A rural Ohio pharmacy school embraces pharmacists' expanded 'provider status' by deploying a mobile care unit

Mobile Health Clinics staffed by student pharmacists and 
supervising faculty provided health care in rural Ohio.

Dozens of states across the U.S. allow pharmacists to have expanded care status similar to the role a primary care medical professional would fill. In 2019, the Ohio legislature granted pharmacists "provider status," which means they are "recognized healthcare providers in the state insurance code and allowed to be reimbursed for services like chronic disease management and immunizations."

Using their change to "provider status" as a launching pad, leadership at Ohio Northern University's Raabe College of Pharmacy in rural Hardin County, Ohio, challenged themselves to reenvisioned how they could use their existing "HealthWise" service, which was originally intended for ONU employees, to address health care deficiencies throughout rural Hardin County and its rural county neighbors, reports Kay Miller Temple for Rural Health Information Hub.

During a Hardin County health needs planning meeting, Michael Rush, PharmD, who teaches residents and is the director of operations at ONU HealthWise, was inspired by a food truck he saw outside; he thought a mobile HealthWise might be the answer.

Location of ONU in Ohio

Once shared, Rush's idea gained traction, and numerous funding awards and grants led to Raabe College hiring a pharmacist and purchasing a bus, which "built out ONU HealthWise into the ONU HealthWise Mobile Health Clinic," Temple writes.

Today, ONU student pharmacists and their supervising faculty aboard the HealthWise Mobile unit provide a broad spectrum of health care, including "preventive health education, medication reconciliation, medication therapy management, and chronic disease state management," Temple reports. Health screenings, immunizations and specialty care are also addressed on-site.

The Healthwise Mobile unit services have continued to expand to meet their community's needs. When two rural pharmacies closed in 2024, the traveling care team filled the gaps. 

Michelle Musser, director of ONU's Rural and Underserved Health Scholars Program, told Temple, "The students need those experiences of working in a pharmacy, different from the mobile outreach experiences. This closure allowed them to experience firsthand what a rural pharmacy closure actually does to rural communities."

Building on the first Healthwise Mobile Clinic's success, Raabe College is investing in a second van. Temple adds, "HealthWise will eventually be present in Hardin, Allen, Auglaize, Hancock, and Wyandot Counties."

Waves of American doctors and nurses leave their practices and head to Canada to avoid U.S. political climate

Often born and trained in the U.S., many nurses and doctors are leaving the U.S. for Canada.
(Graphic by Oona Zenda, KFF Health News)

At a time when Americans can least afford to lose medical professionals, many are leaving the U.S., citing the country's current political climate as their reason for leaving. In rural parts of the U.S., already facing a chronic shortage of medical care providers, the loss of any medical professionals makes accessing care more difficult.

"American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April 2025," Brett Kelman of KFF Health News reports. 

Justin and Amy Miller from Wisconsin serve as one example. They are both nurses who were born in the U.S. and trained at American schools, but didn't want to stay in the U.S. because of policies and cuts by the Trump administration, Kelman explains. They moved their family of five to Canada, where they found new nursing jobs.

As the Trump administration systematically slashed "funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system," Kelman reports.

For U.S.-trained nurses, Canada is rolling out the welcome wagon. "Ontario and British Columbia have streamlined the licensing process for American nurses since Trump returned to the White House," Kelman writes. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state."

Doctors are leaving as well. "Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out," Kelman reports. KFF did not use his last name because he expressed concerns about reprisals if he returned to the U.S. 

Rural Canadians, who also struggle with accessing medical care, are also hoping to attract some American medical professionals. Doctors Manitoba, which "represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S," Kelman writes. 

Report: Rural primary care physician shortages will persist for at least another 12 years

Graph by Celli Horstman and Arnav Shah, State of Rural Primary Care in the United States, Commonwealth Fund

Rural residents will continue to grapple with a shortage of primary care doctors for at least another 12 years, according to a report issued last week by the nonprofit Commonwealth Fund.

Using federal health workforce data, researchers concluded that "rural areas will continue to have only about two-thirds of the primary care physicians they need," reports Nada Hassanein for the Wisconsin Examiner. Report authors noted that the persistent shortage of primary care doctors leaves million of rural residents "with fewer options for routine and preventive care."

The report's release came just days after the window closed for hospitals to apply for a share of the $50 billion federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services. Hassanein writes, "Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one."

Nearly all of the more than 40 million rural Americans live in areas with primary care physician shortages, according to the report. "Forty-five percent of rural counties had five or fewer primary care doctors in 2023," Hassanein adds. "Roughly 200 rural counties lacked one altogether."

The report found that doctor shortages in rural areas vary by region. Hassanein writes, "States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician."

Although rural areas will continue to lack enough primary care physicians, some of the gap will be filled by rural nurse practitioners. Hassanein adds, "Nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the report authors wrote."

