Comment: State’s rural areas facing a health care crisis now

A shortage of medical providers is dire in rural communities. Stakeholders are working to resolve it.

By Steve Jacobson / For The Herald

Your ZIP code shouldn’t determine the type of health care you receive.

Sadly, the simple truth is that it does. People who live in rural communities face poorer health outcomes because of a lack of access to quality health care. A 2017 study from the National Rural Health Association found people living in rural areas have less access to primary and preventative care, and are more likely to experience chronic disease, disability, and premature death. Also, a 2021 study by the Association of American Medical Colleges found that by 2034, the U.S. is projected to face a shortage of up to 124,000 physicians, 48,000 of which will be in primary care alone, the cornerstone of rural health care.

Our country is facing a primary care crisis, which is exacerbated in rural communities, including here in Snohomish County. In fact, 18 percent of the county is considered rural, and overall, 14 percent of Washington state residents live in rural areas.

The primary care crisis in rural communities is not a future problem; it is happening now. According to research conducted for AAMC, 35 percent of respondents said they had trouble finding a doctor in the past two or three years. That’s 10 points higher than when the question was asked in 2015.

Primary caregivers in rural communities are retiring at a higher rate than their urban counterparts. Those posts are not being filled as quickly because newer providers are moving to urban areas where they perceive there are better opportunities.

We must address these growing gaps now or health outcomes for rural residents will continue their steep decline and further stress an already overtaxed health care system. No matter where you live, be it in a city, suburb or rural community, this impacts all of us. We can’t afford to sit on the sidelines and let this crisis continue to grow.

We must make strategic long-term investments in rural health care that ensures access now and well into the future. Premera has committed more than $58 million since 2018 to improve access to care in rural areas. Investments are focused on physician, nurse and health aide recruitment and training; clinical integration of behavioral health; programs to increase the capacity of mental health crisis centers in rural areas; and small equipment grants to rural providers.

Our partners in both the public and private sectors are vital to making these investments successful. For example, Premera invested in the University of Washington School of Nursing to launch the Rural Nursing Health Initiative. Through this program, nursing students will be sent to clinical sites to provide primary care for rural communities in Washington. These students will work alongside nurse practitioners who will be their mentors as well as supervisors.

Although the grant was given to the UW, the Rural Nursing Health Initiative is open to almost all schools across Washington. The UW has invited colleges across the state who have nurse practitioner programs to participate and encourage their students to apply.

Premera also invested in Pacific Northwest University of Health Sciences’ rural family medicine educational pathway and training. This program established a new residency with clinics and hospitals, accepting two new residents every year. It also focuses on establishing a sustainable pipeline of candidates for the residency program by creating a rural medicine rotation for medical students. Medical students benefit from a specialized curriculum that encourages them to serve rural communities along with a living stipend.

We also must address the access issue now. That’s why Premera teamed up with Kinwell Medical Group. They are opening primary care clinics across the state, including in Mill Creek, that primarily serve patients with health coverage through Premera. Our members will see a significant reduction in how long it takes to get an appointment with their primary care physician.

This is incredibly important because your primary care provider is often your first point of contact with the complex U.S. health care system. They’ll serve as your advocate, and can help you with preventive care, teach healthy lifestyle choices, coordinate, and manage chronic diseases and make referrals to specialists as needed. They get to know you and that relationship is invaluable.

Collaborations help address the access problem today and ensures there is a strong workforce pipeline for the future. This is particularly important for rural and underserved communities.

We must continue to innovate to improve access to care now and into the future.

Where you live should never be a barrier to accessing affordable, quality health care.

Dr. Steve Jacobson is medical director for Premera Blue Cross, based in Mountlake Terrace.

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