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Changes in Latitudes, Attitudes, and Rural Health

By Atul Grover, MD, PhD, Executive Director, AAMC Research and Action Institute
Sept. 27, 2023
Notes & Insights from the AAMC Research and Action Institute

“Changes in latitudes, changes in attitudes

Nothing remains quite the same.”

Jimmy Buffett

Singer-songwriter Jimmy Buffett died earlier this month, and while reminiscing about his music, I thought about Key West, Buffett’s home away from home and the inspiration for many of his songs. Key West is part of Monroe County, Florida, a large county in the state — about 3,700 square miles, nearly three-quarters of which is water. Technically it’s not rural, but the large majority of its residents live in a small portion of the county (the Keys), while the rest live in and around Everglades National Park.

Buffett had a really rare skin cancer, Merkel cell carcinoma (MCC) — one most of us physicians remember hearing about in med school but rarely see in practice. He was lucky enough to get specialized care, but not everyone who lives in small or rural towns is as fortunate.

Florida, where Buffett is highly regarded as the king of paradise, has 32 rural counties out of 67. These counties are very different from those in Maryland, where I live, which has 18 rural counties and in which 25% of the population resides in rural areas.

And that brings me to my first observation about rural health care: The problems and solutions for each “latitude,” area, and community are too different to be solved by any one single policy.

For nearly a century, we’ve talked about getting a primary care doctor in every county as the solution to rural health care. It hasn’t happened. And it likely never will.

But, as it turns out, that may not be at the core of access issues (nor is it at the core of poor health outcomes) in rural America.

Rethinking Rural Health

Our latest issue brief takes a look at care obtained by rural residents of the United States and finds that:

  • The number of primary care doctor visits among rural residents and urban residents is similar.
  • Rural areas have more family doctors per capita than urban areas.
  • Rural residents are more likely to have a regular source of care.

Access — at least to primary care — is similar in metro and nonmetro areas. But access to pre-hospital emergency services, hospitals, and specialty care is generally much worse for rural America.

                                                                     READ ISSUE BRIEF

The brief suggests that while policy interventions that geographically locate primary care providers in rural areas have been important and successful, future policies must address access to other types of care. These policies must make new modalities of delivery available to rural residents to improve local (and virtual) access to health care.

And if poorer health status is the problem we’re trying to solve, we must include long-term policies to improve education, reduce poverty, target substance use disorders, improve mental health care, and attend to all the social determinants of health.

Policies that seek to improve the health status of rural communities must also take into account the differences in rural “latitudes” between states like Florida, Maryland, Alaska, and Alabama — including geographic, temporal, and financial access to care and, more importantly, issues beyond primary care and the clinical care infrastructure.

Along with our latest brief, you can find all the institute’s work on our newly designed website that just launched today at aamcresearchinstitute.org.

As always, I welcome your advice, criticism, and insight.


Rest in Music
Jimmy Buffett, 1946-2023