Quick hits: Dairy farming with a robot; CSA debate; Farmers' Almanac ends; rural hospital success; goodbye penny

A robotic milker takes the place of a hired hand as dairy
farmers face labor shortages. (Farm Progress photo)

Marlane Williams always dreamed of owning her own farm and milking her own dairy cows. Now she has both, along with a robot that helps out while she's at a day job that provides income stability. "Williams has held several jobs while trying to be a dairy farmer," reports Chris Six of Farm Progress. "She's owned a dairy farm in southwest Missouri since 2002 and says balancing both is tricky, but she feels blessed to have achieved her dream." Instead of trying to hire part-time labor, Williams purchased a Lely Astronaut milking robot to make sure her growing herd is milked twice a day.  

The debate over whether the Community Supported Agriculture model is dead or alive continues, with a fresh perspective from Ruth Katcher, who runs a thriving CSA for city folk in Brooklyn, New York. "I’ve been mulling over Lauren David’s thought-provoking article on whether we’ve outgrown the CSA model," Katcher writes for Offrange. "I have to admit she made some excellent points, especially about the appeal of models that offer more choice to consumers than traditional CSAs. . . . But the traditional CSA model has features I would hate to give up . . ." Read Lauren's essay here, and Katcher's full counter here.

Pecan trees don't have to be planted every year. 
(Photo by Elizabeth Hewitt, Reasons To Be Cheerful)

In a drastic turn from traditional row-crop agriculture, some Midwestern farmers are planting nut trees that are reviving soil depleted by corn and soybean plantings. "In 2017, Josh Payne planted 20 acres of chestnut saplings, growing commodity crops in wide rows between the trees," reports Elizabeth Hewitt for Reasons To Be Cheerful. "Payne is among a growing number of farmers looking to supplement or even replace common crops planted annually — like corn and soy — with various types of nut trees. . . which can provide a type of multi-generational resilience because they can generate income for decades."

U.S. Mint photos

The U.S. Treasury Department laid the U.S. penny to rest on Nov. 12 in Philadelphia after producing it for 232 years. Victor Mather of The New York Times reports, "Top Treasury officials were on hand for its final journey. No last words were recorded. The cost to mint the penny had risen to more than 3 cents, a financial absurdity that doomed the coin. The American penny was preceded in death by its smaller sibling, the half cent (1793-1857), and its cousin, the Canadian penny (1858-2012)."

Internal medicine residents at Billings Clinic 
in Montana. (Photo by Colton Adams via the Yonder) 

A community hospital in Billings, Montana, is bucking trends with its successful medical residency programs, which train new doctors who often decide to stay in the state and practice. "As rural areas across the country face worsening provider shortages and reductions in health care services, Billings Clinic is celebrating the success of two new residency programs training," reports Madeline de Figueiredo for The Daily Yonder. "Since launching its internal medicine residency program in 2014, Billings Clinic has graduated 75 physicians, with half now practicing in rural communities. The program’s outcomes stand out amid national trends, where only 11% of physicians work in rural areas."

After more than two centuries of publication, the Farmers' Almanac from Maine announced that 2026 is its last print run. "The 208-year-old, Maine-based publication that farmers, gardeners and others have relied on for planting guidance and weather predictions will publish for the final time," report Patrick Whittle and Kathy McCormack of The Associated Press. "The Farmers’ Almanac, not to be confused with its older, longtime competitor, The Old Farmer’s Almanac in neighboring New Hampshire. . . . The almanac cited the growing financial challenges of producing and distributing the book in today’s 'chaotic media environment.'" The first Farmers' Almanac was published in 1818.

New $100K skilled-worker H-1B visa fee could mean fewer Indian doctors to treat rural residents

One in five immigrant doctors in the U.S. is of 
Indian origin. (Photo via BBC News)

The Trump administration's new $100,000 skilled-worker H-1B visa fee could leave fewer Indian doctors to treat rural populations. "One in four doctors providing care in the U.S. are foreign-trained, and recent data shows that most of them practice in the vast, underserved rural areas where American graduates are reluctant to work," reports Savita Patel of BBC News.

For the roughly 50,000 India-trained physicians currently working in the U.S., the new visa fee does not apply; however, there are worries around "whether the steady supply of Indian medical professionals to the U.S. would continue in the future," Patel explains. "According to research, one in five immigrant doctors in the U.S. is of Indian origin."

And while the administration may eventually decide to exempt medically trained workers from the new fee, currently, "there is no indication that any category of workers, including those in the medical field, has been exempted," Patel reports.

The American Medical Association asked the Secretary of Homeland Security, Kristin Noem, to reconsider the new fee, "emphasizing that the fee hike could discourage hospitals from hiring H-1B doctors, affecting future supply pipelines and limiting patients' access to care in communities that need it the most," Patel adds.

Supporters of the fee hike insist it will keep "American jobs for Americans," Patel adds. But research on which jobs foreign medical workers take shows they are filling positions that American doctors don't want -- in regions that are "remote and low-income."

Given the financial straits many rural hospitals are already in, "any hike in the fee would make it harder to bring in new clinicians from abroad," Patel writes. Dr. Bobby Mukkamala, president of the AMA, told Patel, "We have heard from health systems who say this fee would be devastating."

