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Rural residents face shortage of physicians

FARGO -- Rural residents face higher rates of chronic disease than their city cousins yet must cope with fewer doctors and other health providers.

That squeeze between an increased need to manage complex medical conditions and a shortage of providers will grow over time, according to a study released this week by UnitedHealth Center for Health Reform & Modernization.

In North Dakota, for instance, where 51 percent of the population is rural, there are 69 doctors for every 100,000 residents, compared to 132 for urban residents.

The rural-urban doctor divide is less pronounced in Minnesota, where 27 percent of the population is considered rural, and where there are 76 doctors for every 100,000 rural residents, compared to 122 for urban residents, according to the study.

Gary Hart, director of the University of North Dakota's Center for Rural Health, said more rural residents suffer from chronic disease because rural areas have a higher proportion of elderly people.

"That doesn't change anything," he added. "You still have to take care of them."

Among the other findings of the study by the UnitedHealth Center:

n Rural doctors were much more likely than their counterparts in urban or suburban practices to view drug abuse and teen pregnancy as major concerns.

n Rural doctors were more likely to rate the quality of care in their communities as lower than in urban or suburban settings.

n UnitedHealth found that in 70 percent of markets, the quality of rural health care was "measurably worse" than in urban areas.

That's a finding Hart and Brad Gibbens, the UND Center for Rural Health's deputy director, disputed. Other studies, they said, have come to different conclusions.

"I would say the literature in that regard is mixed," Hart said. The best place to have a heart attack would be outside a major medical center, he said, but outcomes of low-risk births in rural and urban settings showed no difference.

The UnitedHealth Center study said improved and more extensive use of telemedicine is a key strategy in extending care to rural areas.

Telemedicine initiatives have received significant federal funding, along with support and incentives to adopt electronic medical records.

In North Dakota, Gibbens said, extensive collaborative networks have been formed with the urban medical centers and rural satellites, with a notable focus in recent years on improving quality of care.

The chronic shortage of physicians and other health professionals in rural areas likely will get worse, the UnitedHealth Center study concluded, if insurance coverage is extended under health reform.

By 2019, an estimated 8 million more insured rural residents will place greater pressure on the health system due to Medicaid expansion and state health insurance exchanges, the study found.