Barriers to Accessing Care in Rural America

The primary reason for the challenges in accessing care in rural areas is the growing shortage of clinicians practicing in rural areas. According to one statistic, only 1 in 10 primary care physicians serving Medicare patients practice in rural areas whereas at least 25% of Medicare recipients live in rural areas. What’s even more concerning is access to specialty care which these days is almost exclusively limited to larger cities.

As an intro to discussing the various ways in which telehealth can help improve access to care, this edition of Telehealth Tuesday will focus on the barriers typically experienced by rural residents.?

Obstacles to Receiving Care

Given the increasing shortage of physicians serving rural communities two factors make access to care more difficult: Transportation and Time.

Transportation is by far the biggest obstacle to receiving care in rural areas due to the larger distances and lack of public transportation options. Sometimes that can mean having no car, not having anyone that could drive you, or simply not having enough money to pay for gas.

As one primary care clinician told me years back, a patient of hers sold the smartphone her grandson had given her for Christmas, so she could get gas to make the 70-mile round trip to see her physician. And just recently I learned about a pregnant patient in rural West Virginia walking 7 miles to see her maternal health provider.

But for many residents of rural areas, due to the geographic distances but also their socio-economic status, being able to make the time for a doctor’s visit can present a huge obstacle. Many patients work hourly or shift jobs and cannot afford to miss work for a medical appointment. When a simple doctor visit takes 2-3 hours due to the round-trip travel, it can be difficult to take time off from work or arrange for childcare.

Barriers to Digital Health?

Since gradually many aspects of the modern care experience are relying more and more on technology — i.e., communication via patient portals, video visits, or online prescription renewals, etc. — it can be difficult for some rural residents to navigate this digital health landscape.

The major barriers here include: access to technology, connectivity, and digital literacy.

While the ownership of smartphones has improved significantly in recent years not all digital health experiences are optimized for the smartphone.

According to the Pew Research Center , as of 2023 about 87% of rural residents in the US own a smartphone with only 10% owning a “non-smart” cell phone, up from 80% in 2021. Computers, on the other hand, are only owned by 72% or about 3 in 4 rural residents as of the 2021 survey.

Despite advancements in smartphone technology, due to the limited size some online tasks are better performed on a computer or at least a tablet (which only 44% of all rural Americans own).

But aside from the availability of digital devices, connectivity (i.e., access to the internet) can also present a big challenge in rural areas. First off, despite a lot of efforts over the past 10-15 years, many rural residents are still without access to high-speed internet, especially fiber. While a new government initiative is intended to expand the fiber network, it will still be years before it is available.

Secondly, the cost for connectivity can be prohibitive too, even if high-speed internet is available. In areas where residents do not have access to broadband, signing up for unlimited data plans with their cell phone provider is oftentimes also cost prohibitive.

Finally, digital literacy (and, consequently digital health literacy) can also be disproportionately lower than in urban areas. People may not have an email (which is often needed to access a patient portal or to conduct a video visit on your computer) or may not be as familiar with downloading, installing, and setting up an App on their smartphone.

The Bigger Picture

While the video visit flavor of telehealth provides a first level of access, much of the care we receive these days, however, oftentimes relies on additional tests or exams to be conducted beyond the visit with the doctor: from lab tests on blood and urine samples to radiological exams (such as X-Ray, CT, PET, or MRI scans) and other more hands-on exams (such as ultrasound, ECGs, EMGs, EEGs, etc.).

This challenge calls for yet another form of innovative care delivery to these rural areas.

Let me close with a good reminder by one of the speakers at a Mayo Clinic Health System Symposium on Rural Health, and I paraphrase: “Rural populations are not problems to be fixed — but rather people to be treated with dignity and respect” (and given the same opportunity as urban dwellers).?

What other barriers to accessing care in rural areas are you aware of??

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Christian Milaster and his team launch, expand, and grow Telehealth Programs for rural health centers, behavioral health agencies, health systems, schools, and libraries. Christian is the Founder and CEO of Ingenium Digital Health Advisors where his team and consortium of experts partner with healthcare leaders to enable the delivery of extraordinary care by accelerating the adoption of digital health innovation.

To explore how we can help your organization solve your challenges, contact Christian by phone or text at 657-464-3648, via email , or video chat .