Despite a shortage of medical care in rural America, some residents insult and undermine their doctors

Dr. Banu Symington is an board-
certified oncologist. 

Dr. Banu Symington treats patients in Rock Springs, Wyo., a town of about 24,500 people, where she was treated with kindness and respect until Covid masking battles and conspiracy theories began to enter her conversations with patients.

Symington's experience is mirrored by many other doctors "who say political attacks on science and medicine are affecting their relationships with patients, particularly in rural communities, where physician recruitment already poses a chronic challenge," reports Yuki Noguchi of NPR.

Some of Symington's cancer patients have sworn at her for "suggesting they vaccinate or wear masks to protect their weakened immune systems while undergoing chemotherapy," Noguchi adds. Symington told Noguchi, "It's very difficult, helping someone who scorns your help, or diminishes the value of it."

Some residents have consumed enough conspiracy theories that they believe physicians are trying to poison them for profit or that medical providers are somehow profiting alongside pharmaceutical companies at the expense of patients. 

Dr. Jennifer Bacani McKenney 
practices in her hometown. 

Dr. Jennifer Bacani McKenney practices family medicine in the tiny town of Fredonia, Kansas, where she was born and raised. McKenney's parents had emigrated from the Philippines to Fredonia, where her father started working as a surgeon. For years, McKenney enjoyed community trust as a "home-grown" physician, but "the spread of Covid-19 also revealed how some of her patients perceive outsiders," Noguchi writes.

McKenney told Noguchi, "My patients were calling Covid the China flu and Kung flu — that kind of thing — and saying about 'Asians needing to go back,' and they would say it to my face."

McKenney has continued her work in Fredonia, but acknowledges that today's political climate has made treating patients more challenging. She still recommends treatments, such as vaccines, that some patients push against. She told Noguchi, "But if I don't have those conversations, I'm not doing my job."

Rural hospitals tap into high schools to meet ongoing staffing challenges

Ballad Health is one of several rural-serving 
hospitals training high school students.

Ballad Health is a rural hospital system in Tennessee that, like many rural hospitals, spends millions of dollars a year paying traveling nurses to cover staffing shortages. To address its recruitment woes, Ballad is working with area high schools to train its next generation of medical care workers, reports Te-Ping Chen of The Wall Street Journal. 

Ballad's high school training academy includes students from "five northeast Tennessee school districts," Chen writes, "The first batch of 200 students will graduate in 2029, with their licensed practical nurse credentials and be eligible to work right away at Ballad, earning $23 an hour." 

Building and implementing a medical training academy for high school students is time-intensive and expensive, so Ballad Health partnered with Bloomberg Philanthropies, which "last year announced it was pumping $250 million into 10 programs in states including Tennessee, Texas and North Carolina to create a high school-to-healthcare pipeline," Chen explains. 

Ballad isn't alone in its staffing struggles, and as the baby boomer generation ages, demand for medical care staffing is expected to grow. Chen reports, "Human resources advisory firm Mercer projects a deficit of 100,000 healthcare workers by 2028."

Since 2006, Baystate Health system, which serves rural populations in western Massachusetts, has invested in a "high-school career program for jobs such as respiratory therapist and sterile processing technician," Chen adds. "Many participants have gone on to pursue additional training, and more than 900 have ended up working for Baystate in the past decade."

Many rural residents drive almost an hour to get to a hospital for surgery, study finds

Rural Medicare patients 'typically drive 55 minutes
to a hospital.' (Adobe Stock photo)

When rural folks need surgery, long-distance drives come with the territory. "Forty-four percent of rural Medicare patients must drive an hour or more for surgery, a recent analysis finds," reports Erin Blakemore of The Washington Post. "The study shows that patients in rural areas typically drive 55 minutes to a hospital — far longer than their counterparts in more populous areas."

While rural Americans have historically struggled to have medical care access that's equal to urban residents, their plight has worsened since 2011. Blakemore explains, "The number of rural Medicare beneficiaries who traveled more than 60 minutes for their procedure rose from 36.8% in 2010 to 44.1% in 2020. . . . Among non-rural Medicare beneficiaries, travel times were lower, with a median of 20 minutes’ travel in 2010 vs. 23 minutes in 2020."

Rural hospital closures could be contributing to the problem, and "high-risk operations are increasingly centralized, the researchers note, which may have contributed to the rise in travel minutes for rural patients who must go farther for such procedures," Blakemore adds. "In a related study from the Annals of Surgery, researchers found that 98.7 million Americans — nearly 1 in 3 — lacked access to 'timely, high-quality, affordable surgical care' in 2020."

The U.S. is expected to face a nationwide surgeon shortage over the next decade, making the lack of local surgical care for rural residents an area of "growing concern," write Brittany A. Long and Michael J. Sweeney for The National Library of Medicine. "When considering the existing barriers to surgical healthcare in rural communities, there is a sense of urgency to identify innovative approaches that will promote a sustainable surgeon workforce."

