HealthDecember 12, 2023

How your medical skills may help improve disparities in specialty care access

Access to primary and specialty healthcare has always been a challenge for rural populations and clinicians can help tackle these disparities in healthcare.

Access to healthcare has always been a challenge for rural populations, with rural residents facing many issues that affect the provision of both primary and specialty care, from being under-insured to lacking reliable internet for telehealth. Luckily, clinicians and the industry at large can tackle these disparities in healthcare in several tangible ways.

1. Understand underlying barriers to rural health care

Compared to urban populations, those who live in rural areas, explain Melissa Cyr et al. in “Access to specialty healthcare in urban versus rural US populations: a systematic literature review,” are overall “older, more likely to be veterans or uninsured, and less likely to have completed higher education.” Because of the challenges inherent to caring for these populations, many systemic issues in rural communities create barriers to treatment, says Mabel Ezeonwu in “Specialty-care access for community health clinic patients: processes and barriers,” including:

“Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers.”

Ezeonwu points out that a reliance on community health clinics versus traditional primary care providers in rural communities can influence outcomes for patients, especially those from “vulnerable populations”:

“Individuals served by the clinics on average have poor health status and higher prevalence of chronic disease conditions than the general population. [25% of clinic patients] require specialty and diagnostic services that are not provided by the centers.”

Because of a lack of specialists, referrals can take a long time to materialize, explains Ezeonwu:

“The average time from referral to actual specialist visit is 1–4 weeks [but varies], often extending 6–12 months. [...] There are long waiting times for high-demand specialties with limited providers [and] lengthy pre-authorization processes from insurance companies delay care.”

The cost of specialty care can also deter patients from treatment, says Ezeonwu: “Inability to pay upfront at specialty clinics is a huge barrier [for] uninsured and underinsured patients [since] the sliding scale they get at [clinics] is not applicable.”

2. Identify which specialties are needed in rural areas

Cyr and the other authors explain the lack of specialists in rural towns: “Due to lower service demand, specialists and subspecialists generally cluster in [urban areas], resulting in fewer rurally located specialists and thus greater reliance on primary care providers.”

Every location’s needs differ, but rural areas often lack several commonly mentioned specialties, including:

  • Mental/behavioral health
  • Substance abuse treatment
  • Women’s health & hospital-based OB-GYNs
  • Advanced neonatal care
  • Neurology & stroke treatment
  • Dentistry
  • Ophthalmology
  • Podiatry
  • Rheumatology
  • Urology
  • Cardiology & cardiac surgery
  • Oncology
  • Dermatology
  • Chronic pain management
  • Gastroenterology
  • Anesthesiology

3. Take responsibility to ensure access to quality health care in underserved areas

Specialists working in cities who travel to rural areas for outreach can make a significant impact, note Cyr et al.: “In four studies examining specialist [...] outreach in rural Iowa, roughly 45–46% of specialists engaged in outreach services and [reduced] patient driving burden [while] increasing care to over 1 million patients.”

Increasing rural access without putting travel stress on providers is possible with telehealth, although this must be coupled with affordable and stable internet access for rural patients to be able to make use of it. Though not appropriate for all specialties, such telehealth programs, Cyr et al. explain, can save patients, providers, and healthcare systems money and time.

Clinicians who can, should consider getting in touch with a non-profit that partners with rural hospitals and medical groups to volunteer in areas that need help most. Ezeonwu explains that,

“Patients benefit from individual volunteer specialists who occasionally visit their clinics. [A survey] respondent noted that a volunteer urologist visits her clinic once a month, and another reported that a volunteer optometrist visits her clinic [for] diabetic retinal screenings.”

4. Help demonopolize medical knowledge and increase specialist availability

Making specialists available can improve outcomes and keep costs down in the long run since, as Kenton Johnston et al. writes in “Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries,” “Having one or more specialist visits during the previous year was associated with a 15.9% lower preventable hospitalization rate and a 16.6% lower mortality rate for people with chronic conditions.” The health care industry can help ensure that specialty medical knowledge and care are demonopolized across rural populations by:

  1. Implementing, as Ezeonwu suggests, referral coordination to help patients easily move from primary care to seeing a specialist. Coordinators can help patients overcome “challenges related to cost, language, transport, and clinic location”
  2. Increasing funding for rural hospitals; the U.S. Government Accountability Office notes that between 2013-2020, over 100 rural hospitals closed, meaning “residents had to travel about 20 miles farther for [...] inpatient care, and 40 miles farther for less common services”
  3. Easing electronic communication and coordination among those caring for patients, including sharing patient information across health care systems in a timely manner by affiliating hospitals with clinics and connecting clinics to one another
  4. Incentivizing an increase in rural personnel by raising salaries, which Cyr et al. cite as a barrier to staffing
  5. Supporting virtual, case-based learning systems such as the one described by Dr. Sanjeev Arora et al. in “Demonopolizing Medical Knowledge” to connect rural providers with broader access to continuing medical education
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