Rural Reads: On rural definitions and rural doctor shortage

Mar 8, 2013

With the Rural Reads series, we’re trying something new. Every Friday, KBIA’s Health and Wealth Desk curates the week’s most interesting (or so we think) articles and reports on rural issues.

What’s in a definition? The eligibility for federal grants

In February, the U.S. Department of Agriculture released a report that recommends defining ‘rural’ as areas with 50,000 or fewer residents - a number that's getting some strong reactions. The rural definition determines eligibility for USDA’s rural grants and programs. 

The excellent online news service The Daily Yonder is publishing a series of opinion pieces in response to USDA’s newest recommendation. Last week, Aletta Botts, a legislative staffer who helped draft the 2008 Farm Bill, wrote that the 50,000 size limit is too large and would hurt smaller communities that can’t compete with larger towns to win federal grants.  

This week, the USDA’s undersecretary of rural development Doug O’Brien gets to have his say. He argued that simplifying and making a consistent definition for rural is necessary to streamline the department’s rural development programs. The department currently has several different classifications schemes to determine eligibility for federal rural programs, most of them concerning the rural area’s relationship with a nearby urban area.

A day in the life of a dying breed

Howard McMahan has worked as a primary care physician in rural Ocilla, Ga., for 20 years.  Parade Magazine’s Jennifer Kahn followed McMahan for one day, documenting the evolving challenges facing rural doctors and why they keep on doing what they do. A pleasant narrative that gives a face to the ongoing issue of rural doctor shortage.

The per capita income around here is roughly $15,300, and unemployment is over 12 percent. Insurance companies have been chipping away at your earnings, and a growing number of your patients are now battling chronic diseases like diabetes and emphysema. Things would be easier if you closed your practice and took a position with the regional medical center 30 miles away. At times, you've been tempted. But then, what would your patients do?

Public health agencies getting accreditation for the first time

Did you know that public health agencies were never nationally accredited until earlier this month? These agencies are your local health departments: the ones that inspect your local restaurants, train your food handlers and work to prevent disease outbreaks, among others. Though these departments perform crucial tasks, they’ve never had national standards by which their performance in keeping the community’s health is measured.  

The nonprofit Public Health Accreditation Board recently accredited 11 public health agencies across the U.S., many of them serving rural areas. The board’s director, Kaye Bender, told me that as of March 6, more than 125 more public health departments have applied for accreditation. The process is pretty involved and isn't cheap. The Columbia/Boone County Public Health and Human Services is currently in the pre-application stage, the first of the seven-step process. 

Quick hits
- Sequestration cuts to Medicare, which has been predicted to hit rural health care providers harder than their urban counterparts, are set to kick in on April 1.

- As The Rural Blog reports, a study by the Guttmacher Institute shows that while teen pregnancy rates in rural areas are higher than in urban areas, their abortion rates are lower.  

- A study published in the journal Health Affairs concluded that states’ Medicaid expansions under the Affordable Care Act could push the demand for primary care to greatly exceed presently available services in some parts of the U.S. The study claims 7 million Americans live in areas where demand for primary care would exceed supply by 10 percent.