A new proposal to cut down on medical research costs could lead to less medical research

Less funding could lead to less
medical research. (CDC photo)

The Trump Administration proposed to reduce the size of medical research grants conducted by institutions, including hospitals and state universities.

If it goes through, indirect medical research funds would be reduced to a set 15%. However, the proposal has been “put on hold by a federal court,” according to an article by Emily Badger, Aatish Bhatia, Irineo Cabreros, Eli Murray, Francesca Paris, Margot Sanger-Katz and Ethan Singer at The New York Times.

The Times reported that in 2024, $32 billion was spent on medical research, with $23 billion having gone toward direct costs and the remaining $9 billion toward indirect costs. These indirect costs include laboratory upkeep, access to hazardous materials disposal, utility bills and administrative staff. The term itself isn’t very descriptive, but recipients say the costs are necessary for research operations.

A set 15% for the indirect costs would reduce overall funding by $4 billion to $5 billion a year according to the Times. The Times reports, “The White House said the savings would be reinvested in more research, but the rate cuts would open up sizable budget holes in most projects at research institutions.”

Heather Pierce, senior director for science policy at the Association of American Medical Colleges, told the Times, “‘A slash this drastic in total research funding slows research’… And slower scientific progress, she said, would affect anyone who depends on the development of new treatments, medical interventions and diagnostic tools.”

A high school public health care boarding school is planned in Alabama; part of its mission is to serve rural counties

Alabama will launch a high school focused on health
care. (Adobe Stock photo)

Amid national health care provider shortages, Alabama is investing in a high school public health care boarding school "to address [the state's] health care staffing crisis, particularly in rural parts of the state, by training students for roles across the medical field," reports Alander Rocha of the Alabama Reflector. The board "overseeing the creation laid the groundwork to select a leader and prepare a curriculum."

With planning under way, the school "is scheduled to enroll its inaugural ninth-grade class in 2026," Rocha writes. "Rob Pearson, interim president of the Alabama School of Healthcare Sciences Foundation, said that the school will offer 'certification levels beyond what’s currently available in Alabama high schools for those looking to become health care professionals.'"

Health disparities between the state's rural and urban populations, which are particularly dire along the Black Belt, motivated health care leaders and stakeholders to work creatively to increase health care access in rural areas. Rocha reports, "The Black Belt experiences some of the state’s worst health outcomes, and Alabama already ranks among the lowest nationally. Life expectancy in every Black Belt county is below the state average of nearly 75 years."

Demopolis is in Marengo
County, Ala. (Wikipedia)

True to its rural service mission, the new Alabama School of Healthcare Sciences will be built in Demopolis, a small town with roughly 7,000 residents in west-central Alabama. State Superintendent Eric Mackey "said the school’s recruitment strategy will focus on drawing students from across the state to build a workforce pipeline beyond those wanting to attend medical school, like nursing," Rocha reports. The school "will join a network of specialized boarding schools, including the Alabama School of Cyber Technology and Engineering."

Through their initiative to establish high schools focused on health care, Bloomberg Philanthropies "is providing $26 million of the estimated $80 million needed," Rocha adds. "A groundbreaking expected by mid-2025. . . . The school is the only rural residential school funded by Bloomberg."

A simpler assessment tool for newborns exposed to opioids means more mom time and fewer medications

Cailyn Morreale continued using buprenorphine during her pregnancy. Once her baby was born, the two were never separated. (Photo by Taylor Sisk, KFF Health News)

A new approach is helping mothers recovering from opioid addiction and newborns with opioid exposure stay together after birth. Historically, babies born with opioid exposure have been separated from their mothers and received heavy medications in neuro-intensive units, but "research has since indicated that in many, if not most, cases, those extreme measures are unnecessary," reports Taylor Sisk of KFF Health News. "A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced."

Over the past decade, how pregnancy pairs with addiction treatment has changed, meaning most women can continue to take addiction-recovery medication throughout pregnancy. For Cailyn Morreale, a West Virginian from rural Mars Hill, the new methods helped her continue her recovery medicine, buprenorphine, and her care team assured her "that her baby would be assessed and monitored using the Eat, Sleep, Console approach," Sisk explains. "Morreale was never separated from her son. She was able to begin breastfeeding immediately. She was told, the trace of buprenorphine in her breast milk would help her son withdraw from it."

The Eat, Sleep, Console method is slowly replacing the older Finnegan Neonatal Abstinence Scoring System, which involved 21 evaluative questions. Sisk writes, "David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine, suggests this protocol could simply be called 'parenting.' Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade. . . .The results are persuading more health professionals to adopt the method."

A 2023 study found "babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care," Sisk reports. "Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, found a non-pharmacological-first approach works best. He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks."

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, "found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020," Sisk adds. "The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home."

