Extinction of the Rural Practitioner

The changes taking shape in rural parts of our country are causing access issues for rural consumers. Not surprisingly, money is at the root of the problem. General practice physicians in rural areas just aren’t able to maintain the financially viable private practices they once were.

Decreasing reimbursement rates are frustrating the private practice business model. Federal reimbursement rates, most notably, have been decreasing over the past several decades, and should continue decreasing beyond next year. While these lower reimbursement rates have directly contributed to the reduction of private practices in both rural and urban parts of our country, rural physicians are having a harder surviving. Simply put, reduced reimbursement rates are making it harder for private practice physicians to do what they’ve always been doing—caring for patients while being their own boss.

The physicians in rural America have been some of the hardest hit by the reductions. To truly understand this effect, you must first understand a few points. First, general practice physicians tend to predominate the physician make-up in rural areas. Second, general practice physicians, especially those in rural areas, have limited opportunities to bill insurers and the government for high revenue-generating services. Instead, they typically spend a lot of their time and energy providing routine, low revenue services. Contrary to what some may think, practicing general medicine in a rural market is not a lucrative business today.

Compound these points with a third point—the severe recessions currently affecting rural economies—and one can more clearly see how general practice physicians are finding themselves increasingly unable to maintain private practices. Today’s economic and political climates are unfavorable to rural practitioners, and Federal reform isn’t providing the respite that many desire.

Reform prescribes that physician practices implement new technological developments (e.g., electronic health records, data management software, etc.) at risk of receiving even lower reimbursement rates than they’re projected to receive. So, why is it that private practitioners don’t adopt these measures to prevent further reductions? Well, it’s because these technologies are expensive! The initial cost for the new systems cost physicians upwards of $1 million, not including other, non-license costs (e.g., costs routine maintenance, database management, etc.). Many small practices—like those scatter throughout rural areas of our country—are effectively priced-out. To them, the decision comes down to early retirement or taking the loss.

It will be interesting to see how the younger generation of general practitioners will rise to the challenges facing rural patient populations. Of course, they can’t be expected to assume the entire caseload of the retiring physicians. A young physicians are at the beginning of a long career. They have a lot of opportunities available to them. They aren’t limited to purchasing an aging private practice. They can become part of a hospital system, in a big city, getting wonderful experience caring for a diverse patient base. What will prompt them to move to the rural areas? Will it be the prospect of taking out thousands of dollars in loans to update an aging private practices office? I highly doubt it, especially not when they’re already swimming in debt from medical school. Nevertheless, the younger generation of physicians definitely has its hands full.


James Shannon

Nursing Leader | Quality Leader | Healthcare Attorney

View all posts by James Shannon
2 Replies to “Extinction of the Rural Practitioner”
  • Gary Lishinski
    September 6, 2014 at 9:28 PM

    Thank you for the thought provoking article. We need a national initiative to provide economic incentives to primary care providers to relocate to rural areas. This can be done with more attractive incentives through programs such as the National Health Service Corp. CMA also needs to consider providing higher reimbursement rates for the services provided in rural areas. We need create the financial incentives to redistribute providers to the rural communities. We also need to provide financial support for rural providers to develop the infrastructure needed to build medical home teams to support the work of primary care physicians.

    • MissionVisionValues • Post Author •
      September 7, 2014 at 5:28 PM

      I agree: there’s big need for re-structuring the practice incentives for rural providers. The term “Rural Healthcare” may need a rebranding, too–maybe “Community Healthcare,” or another combination of healthcare lexicon that can more clearly direct all populations to recognizing the importance of rural societies to America’s overall health and welfare. It’s a part of America that I hope receives the same benefits of the innovations that are beginning to shape the way healthcare is practiced in the urban sphere. As you’re probably aware, there’s a large knowledge-gap between DC and rural communities, and that gap likely affects effected-Policy’s ability to empathize with rural environments to help better manage their palpable, continuing need(s).

      Thank you for the comment, as well as your kind words.


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