Eyal Kedar didn’t start out in rural healthcare. He spent several years working in a big city before eventually realizing he wanted to become a generalized specialist in rheumatology, a branch of medicine that treats inflammatory or infectious conditions of the joints and other parts of the skeletal system.
“I felt that the best way to do that would be in a rural community,” he said.
Kedar is now the sole rheumatologist in St. Lawrence County in New York state. The county is about the size of the state of Delaware and has a widely dispersed population of about 109,000.
“In an ideal world, a rural rheumatologist has a full staff and a team of advanced practice practitioners who help them with taking care of more stable cases in the community,” he said. “[They] really try to make their job as easy as possible because the job is going to be inherently hard. And you let rural rheumatologists, rural specialists focus on the complex cases in their community. And that keeps the job interesting.”
But, as reporters from Carolina Public Press in North Carolina, Honolulu Civil Beat and Shasta Scout in northern California will show over the next few days in a series examining rural healthcare, it’s not quite so simple.
From mental and behavioral health to maternity care, specialists in rural areas of the United States are in short supply. For the people who live there, that has meant doing without specialized care or traveling long distances to get it.
On Lanai in Hawaii, for example, 25 people who receive psychiatric care through the Hawaii Department of Health’s Adult Mental Health Division were left without support on the island when the care was outsourced to the mainland, making a temporary COVID-19-era safety measure permanent, Honolulu Civil Beat reports.
“The lack of access to behavioral health is one of the top-tier issues,” said Alan Morgan, chief executive officer of the National Rural Health Association. “No. 2: maternity care. I’d say that’s a huge issue, because we’re talking about the future of rural. You’ve got to be able to have a community in which young families can move to live there and have access to healthcare to start their families off.”
In the case of psychiatric treatment on Lanai prior to COVID, AMHD patients had access to a full-time on-island social worker and in-person appointments every two weeks with a Maui-based psychiatrist, Honolulu Civil Beat found. Availability of in-person mental health care of any kind is now sporadic, amounting to a few days per month. Of the 122 psychiatric visits Lanai patients received this year, only nine of them were in person, according to the Hawaii DOH.
Although milder symptoms related to mental health can improve with a variety of treatments, there’s no consensus about whether new virtual tools are effective at helping more severe cases of mental illness, experts say.