Quick hits: Canned bread nostalgia; loneliness primer; python teeth inspire improved shoulder repair; fall skies

B&M introduced canned bread to America in 1928.
(Photo by Kaleigh Brown, The Takeout)

Canned bread might fit nicely on a list of non-perishables that are nostalgic and still worth making or buying. "Canned bread's legacy is tied to the survival instincts of early New Englanders," writes Kaleigh Brown for The Takeout. "When the first settlers arrived in Massachusetts, they hoped to grow wheat, but the local climate made it difficult. Instead, they turned to more affordable and resilient grains like rye and corn. . . .Lacking ovens, they steamed their bread over open fires, often using cans as makeshift molds."

Loneliness is a common experience across the United States, but some Americans are more susceptible to the harm long bouts with the emotion can cause. "Loneliness is more than just isolation: It’s the subjective experience of craving more social interaction than you currently have. It isn’t binary, either, and no one is immune," reports Allie Volpe of Vox. "Chronic loneliness has severe negative physical and mental effects. . . . Rather than point to certain populations as explicitly lonely, understanding what increases someone’s risk for loneliness can help address it on a population level."

Python teeth are uniquely curved and sharp, which helps
them grip their prey without tearing. (A.S. photo)

Picking fruit, baling hay and moving or handling food animals can all end in a farmer or farm worker tearing their rotator cuff, which hurts like heck and normally requires shoulder surgery to repair. The surgery is tricky and often fails, which is why a "python-like surgical implant" could help, reports Eric Niiler of The Wall Street Journal. "Medical researchers at Columbia University designed and built a python-tooth-inspired implant to better mend rotator cuff tear. . . . [The snake's] prey-grabbing method was the inspiration for the device."

Failing to have end-of-life discussions can leave important decisions to a time when there is no time. "Morbidity, mortality, and the many grey zones in between are ever-present in healthcare, writes Nidhi Bhaskar for MedPage Today. "I believe it is crucial to equip future physicians with the skills to navigate these conversations, especially in acute situations where time is limited and patient capacity for decision-making can quickly change. . . . Multiple studies have highlighted the positive impact that early exposure to palliative care and end-of-life goals can have on patient satisfaction at the end of life."

Remember to star gaze this fall; there's going to be a lot to marvel at. Mars and Jupiter will be easily visible on Aug. 27 and "will be accompanied by the crescent moon, creating a dazzling pack in the sky, according to NASA," reports Juliana Kim of NPR. If you missed August's super 'blue' moon, don't despair, "next month’s supermoon will be on Sept. 18. It will be a super harvest moon. It’s called a harvest moon because of its proximity to the autumnal equinox: An equinox is when the Earth’s equator is most directly in line with the sun. This supermoon will also undergo a partial lunar eclipse, reports Mansee Khurana of NPR. "The next two supermoons will occur on Oct. 17 and Nov. 15."

New doctors are avoiding abortion ban states, new analysis shows. Restrictions may add to mutiple-care shortages.

Fewer new doctors are applying for residency in
abortion ban states. (Hush Naidoo Jade photo, Unsplash)

States with significant restrictions or bans on  abortions may be inadvertently discouraging graduating medical students from applying for residency in their state, which could exacerbate regional physician shortages. Julie Rovner and Rachana Pradhan of KFF Health News report, "According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions."

State battles over abortion aren't limited to uncertainties for doctors and pregnant patients; the tensions have "also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers," Rovner and Pradhan write. "Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. . . . A preliminary review of a new analysis by the AAMC found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal."

The AAMC's analysis shows that when new doctors start avoiding certain states, those states gain fewer doctors, which adds to regional physician shortages in many specialties. KFF Health News reports, "The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties."

The number of new doctors applying for OB-GYN and internal medicine residency slots in those states "dropped 6.7%, compared with a 0.4% increase in states where abortion remains legal," Rovner and Pradhan explain. "For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal."

In Montana, the cost of living and lack of affordable housing and child care contribute to growing workforce shortages

Rural Montana is a 'canary in the coal mine' for severe 
 labor shortages in needed sectors. (N. Fouriezos photo)

Across the country, the need for a younger workforce to fill a wide range of positions is reaching a critical point, but particularly for rural areas. Students and potential workers face a range of obstacles that prevent them from filing those roles, reports Nick Fouriezos of The Daily Yonder. In Montana, medical, academic and labor professionals are working to address these issues.

Lindsey Flather from Bitterroot Valley, Montana, is the kind of student Montana's new strategies aim to help. Fouriezos writes, "A working mother in her thirties, Flather decided to pursue a new career in health care. . . . And she is urgently needed. In Montana, 52 of 56 counties — including Ravalli County — are considered medically underserved, and nearly half of the state’s nurses say they plan on retiring or leaving the profession in the next five years."

Like many of her fellow students, Flather has faced long commutes for classes, a lack of child care options, and juggling to make work and school mend together. "At the same time, employers are desperate to get more people through these workforce pipelines," Fouriezos explains. "They, too, are challenged by geography, says Rebecca Conroy, the chief transformational officer at Bitterroot Health, a regional hospital in western Montana."

Yet even when needed professionals, such as medical assistants, graduate they often can't afford to live in the county where they are needed most. "The median rent in Hamilton, Bitterroot Valley's biggest town, is now $2,087, up 30% over the previous year," Fouriezos reports. "The lack of affordable housing makes it almost impossible to recruit out-of-towners, and the in-town workforce is drying up. The talent pipeline is thin, Conroy says. And the pressure is only growing."

