Updates on the Rural Health Care Crisis

by James A. Bacon

It turns out there’s not just a hospital shortage and a physician shortage in rural Virginia — there’s a nursing shortage. A couple of articles over the weekend highlighted growing problems with health care access in rural and small-town western Virginia communities.

Community leaders in Patrick County have given up on bringing back a local hospital from the dead, reports the Associated Press. Efforts to resuscitate the old Pioneer Community Hospital were hampered by complex licensing issues and the high cost of retrofitting the 1960s-era hospital building, which has deteriorated since it closed two years ago and suffers from extensive deferred maintenance issues.

Local officials now are looking for other ways to deliver health care services to the mountainous county where the population is declining and aging, the AP says. In the meantime, still-functioning hospitals are shutting down floors and units due to an inability to staff them with nurses.

A Roanoke Times article highlights the problem at the Holston Valley Hospital in Kingsport, Tenn., which serves parts of far Southwest Virginia. The nursing shortage, though national in scope, is especially acute in western Virginia. The job growth rate for nurses is the fastest of almost any occupation in the U.S., and nursing schools are hard-pressed to keep up. There are two big problems: a shortage of faculty and a shortage of clinical spots to train them.

As nursing schools struggle, hospitals are resorting to a variety of strategies to address the shortages, from increasing pay and recruiting nurses from other countries (particularly the Philippines) to experimenting with “shared governance” systems that give nurses a bigger voice in management.

Bacon’s bottom line: There are no simple fixes to Virginia’s rural health care crisis. One of the promises of Medicaid expansion is that it would put more money into the pockets of small community hospitals like those in Patrick County and Lee County that have shut down. Maybe the influx of funds will help keep other community hospitals afloat — we’ll see how that works out. But if an inability to hire doctors and nurses forces community hospitals to close floors and departments, extra Medicaid money may not make a difference.

Absent a magical infusion of billions of dollars into Virginia’s rural health system, we may have to come to terms with the reality that it is economically impossible to maintain the same level of hospital service as in the past. But that’s not to say that rural residents need to travel 30 to 60 miles for all their treatment. Perhaps the focus should shift to providing primary care, urgent care (as opposed to emergency room care), and outpatient ambulatory surgery in lower-cost settings than hospitals. Such a vision is far from perfect, but it’s better than no local health care at all.

What is preventing such a transition? Does the Certificate of Public Need review process and other licensing barriers make it more difficult for health-care entrepreneurs from devising lower-cost settings and providing a less-than-perfect-but-better-than-nothing level of health care? It’s a question worth asking.

Share this article


(comments below)


(comments below)


5 responses to “Updates on the Rural Health Care Crisis”

  1. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    The best remedy to this problem in my neck of the woods is the Urgent Care Center, typically staffed with a single primary care physician ably assisted by highly one or two highly capable nurses. Done right this small facility takes a heavy load off hospital emergency care, and off of traditional primary practices. Many daily medical issues thus require patient to go no further than urgent care that is available 12 hours a day on short notice, and often too within far shorter driving distance than the local hospital or standard doctors offices, and with much quicker more efficient service.

  2. djrippert Avatar

    Patrick County has experienced a notable population decline since 2000. Lee County is steady since 2000 but had its population peak in 1940. Since then the population has declined by 38%. Of course the hospitals are closing. It seems inevitable to me. The real elephant in the room is what to do about rural Virginia. Encouraging people to relocate to areas of Virginia with greater economic opportunity seems like the only answer.

  3. NorrhsideDude Avatar

    I don’t subscribe to the premise that we should be concerned with providing services to rural citizens. By definition these people chose to live in rural areas. If they desire to have certain amenities then they should relocate. When I was a boy we lived in a depressed area. My father wanted different for his kids, so he moved to a booming area, made some money, and then moved his family. It sucked and we sacrificed for a better life. We moved away from family and roots but we started new roots in Virginia.
    I also believe if market forces were in place they would have a hospital. It’s no place for tax payers to provide any incentive to make that happen.

    1. djrippert Avatar

      I reluctantly agree. The continuing depopulation of rural Virginia counties is making it all but impossible to provide the full range of services people want / expect. Highland County has a population density of 5.32 per square km. It lost 3.79% of its population since 2010 while the US grew 5.96%. The county now has 2,210 residents across 416 sq mi. Bath County, the adjacent county to the south, has a population density of 8.11 per sq km and lost 9.09% of its population since 2010.

      I don’t know how you look at this map and see a solution …


  4. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    If they have to relocate to areas that have the services and the infrastructure to support the good jobs, i.e. the urban areas, then the folks in Richmond, NoVa, and Hampton Roads should stop complaining about the increased traffic, crowded schools, and lack of affordable housing.

Leave a Reply