health professionals Lack areas Nationally, though only 20% of Americans live there Rural areas.

The problem is likely to get worse with time. Predictions In the year By 2034, the United States could face a shortage of between 17,800 and 48,000 PCPs.

What’s more, healthcare professionals believe that a shortage of PCPs could make other healthcare entities more expensive and worsen overall patient outcomes. Sawin gave the example of a person having a stroke in the throat. Without a PCP, the person may go to a local hospital emergency room, which is more expensive than other medical options.

“In terms of resource inequality, you know, a kid with strep throat showing up in the ER is like cutting butter with a chainsaw,” Sawin said.

Foster added that primary care providers’ role in early identification of cases, their ability to diagnose mental health issues and their approach to preventive medicine are “critical to controlling health care system costs.”

According to Foster, PCPs in rural areas, however, struggle to find and retain staff, negotiate with insurance companies and prevent fires. The shortage of PCPs, combined with the health care needs of the elderly in rural areas, creates a compelling combination.

Despite these issues, Foster said he’s optimistic about some approaches to making primary care more affordable, including increasing spending floors for PCPs in health plans and state rate caps.

A new generation of students graduating from rural track programs has the potential to reverse the PCP shortage in rural areas. 571 More primary care matches this year. For example, Stevenson was associated with Sweden’s Cherry Hill Rural Program in Washington state.

“If we do a better job of funding primary care and preventive care and creating healthy environments, I think we have an opportunity to do a much better job in this country of taking care of our patients,” Stevenson said.

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