"Employers like Conroy are the canaries in the coal mine of a growing talent shortage nationwide. So smoothing the route to jobs like medical assisting has become a key focus of Montana’s government and educational infrastructure," Fouriezos writes. "The state’s colleges recently partnered with the national nonprofit Education Design Lab to interview Conroy and local business leaders statewide about how they might create new educational opportunities, like a set of micro-credentials to allow people to build key skills in shorter courses over time."

Opinion: Why prescription drugs have little to do with the current illicit drug epidemic in the United States

The 1990s marked a time in U.S. medicine where doctors were taught to give narcotics.
(Graphic via Life and Limb blog, Edwin Leap)

Emergency physician Edwin Leap explains that U.S. doctors in training during the 1990s were instructed to treat pain with pills. He said a medical career taught him how misdirected those practices were. He adds that the nation's current addictions and overdoses aren't centered on prescription drugs anymore; they're all about super cheap, available and deadly fentanyl -- other opioids are almost an afterthought. An excerpted version of his commentary from MedPage Today is included below.

"When I was in my residency training, from 1990 to 1993. . . . We were told, over and over, that we should treat pain aggressively and should not be afraid to give narcotics to patients in pain. Who were we to judge someone's pain, after all? The young man who fell onto his knees at work, with a normal blood pressure and heart rate, looking about the room, might well categorize his pain a '10/10,' and we should honor that, respect it, and treat it."

Pain medicines such as hydrocodone and oxycodone (Oxycontin) were first marketed to doctors as a miracle for patients in pain. Given their addictive nature, it didn't take long for the drugs to take hold. Leap writes, "Much of our work as physicians was a balancing act between trying to show genuine compassion, mandated compassion, and appropriate skepticism about pain scales and the lies concocted in pursuit of drugs."

Given doctors' role as the prescription writers who "started" patients on the path to addiction, physicians are now forced to take additional narcotic treatment training. "I have to take a new 8-hour class on proper prescribing habits and pain management," Lead adds. "[But] nobody really argues with me about pain pills anymore. . . .We're only supposed to give a 3-day supply. We tell people that, and they shrug."

The likely reason a 3-day narcotic supply isn't a problem is the availability of fentanyl. "It's just so easy to get the stuff. It's inexpensive, and it's everywhere. It's in drug houses and gas station parking lots. It's in high schools and college campuses," Leap writes. "It's in prisons and homeless encampments. In fact, according to independent journalist Jonathan Choe, it can sometimes be found for 50 cents per dose in homeless camps."

U.S. physicians have little to do with fentanyl's street dominance. Leap writes, "The flood of illegal fentanyl precursors from China, which then become fentanyl and began flowing across the Southern border, continues unabated. . . . It's all rearranging the deck chairs of the Titanic until someone gets a handle on the crisis from a geopolitical standpoint. And yes, that means dealing with the border as well. . . . I'm not blaming one political side or another. I'm just saying that if it isn't taken seriously, then the deaths will keep skyrocketing."

This piece was originally published on Leap's blog, Life and Limb.

Opinion: Recruiting physicians to rural areas needs to show what communities offer, which goes far beyond money

Rural medicine is often more about relationships than diagnoses,
which is a hard concept to incentivize. (UIC photo)

Student loan reductions and payoffs have not enticed enough graduating doctors to move into rural areas. But when medical providers experience working in less populated places, they often find smaller communities have so much more to offer, writes Arjun V.K. Sharma in his essay for Undark. "Strategies to attract doctors to rural areas can take many forms, but it is hard to imagine any being successful without the doctor seeing the benefits of the community in which they reside."

Government officials, public policy writers and community planners would do well to look at what it takes for a resident to opt to live in a rural location. Sharma explains: "Often, it is interminably fraught — already hard work is made harder, significant others are uprooted, and certain city comforts and sensibilities may be sacrificed. Physicians, then, must rely on forces internally summoned — autonomy, altruism, competence — to propel them forward. These qualities are harder to define and measure, which make them difficult to meaningfully pin to any reward."

"When I left the city for work in a rural hospital, I put those virtues to the test. I was unsettled, initially wading through the steady stream of 'hellos,' 'good mornings,' and 'good nights' from passersby in the corridor, and unsure of how to interact with psychiatric patients who ran a café near their small ward to ease their transition to the world outside," Sharma writes. "And I was uneasy, at times, with the care we provided — even if patients were appreciative of what they received. The same decisions we fashioned in the city — to get antibiotics delivered at home or to get a surgeon to clear out an abscess — came together with fewer resources, and with doctors stretched hundreds of miles apart."

Rural settings offer a space where all people intermingle and get to know each other. And the closeness of being together while all others are miles away "lent a power to something decidedly tangible. Interactions with patients had an unflinching honesty and tenderness about them," Sharma adds. "One morning, an older man with anxiety was referred from the emergency department to a senior physician. They ran into each other at the grocery store and at local hockey games; living down the street, the physician would often check in on him."

