The Challenge Facing Rural Hospitals


This article and the related comments are for educational and discussion purposes. They do not establish the standard of care in every patient’s situation. In each patient’s situation, the treating physician or other medical professionals must exercise their professional judgment. Similarly, these materials are not medical advice to patients, who must consult with their own physician or other medical professional.

I’ve often thought that the US doesn’t have a physician shortage, it has a resource allocation problem.   When I was living and working in Tennessee (TN), I had worked with Apogee on rolling out our Tele-Medicine platform… Apogee Doctor On Call (ADOC)™.   One of the reasons we chose TN as a test state, was because research showed that doctor/patient ratios in metro areas like Knoxville, Nashville and Memphis were about 1:350.   But if you ventured out to rural TN, those ratios plummeted to 1:7,000.   This is a unique challenge for our most vulnerable communities. 

The next time you’re on a road trip and driving down the Interstate… you’ll notice a blue sign with a white ‘H’ at every exit with a little town.   And if you’ve ever had an emergency or gotten sick on a road trip you’ll be glad to see one of those signs.  We have taken for granted that there will always be a doctor waiting in that little ER to care for us.  

Physicians essentially give up their 20’s to earn the privilege of taking care of patients.  In the case of Hospitalist Medicine (mostly FP and IM) a full 7 years and an average of $300+K in student debt.  When they look for their first job, they often seek culturally rich cities with diverse educational opportunities for their children and job opportunities for their spouses.   They are also looking for a competitive compensation package that will allow them to pay down their large student debt while enjoying the fruits of their labor.  

All of these are challenges for smaller and more rural hospitals.  Yes, there are doctors (like me) who will actively seek out these quiet communities to raise their family, but that pool of physicians is certainly smaller.  I believe these opportunities are the most under-appreciated in our profession.   Having worked in a small rural hospital, and now managing programs in several similar facilities, I can tell you without reservation, that any physician who doesn’t explore these unique opportunities is missing out on quite possibly the most rewarding path in modern medicine.   

Telemedicine can help bridge the gaps and creatively solve our ‘resource allocation’ challenge that our small towns face… while recruiting like-minded physicians who appreciate the benefits and charm of a small town and hospital. 


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