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Lack of rural medical centers is a growing issue

The impending closure of Sentara Martha Jefferson Medical Group’s Buckingham Family Medicine in Dillwyn brought disappointment to many county citizens who have received medical care at the location for decades, but it may also be a sign of a growing difficulty to operate medical clinics in rural Virginia.

When Sentara announced the planned closure of Buckingham Family Medicine earlier this month, officials cited an inability to recruit a new primary physician as a prime reason for the shutdown.

On Monday, Sentara Vice President and Executive Director Bruce Clemons explained Sentara, like many health care providers, recruits its doctors to work in a specific region, but doesn’t advertise a vacancy at a specific practice. He said finding a physician willing to relocate or make the drive to Buckingham from a nearby city was a problem.

“I would say it really came down to two issues,” he said of the staffing troubles. “One, most people wanted to live in Charlottesville and didn’t want to have such a long commute, and the second one was that the majority of the people we tend to hire are coming directly out of training, and they typically want to be in a bigger practice setting so that they can have colleagues with them to help as they sort of get started in their career.”

Clemons said it can be difficult to find someone with enough experience to comfortably work in a small clinic.

But it’s not just staffing that can pose a real problem to health care providers. Small town medical offices across the commonwealth are struggling to stay open as the cost of running these practices increases. Clemons said Sentara itself has had difficulty in maintaining rural practices in other parts of Virginia.

“I think we have to look at the whole situation of what is the state of rural medicine in general,” Clemons said. “What we’ve found over the past 10-15 years is that the expense of running a practice for rural medicine has made things significantly more difficult. Medicine now pretty much requires physicians to have an electronic medical record, which is an extra expense, and not only does it cost to have the electronic records, but you have to have all the equipment, often have to update your broadband and internet, and then even have someone potentially on staff who can help just manage the electronic record system.

“The other thing is in this regulatory environment with Medicare and other insurances requiring the reporting of more information, it’s put more burden on the practices to have the ability to capture health information and then be able to send that to insurances just to be able to get paid,” he continued. “So, I think you’ve got problems with potentially finding physicians to go into these clinics, but also we’re seeing many of them completely closing down across the state because of some of those factors.”

Difficulty recruiting doctors and keeping rural practices open isn’t just a problem in Virginia. According to the National Rural Health Association, ease of access to a physician is greater in urban areas around the country. The patient-to-primary care physician ratio in rural areas is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas.

Counties with fewer doctors tend to have difficulty retaining residents.

A 2018 study last updated in 2020 by “24/7 Wall St.” tracked rural counties in all 50 states with no doctors. Researchers found 41 of the 50 localities saw a decline in population over the last five years or grew slower than the 3.9% national growth rate.

But with rural doctor’s offices shutting their doors, how can residents of small counties still obtain quality care without having to travel long distances?

“I think that probably the best way to solve the issue is exactly what already exists in Buckingham County, which is the federally-qualified health center,” Clemons said. “So, they get extra support either from the state or the federal government to be able to maintain and run a comprehensive medical practice in a rural area.

“So to me, that’s probably the best answer, and then secondly somehow I think we’ve got to continue to encourage medical school graduates to go into primary care.”

Clemons said telehealth appointments may also serve as a way to alleviate some of the trouble rural Virginians experience when trying to access health services, allowing medical practices to reach a broader region while actually becoming more consolidated.