Sharma writes. "A connection to a rural identity could be bought with incentives, or it could be learned. . . . It could be lived through simple and heartfelt things: a teary 'thank you,' a firm handshake, or the question, over and again, from patients of your plans to stay. These gestures don’t absolve the system of its responsibility to make positive reforms. But they affirm value and purpose of work that, whittled down by staffing shortages and burnout, can still impact lives our society willfully neglects."

Health quick hits: Sacklers could compensate opioid victims, but deny responsibility; blood donations sink to 20-year low

Many family members want the Sackler family to pay for 
their part in the opioid overdose epidemic. (Photo via CNN)

The Sackler family, who owned Purdue Pharma, the maker of the synthetic opioid OxyContin, could "act today to compensate opioid overdose victims," write Regina LaBelle, J.D., and Madison Fields, J.D. in their opinion for MedPage Today. "The family could voluntarily establish a fund to compensate people harmed by Purdue's marketing of OxyContin and allow individuals to choose to release future claims. However, it appears that the family's insistence that they bear no responsibility for the overdose deaths involving OxyContin and their desire to be shielded from future civil litigation [through bankruptcy] will prevent this from happening. . . . Purdue has made the Sacklers one of the wealthiest families in the U.S., with a collective worth estimated at $11 billion."

As blood donations sink to their lowest level in 20 years, the American Red Cross has issued a blood shortage emergency. "There does not appear to be enough donated blood to meet demand among hospitals and patients in need," reports Jacqueline Howard of CNN. "Data from the national organization America's Blood Centers indicates that at least 17 community blood centers have a one-day supply or less. . . . One unit of blood, equivalent to about a pint, is typically collected during a donation, and experts estimate that a single car accident victim can require as many as 100 units of blood."

Mobile medical units can reach more rural residents
in need of addiction care. (HealthAffairs photo)

A new study by the University of Colorado shows that one way to help rural areas fight addiction is to send more mobile methadone clinics to remote areas, reports Julia Milzer of CU Anschutz Medical Campus. "The research focused on the impact of adding new treatment services exclusively to rural Louisiana, where, like in many other remote parts of the country, there are limited care infrastructures and barriers to transportation. . . . The analysis revealed mobile methadone would have a distinct impact in rural communities if these locations were prioritized and recommended operators collaborate with state and local policymakers regarding where to locate them to help maximize their impact." To learn more about mobile methadone, click here.

Family medicine doctors who train in obstetrics could
help fill care gaps. (UIC photo)

A key to solving some of the rural maternal health care shortage could be obstetric training for family physicians. "In the 1980s, about 43% of general family physicians who completed their residencies trained in obstetrics," reports Sarah Jane Tribble of KFF Health News. "In 2021, the American Academy of Family Physicians' annual practice profile survey found that 15% of respondents had practiced obstetrics. . . . In July, the Department of Health and Human Services announced a nearly $11 million investment in new rural programs, including family medicine residencies focusing on obstetrical training."

 Ian Cousins
(Courtesy photo, Undark)

Removing forever chemicals from drinking water is expensive, with consumers the most likely target for paying the bill. Some experts are suggesting a different course to avoid the extreme cost.

The Environmental Protection Agency is set to "finalize an enforceable cap on PFAS in drinking water that will require thousands of utilities around the country to update their treatment methods," reports Charles Schmidt of Undark. Ian Cousins, an environmental chemist at Stockholm University and "one of the world's leading researchers on PFAS exposure, said the public might be better served by a policy that prioritizes hot spots of PFAS contamination."

 

Rural areas desperately need more physicians, but even adding residency slots isn't a simple solution

Illustration by Shoshana Gordon, Axios

Rural areas don't have enough physicians because rural hospitals have not been able to add residency slots. Adding more slots may sound simple, but until the Covid-19 relief bill, slots, which are funded through Medicare, were capped. The relief bill added 1,000 residency slots and required 10% of those to be granted to rural hospitals, but few have applied. Maya Goldman of Axios Vitals reports, "Just seven of the 199 hospitals that have received federal dollars for new residency slots in initial funding rounds are in rural areas, federal health officials confirmed."

Because residents are more likely to stay where they completed their training, adding slots is considered the most reliable way for areas to "grow their own" doctors. However, hospitals must have the capacity to go through the slot application process and have the resources to train more physicians. Goldman explains, "A combination of limited infrastructure and staff to run residency programs, as well as a lack of awareness about the funding opportunity, has prevented more hospitals from applying, said Carrie Cochran-McClain, chief policy officer of the National Rural Health Association. . . ."

Part of the reason more funding has gone to more urban hospitals is because of a reclassification loophole. "The 2021 law requires that 10% of new Medicare-funded residency slots go to rural hospitals or hospitals that are 'treated as being located in a rural area," Goldman reports. "That wording is key: A 2016 court ruling allows urban hospitals meeting requirements to reclassify themselves as rural hospitals for certain financial purposes. Changing geographic classification can boost a hospital's Medicare payment and open them up to more residency funding."

