Why young docs shun practicing in rural America
Filed under: Health journalism, Hot Health Headline
For a look at the quotidian struggles facing young doctors who accepted federal loan aid in exchange for a three-to-five-year commitment to practicing in underserved rural areas, The Washington Post’s Darryl Fears profiles a 33-year-old, Northwestern-trained doctor working as the only full-time physician at a practice in rural Virginia.
Having learned her trade in a world of electronic medical records and iPhone diagnostic apps, the physician is at sea in a world of paper records, dial-up Internet and 40-mile drives to the full-size grocery store. There are few dating prospects, and even less culture. She’s not convinced that she’ll stay in town beyond her initial commitment.
Retaining these young, eager physicians is the next big challenge facing the stimulus-boosted National Health Service Corps, which placed thousands of doctors in rural areas last year, and is gearing up to do the same this year.
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Rural Health Journalism Workshop: Speaker presentations
Rural Texas hospitals seek lifeline from state
The Texas Tribune’s Elizabeth Titus reports that rural hospitals in the scores of Texas counties without tax bases strong enough to support a full, modern facility are struggling to find a sustainable model. The latest effort is a push to allocate $50 million on the state level to renovate or replace as many as 42 rural hospitals.
The ultimate goal is to keep the hospitals in line with state and federal safety codes, which must be met in order to receive Medicare and Medicaid reimbursements. Urban lawmakers are skeptical, and there are questions as to whether the one-time fee would really help in the long term, as codes and technology are continually evolving. “For example, a state or federal mandate that all hospitals have sprinkler systems could bust their budgets,” Titus wrote.
For a stupendous primer on covering rural health issues, AHCJ members can check out presentations from Rural Health Journalism 2010. Washington University Professor Timothy D. McBride’s guide to understanding rural health disparities in context should be particularly useful to reporters looking for stories like Titus’.
Workshop explored health needs of rural residents
Filed under: Health journalism, Health policy, Public health, Studies
Dennis Berens, president of the National Rural Health Association, called media coverage of health reform a failure – but not the only failure in framing the issue for the public.
Kansas psychiatrist Roy Menninger said barriers to mental health services in rural have changed little over the past three decades, with serious consequences.
And while a growing population of seniors are drawing on health resources, soaring childhood obesity rates are another drain in the often impoverished areas, experts on aging and childhood said.
Those were some of the highlights of Rural Health Journalism Workshop 2010 in Kansas City, Mo., on June 4. More than 50 people attended the event, part of the Association of Health Care Journalists’ Midwest Health Journalism Program.
With 15 speakers and other topics including health disparities and oral health, attendees of the free, daylong event left with story ideas and new resources to enhance their reporting.
Read more about the workshop …
Practical concerns facing NPs in rural areas
Filed under: Health journalism, Hospitals, Hot Health Headline
Susan Presley, writing for the American Journal of Nursing, examines the role nurse practitioners are playing in addressing the well-documented shortage of primary care physicians in rural areas. The number of rural NPs is growing, but those looking to work in underserved and often remote areas still face numerous practical challenges.
Mary Jo Goolsby, director of research and education for the American Academy of Nurse Practitioners, said that just over 20% of NPs practice in rural areas. “This is actually about the same percentage of the U.S. population we have living in rural areas and more than twice the percentage of physicians who practice in rural areas.” And the trend is moving upward, albeit slowly. Thirty years ago, a small cohort study from the Department of Health, Education, and Welfare (published in the October 1978 issue of the American Journal of Public Health) showed that only 16% of NPs worked in rural settings.
She then enumerates the challenges facing NPs who are looking to practice in rural areas, challenges which include setting up their own private practices, insurance, relatively low salaries and opposition from physician groups.
Rural health journalism workshop
AHCJ’s one-day workshop on covering rural health issues will take place tomorrow (June 4) in Kansas City. It’s free to AHCJ members, go here to register or to learn more about the day’s training.
Wisconsin’s low Medicaid fees create dental woes
Filed under: Health data, Health journalism, Hot Health Headline
The Wisconsin State Journal’s David Wahlberg reports that access to adequate dental care is a major public health issue throughout the state, especially among Medicaid recipients. Federally funded clinics are starting to fill the gaps, but there is still quite a bit of catching up to do. Waiting lists are long, and it’s the nature of remedial dental care that getting each mouth back on track is a long and involved process.
Photo by dbgg1979 via FlickrDentists told Wahlberg that they are reluctant to serve Medicaid recipients because the state’s reimbursement rates are too low. According to HHS, Wahlberg writes, “Just 23 percent of the state’s enrollees got dental care in 2008. Only Delaware, Florida and Kentucky fared worse.”
Rural areas have only about half as many dentists per person as urban areas do, making the search for dental care even harder in small towns.
That, combined with low fluoride levels in many rural drinking water supplies, means more tooth loss and untreated decay for many rural residents, state health officials say.
