Access to Care: Connecting Rural Residents to Medical Services

By Molly Moore

The 16-county area in western North Carolina served by the Mountain Area Health Education Center is short 140 doctors.

Created in 1974 as part of a statewide effort to increase the supply of rural physicians, MAHEC offers nine competitive residencies for medical students. On average, 62 percent of those residents go on to practice in the MAHEC service area, compared to just 2 percent of those who are not associated with the program.

“MAHEC was created because data show that where you train doctors is where they tend to stay,” says the organization’s Tina Owen.

States with higher ratios of primary care physicians to citizens have better health outcomes, fewer premature deaths and lower healthcare costs. Yet the supply of primary-care physicians is dwindling nationally, and the shortage is acute in rural areas. Twenty percent of the United States population is rural, but just 9 percent of the nation’s physicians work in rural areas, according to Owen.

Other efforts to train and retain rural practitioners are ongoing across the region. The Appalachian Regional Commission helps to fund 200 osteopathic internship and residency slots and has developed a masters-level physician assistant program with Marietta College in southeastern Ohio. And the Healthy Appalachia Institute connects students at the University of Virginia in Charlottesville to their counterparts in Wise County to develop interest in rural public health.

Dr. Teresa Gardner, a nurse practitioner, runs the Health Wagon, a nonprofit that provides mobile healthcare to medically underserved communities in southwest Virginia. She would like to see a higher concentration of nurse-practitioners in the area as well as changes to state health laws to allow them to perform more services without a supervising physician.

In the Bluegrass State, residents serving as community health workers are helping their neighbors access healthcare through Kentucky Homeplace, a program of the University of Kentucky Center for Excellence in Rural Health. The services they provide include educating clients about how to manage diabetes, follow medical instructions, and access home heating assistance or free medical care.

Sometimes, however, a medical situation calls for an expert — even if that expert is hundreds of miles away. To bring specialized care to remote areas, local providers are increasingly relying on technology and a practice known as telemedicine or telehealth.

“Telemedicine, regardless of whether for psychiatrists or other specialists, is pretty important,” says Dr. Amy Russell, a physician with MAHEC. “For some of our communities, depending on the time of year, it is actually very difficult to get anywhere.”

Telehealth is also a familiar concept in southwest Virginia — the Center for Telehealth at UVA has provided long-distance medicine since 1994, and their connections in the area are expanding. Instead of driving 600 miles round-trip for a cervical cancer screening, women in southwest Virginia can meet with a trusted nurse practitioner at one of the Health Wagon’s biweekly colposcopy clinics while a specialist from UVA joins via secure video for a virtual examination.

Margaret Tomann, program manager at the Healthy Appalachia Institute, sees telehealth as a key tool, and not just for patients. By connecting local doctors and nurses to the telehealth network and providing workforce training for careers in the medical industry, the institute aims to both bring skilled jobs to southwest Virginia — the types of jobs that support a healthier community — and to improve patient health by ensuring that quality medical care is within reach.

Protecting the Central and Southern Appalachian Mountain Region