Accessing Specialist Services in Rural Healthcare
In the complex analysis of rural healthcare, it is of paramount importance to understand the role that access to specialized services and lack of resources plays in the daily lives of rurally located individuals. Specialists can be classified as care providers focused on a specific area of medicine outside the realm of general care practices and beyond the standard emergency room or medical practice: cancer treatments, neurosurgery, women’s healthcare, etc. In a study conducted by Ines Weinhold and Sebastian Gurtner, general rural healthcare insufficiencies were found to be clustered under means of provider shortages, maldistribution, lower quality, inaccessibility, and inefficient utilization, caused by a multitude of political, educational, and infrastructural issues (Weinhold & Gurtner). With a specific focus on specialization access, be it transportation issues, poor talent retention, or communication barriers, rural healthcare disparities play a pivotal role in individuals’ access to holistic healthcare.
Specialized healthcare inaccessibility comes in a variety of forms, but most notably, persons with unreliable transportation networks are most impacted by the ability to travel long distances to receive exclusive care. In an oral history interview with Madelaine Katz, Kesha Neely, a resident of Fayetteville, NC, discusses the lack of resources and healthcare accessibility in her area. She focuses on the lack of transportation that makes it difficult for communities to access grocery stores, hospitals, and other vital industries, especially as working at the local CommWell Health has exposed her to many of the societal and medical issues that she has come to understand about her community, including the stigma associated within certain neighborhoods or with certain illnesses. Since specialized resources and higher quality of care are typically focused around urban nodes, driving to specific clinics could be too time-consuming to undertake, impossible without the possession of a vehicle, or too distant in emergencies. Neely explains that in her own experience, a valuable resource addition to the community would be attainable transportation. “I think that maybe there should be more resources for…people who don’t have cars or other transportation, because there are some places that you can get to, but you’re going to have to maybe walk another mile or whatever to get to that” (21-22). Without a reliable means of transportation, specialized healthcare and nutrition services prove unavailable for many rural residents, especially as most rural areas do not have public transportation or even rideshare services.
Alongside Neely’s concerns about transportation issues, talent retention–especially among medical specialists–is a potent rural healthcare issue that reinforces the transportation difficulties. Janet Ross, a public school teacher and resident of Albemarle, NC, details her understanding of medical specialization in Stanly County in an interview with Caroline Efird. Ross explains, “The biggest issue would be when we have doctors who leave to go to a different area or we don’t have many doctors of that type right here. For instance, I saw in the newspaper that the local dermatologist is retiring and closing his practice, and so we don’t have a dermatologist now…So that would be one of the biggest issues, is the lack of choice of doctors in a small town” (33). Without local specialists, healthcare services become inconvenient, expensive, and more impersonal. In this situation, paths of care move from being small-town family practices with local, tight-knit patient bases to suburban or urban franchises that can be costly with the added expenses of travel and additional fees.
An equally relevant but less discussed rural healthcare barrier in specialist access comes in the form of communication issues, stigma, and a lack of medical literacy. In an interview with Maddy Kameny, Jane “Sabra” Hammond conveys her experience in working with rural communities and the ways in which she consciously influences her own interactions with individuals in an approachable manner for all education levels, races, ethnicities, experiences, and backgrounds. She remarks, “Well, if I can look into their eyes and I talk to them–I’m talking to you more on your level. I try to read their level of education, and I’ll go slower and I’ll use simpler words…I almost always get someone who is more compliant and who may have some difficulty understanding the medications, but is more willing to work with me” (10). By addressing each patient’s needs on a case-by-case basis, Hammond is tailoring her communication style based on her patient’s understanding of the medical field whilst encouraging broader medical literacy through personally relevant means, approaching accessibility through a doctor-patient relationship lens. Furthermore, by engaging with the individual and community at large, Hammond can root out the cause of inherent care stigmas and reexplain them in an approachable, non-judgemental way, carving a new path for care receptivity. Inaccessibility in rural healthcare is about more than the transportation that brings a patient to a medical center or even the quantity of specialists available, it is also about the communities it serves–cognizant of the community stigmas, education levels, and cultural norms.
However, with the rise of telehealth care following the COVID-19 pandemic, some of these difficulties presented above may be mitigated. Virtual patient portals allow individuals to communicate with their physicians, seek medical care, and be prescribed medications in an expedient manner and at no cost, making it unnecessary to arrange for reliable transportation to designated spaces. Furthermore, this platform can allow for a network of medical education in the general public, allowing for higher medical literacy rates even in rural areas, as long as individuals have a secure WiFi network. As explained in the Pediatric Research Journal, “Distance education delivered using telehealth technologies can overcome several of these barriers. Delivery methods for continuing education may include videoconferencing with subspecialists, web-based education, and live Internet case conferencing” (Marcin et. al.). Nationwide access to these services would not only roll out accessible virtual healthcare but could inspire cultural mindset shifts that could even encourage change in the communication issues listed prior. Despite these revolutionary benefits, patients who lack access to technology, cannot afford WiFi services, or require in-person care for treatment like physical therapy or emergency surgery would still face these hurdles.
In summation, U.S. rural specialist healthcare services can be difficult to come by due to many transportation, systemic, and communicative roadblocks embedded within the medical system. Through the oral history narratives of the individuals shared, a more comprehensive picture of rural healthcare may be painted: one that allows for the individualized accommodations and specifications required for every individual to thrive.
Works Cited
Hammond, Jane “Sabra”. Interview Y-0028. Stories to Save Lives, Southern Oral History Program Interview Database, UNC Chapel Hill. 27 June 2018. https://dc.lib.unc.edu/cdm/ref/collection/sohp/id/27900.
Marcin, J., Shaikh, U. & Steinhorn, R. “Addressing health disparities in rural communities using telehealth.” Pediatric Research 79, 169–176 (2016). https://doi.org/10.1038/pr.2015.192.
Neely, Kesha. Interview Y-0011. Stories to Save Lives, Southern Oral History Program Interview Database, UNC Chapel Hill. 10 July 2019. https://dc.lib.unc.edu/cdm/ref/collection/sohp/id/28696.
Ross, Janet. Interview Y-0045. Stories to Save Lives, Southern Oral History Program Interview Database, UNC Chapel Hill. 15 June 2018. https://dc.lib.unc.edu/cdm/ref/collection/sohp/id/27891.
Weinhold, Ines, and Sebastian Gurtner. “Understanding shortages of sufficient health care in rural areas,” Health Policy, Volume 118, Issue 2, 2014, pages 201-214, https://doi.org/10.1016/j.healthpol.2014.07.018.