“Of all of the holes (in health care), dental care is the biggest and the deepest,” said Greg Nycz, executive director of the Family Health Center of Marshfield, which serves much of rural, northern Wisconsin.
The article is the latest in Wahlberg’s yearlong look at rural health care. Wahlberg will be moderating a panel about oral health for rural residents at next week’s Rural Health Journalism Workshop in Kansas City.
Feds want to fight food deserts
Filed under: Health policy, Hot Health Headline, Public health
The Detroit News‘ Nathan Hurst reports from D.C. on the Healthy Food Financing Initiative, proposed legislation that would commit between $400 million and $1 billion dollars to “building and improving stores where access to fresh food is limited.”
It’s modeled on a Pennsylvania program which provided start-up costs to grocery stores that promised to offer fresh food in low-to-moderate-income areas which didn’t yet have adequate access to such things. Detroit is the sort of city that would benefit most from a boost in urban groceries, Hurst writes.
Photo by paige_eliz via FlickrCarr said the prospect of federal subsidies to increase the number of grocery stores could be a boon to a city where large areas for years have had limited access to fresh produce and meats. In 2003, a University of Michigan study showed Detroit could easily support 41 large supermarkets — which measure more than 40,000 square feet — but at the time had only five with more than 20,000 square feet, and at least two of those have closed since the study was done.
How do these food deserts emerge in the first place? The Cincinnati Enquirer’s Laura Baverman explains by looking into that city’s shrinking grocery selection. Baverman explores several contributing factors, including a lack of the huge lots preferred by big box stores, booming suburbs and struggling independent stores, but in the end she comes back to brutal economic reality:
“You don’t get the sales levels in the inner city that you do out in the suburbs,” said Matt Casey, president of Matthew P. Casey & Associates, a New Jersey-based grocery industry consultant. “You tend to have a lower-income customer base, so they’re not spending as much. They don’t make the impulse buy.”
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Challenges of rural health care get a closer look
David Wahlberg, the health and medicine reporter at the Wisconsin State Journal, has embarked on a project to examine “the challenges of providing health care services to rural communities.”
The first piece of the series focuses on the doctor shortage in rural areas as well as programs intended to help full the gap. There are a number of sidebars about aspects of the doctor shortage, including one about a hospital that employs a doctor with a felony conviction. That hospital’s CEO says, “But in a rural market like this, you can’t not consider keeping him.”
The second piece looks at the aspects of rural life that hinder good quality, consistent health care. The story cites doctor shortages, hospitals that don’t perform specialized services and an abundance of patients who are poor, elderly or have little or no insurance as factors that make health care in rural areas precarious.
The fragile, fragmented care in rural settings is thought to be responsible for a startling mortality gap nationwide: The death rate, adjusted for age, dropped only slightly in rural America the past two decades while declining significantly in cities, according to the U.S. Department of Agriculture.
Wahlberg said in an e-mail that he expects future installments to come roughly once a month.
Rural health costs: Lower, but just as uneven
Writing on the rural news site Daily Yonder, Bill Bishop and Julie Ardery take a look at the Dartmouth Atlas, using only cost data from the two-thirds of hospital service areas that have mostly rural or exurban populations. They found that only 27 percent of the rural HSAs had Medicare reimbursement costs above the national average, but that variations in spending between rural areas were just as pronounced as those among their urban counterparts.
Bonners Ferry, Idaho, a town of about 2,500 near the Canadian border that’s home to the lowest Medicare costs of any American majority-rural area. Photo by prentz via Flickr.
The accompanying map is particularly nifty, not just because of what it shows about rural health differences, but also about the coverage and costs of rural hospitals.
To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.
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- AHCJ Rural Health Journalism Workshop
- Covering Health: How hysterectomies spurred Dartmouth Atlas’ birth
- Covering Health: Poor, rural hospitals have higher death rates
- Covering Health: Students look at rural health care in north Ga.
- Covering Health: S. Dakota may be model of health-care efficiency
- Covering Health: Dartmouth Atlas: Powerful when used right
- Covering Health: Why health costs in McAllen, Texas, resonate
Students look at rural health care in north Ga.
Filed under: Conflicts of interest, Health policy, Hot Health Headline, Member news, Pharmaceuticals, Studies, Uncategorized
Students at the University of Georgia spent the past few months assembling a 19-story package on health in six rural counties near the school’s Athens, Ga., campus. The package, done by students from Pat Thomas’ health and medical reporting class and Mark E. Johnson’s documentary photography course, makes extensive use of video and multimedia slide shows.
The stories focus on particular areas of interest in each county and help tell stories ranging from the challenges of starting a family in economically disadvantaged rural areas to the influence of gangs on the lives of folks living in those areas. In other counties, the reporters covered the prison system, the struggles of aging residents and the senior centers that serve them, and emergency services and rural medicine.
The stories show the breadth of reporting possible within the health care beat and paint a picture of rural health using varied approaches to storytelling.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
