New study creates model to predict financial costs of maintaining rural cardiology care

Rural communities are struggling to provide cardiac care. Between 2010-2015, the heart disease death rate in rural areas was 118.2/million versus 106.2/million in urban areas. The rural cardiologist shortage contributes to the poor outcomes.

The rural shortage will balloon into a national issue as more cardiologists retire. According to projections, each year 2,000 cardiologists leave the profession while 1,453 new ones enter the profession.

Rural communities do not offer enough patients to entice cardiologists to open a full-time clinic. In Iowa, there are 10.6 cardiologists per 100,000 people in urban counties, but 1.5/100,000 people in rural counties. This urban surplus has led some Iowan cardiologists to open part-time outreach clinics in rural communities.

Rural outreach clinics have several benefits. Shorter patient commute times decrease the probability of missed appointments. Rural hospitals can perform basic cardiac tests, which keeps more revenue in the community. Primary care providers can coordinate local cardiac care while cardiologists keep and expand their referral bases.

Outreach clinics also have their downsides. Cardiologist commute times to outreach clinics can exceed 90 minutes, which leads to huge productivity losses. A study calculated that in Iowa the direct travel costs and opportunity costs resulted in a $2.1 million loss per year. Rural practice is limited to basic tests and office visits; therefore, trips to urban centers for advanced care are inevitable.

The Journal of Marketing released a study that reviewed 30 years’ worth of data from Iowa’s Office of Statewide Clinical Education Programs. The authors used the data to create a model. The model predicted outcomes for a future, hypothetical 10% decline in Iowan cardiologists. The model revealed that cardiologists would face sparse competition for urban patients. This would remove the incentive to open rural clinics.

The authors applied the model to predict the cost of strategies to maintain cardiac care in rural Iowa. They looked to Australia for ideas. Australia subsidizes physicians to travel to rural communities. Australia also allows for targeted immigration to recruit specialists for rural areas. If Iowa implemented a subsidy program, then a $406,000 (1 cardiologist FTE) subsidy would suffice. The results of the targeted immigration model were less impressive. Iowa would need to recruit five new cardiologists to practice in rural counties.  

The authors did not explore other mitigation strategies. Physicians could staff outreach clinics with physician assistants, nurse practitioners, and longer-term locum cardiologists. Telehealth services increase access, but many patients prefer in-person care for complex medical needs. Also, some rural communities lack adequate high-speed internet. The federal government could create a student loan forgiveness program for rural physicians.

The authors created a fascinating model that should be replicated for other states and specialties. These models would help government leaders evaluate the financial costs of mitigating rural healthcare shortages.  

References

1. Bell, J. J., Lee, S., & Gruca, T. S. (2024). Bringing the Doctor to the Patients: Cardiology Outreach to Rural Areas. Journal of Marketing, 88(1), 31-52. https://doi.org/10.1177/00222429231207830
2. American Marketing Association. The secret to better rural healthcare: pay doctors to travel from urban to rural areas. Newswise. January 9, 2024. Accessed January 10, 2024. https://www.newswise.com/articles/improve-rural-healthcare-pay-urban-doctors-for-rural-service?sc=mwhn&user=10053559
3. Sauer J. The vexing challenge of physician slowdown: how to create an effective policy. Cardiology Magazine. September 15, 2020. Accessed January 10, 2024. https://www.acc.org/latest-in-cardiology/articles/2020/09/01/01/42/the-vexing-challenge-of-physician-slowdown-how-to-create-an-effective-policy
4. Johnston KJ, Wen H, Joynt Maddox KE. Lack Of Access To Specialists Associated With Mortality And Preventable Hospitalizations Of Rural Medicare Beneficiaries. Health Aff (Millwood). 2019 Dec;38(12):1993-2002. doi: 10.1377/hlthaff.2019.00838.
5. Gruca TS, Pyo TH, Nelson GC. Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics. J Am Heart Assoc. 2016 Jun 30;5(7):e002909. doi: 10.1161/JAHA.115.002909.
6. Rodriguez T. Expert roundtable: addressing the rural cardiology shortage. Cardiology Advisor. January 20, 2023. Accessed January 10, 2024. https://www.thecardiologyadvisor.com/home/topics/practice-management/expert-roundtable-addressing-the-rural-cardiology-shortage/
7. Bokhari S. Why locum? American College of Cardiology. May 21, 2019. Accessed January 10, 2024. https://www.acc.org/membership/sections-and-councils/early-career-section/section-updates/2019/06/11/07/42/why-locum
8. Tate S. Student loan forgiveness for rural medicine practitioners. Tate Law. Updated April 30, 2023. Accessed January 10, 2024. https://www.tateesq.com/learn/student-loan-forgiveness-rural-medicine