The awards show how urban hospitals used reclassification to add slot funding. "In the first tranche of new residency slots awarded, about 6% went to geographically rural hospitals, while 42% went to geographically urban hospitals that reclassified as rural, according to NRHA data," Goldman adds. "NRHA wants the law changed so reclassified urban hospitals no longer qualify for the 10% rural residency slot allotment, said Cochran-McClain."

Fixing the rural physician shortage can begin with adding more federal and state funded residency slots

When residency slots increase, the number of
rural physicians can increase. (UICOMP photo)

By any measure, rural America is hurting for physicians, but more broadly, the nation doesn't have enough doctors. While U.S. medical schools have increased their enrollments, hospitals have yet to increase their number of residency slots, reports Brenna Miller of the Lown Institute, a nonpartisan health think tank.

"Medical school enrollment has been consistently growing, but funding for residency slots hasn't caught up. For every medical school graduate looking for a resident position, there have been between 0.8 and 0.85 slots available in recent years. This a problem as states require at least one year of hospital residency as a licensing requirement."

Without intervention, rural physicians will become increasingly scarce. "Rural areas face the brunt of this shortage as urban areas have higher densities of primary care physicians and specialists," Miller writes. "Patients in rural areas tend to be older, poorer, and sicker, especially with chronic conditions. With fewer doctors around, they have to travel further for both preventative and emergency care, putting them at greater risk for poor health outcomes and mortality."

If rural areas want more doctors in the future, there must be fundamental changes to residency funding and slot offerings. Miller explains, "The mismatch between medical school enrollment, residency slots, and the need for physicians in the workforce has resulted in a lose-lose situation where perfectly competent physicians face barriers to working while simultaneously, entire regions of the country are without sufficient access to physicians."

Some changes need to begin at the federal level. Residency slots are primarily funded by the Centers for Medicare & Medicaid Services, meaning that "they need action by the federal government for expansion. This also means that no significant action had been taken for over 20 years (Congress had actually capped the number of residents) until the Covid-19 relief bill was passed," Miller reports. "The  bill opened the door for 1,000 new residency slots, 10% of which must be in rural areas. Another similar bill has been introduced in Congress that would allocate funding for an additional 2,000 residency slots every year for seven years starting in 2025."

State funding is an additional option. Miller reports, "The majority of doctors stay in the states where they completed their residency. Both California and Texas – where the shortage is predicted to be the worst – approved multimillion-dollar expansions in funding, resulting in increased retention of physicians in underserved, local areas."

Expectant moms face OB-GYN deserts; one state is an example of the national problem

A mother holds a newborn baby.
(Photo by Katie Klingsporn, WyoFile)

Wyoming is one of many states where women and families are finding obstetric care harder to find. "More than 15% of Wyoming women had no birthing hospital within 30 minutes of home in 2022, compared to 9.7% of women nationally, a report by the March of Dimes shows," Katie Klingsporn of WyoFile reports. "Such distance from care comes with real risks. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes. . . . In rural areas of Wyoming, 22.4% of women live over 30 minutes from a birthing hospital compared to 5.2% of women living in urban areas, according to the March of Dimes."

Nestled in west central Wyoming, Fremont County is "not unique, but with one obstetric practice, one midwife and one birthing hospital serving the general population of Fremont County — a New Hampshire-sized area that's home to nearly 40,000 people — the situation here offers a window into the challenges, and consequences, of limited maternal health services," Klingsporn writes. And while Fremont County has a 24/7 delivery center in SageWest Hospital in Lander, women who labor and deliver there will most likely be treated by a traveling doctor, who is also a stranger. 

Map of towns Fremont County women travel to for
obstetric care. (Map by Eda Uzunlar,WyoFile)

Traveling in Wyoming can be both risky and expensive. It "requires money, childcare, work flexibility and other resources that not everyone has. And then there's the issue of winter travel in Wyoming, where icy storms regularly close roads and ground air ambulances," Klingsporn reports. "The OB shortage is not isolated to Fremont County. Hospitals in Rawlins and Kemmerer stopped offering delivery services in recent years. Other counties like Sublette and Weston don't have birthing facilities at all."

Jen Davis, Gov. Mark Gordon's senior policy advisor on health and human services, "said of the dearth of maternal health care, 'It's a huge problem,'" Klingsporn writes. 

While traveling longer distances to see obstetric providers can lead to poor outcomes, more pregnant women in Wyoming are having to take that risk. "The farther a woman travels for maternity care, the greater the risk of maternal morbidity and adverse infant outcomes," Klingsporn reports. 

The loss of labor and delivery care is a national problem. "In 2022, the March of Dimes reported on the problem of 'maternity care deserts' across the United States," reports Stacey Kelleher for Health eCareers. "These communities do not have birthing centers or hospitals offering obstetric care. Outside these maternity care deserts, which affect more than two million women of childbearing age, nearly seven million other women and 500,000 births are also impacted by low or no access to Ob-Gyn care in this country."