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Rural healthcare in crisis



By Erin Bills

A large percentage of Montanans rely on primary care physicians for initial and ongoing healthcare. But in the past decade, the number of primary care physicians practicing in rural clinical settings in Montana has declined. Because of this, many small communities lack counseling on preventive medicine and have little access to healthcare or emergency health services.

Despite increases in medical graduates, the number of primary care physicians remains low, according to recent studies*. Medical students and medical residents’ decreased interest in primary care specialization is due to low compensation compared to urban counterparts and specialty practice, rising malpractice premiums, professional isolation, and limited time off, according to the Rural Health Research Center. Recent economic instability and declining Medicare reimbursement have also spurred the decline.

The Medical Clinic of Big Sky has addressed this issue by establishing a student program open to fourth year medical students and medical residents. This clinic specializes in internal medicine, sports medicine, family care and women’s health care. Without this, Big Sky residents wouldn’t have access to primary care.

Because residents of rural communities may sometimes require specialty care, public health professionals and primary care physicians maintain relationships with specialty referral healthcare centers. Big Sky’s clinic has established operational and clinical peer networks with several specialty care clinics such as orthopedic care and obstetric care in Bozeman.

A quarter of Montana’s active physicians are 60 or older and will retire in the next five years. There are approximately 19 primary care physician openings in Montana each year, according to the MSU Office of Rural Health. Without a sufficient number of primary care residents training to fill these positions, the problem of provider shortages will expand. The practicing medical community must assume a leadership role to facilitate quality education and successful return of rural practicing physicians.

As Montana residents, we need to communicate with our legislators and policy makers, asking them to create sustainable programs and policies that will improve physician recruitment and retention in all rural Montana communities.

Erin A. Bills, MPH, is a public health consultant who lives in Big Sky. Her ongoing research of social capital with the University of Montana and CARD Clinic in Libby, Mont. has aided in the development of effective health policy in rural Montana.

*Completed by the Rural Health Research Center, in conjunction with the University of Washington School of Medicine and the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho)

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