|
Rural Health CareJames Reschovsky and Andrea Staiti’s paper on access and quality in rural America (Jul/Aug 05) provides important data. Although the authors report that there are almost 50 percent more primary care physicians (PCPs) in urban than rural areas, nevertheless they find that rural patients say that they have no problem seeing their PCP and have their medical needs met in a timely way. Similarly, rural physicians care for the uninsured and say that they can usually obtain medically needed care for their patients. Rural physicians feel that they provide high-quality care and a broad range of services. Rural patients also feel that they get high-quality care. Thomas Jefferson University has a medical school program that has increased the supply and retention of rural family doctors.1 More recently we have visited, interviewed, and shadowed ten former students in rural family practices.2 After reviewing their data, and on the basis of what we have learned about rural family practice during the past three decades, I am concerned that the authors might have reversed their conclusions and limitations. I think it more likely that these primarily self-reported data reflect differences between the sociocultural attitudes and behavior of rural versus urban doctors and their patients rather than access to and quality of care. Living in the same town with patients, knowing everyone in town, and often having additional associations with people outside of the doctor-patient relationship all make it more likely that doctors will take responsibility for making sure that everyone in town obtains needed medical care (irrespective of insurance, income, or how many hours the doctors work). Similarly, rural patients might have lower demands and expectations about their health care than urban patients. As a result, the authors’ conclusion—that access and quality in rural areas are equal or superior to those in urban areas—while certainly possible, is not justified by their data. In fact, I doubt that few living in urban areas would prefer to have the access and quality that exists in rural areas. Further, I am convinced that the authors’ conclusions could contribute to decreased efforts to provide physicians for rural areas, with serious implications for those living in rural communities.3
NOTES
| ||||||||||||||||||||
