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Leadership Series

Addressing Challenges in Rural Health Care

Monte Bostwick, Market President of St. Luke’s Health-Memorial

February 17, 2024 Posted in: Leadership
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Along with other rural regions throughout the U.S., East Texas faces significant health care challenges. Across the country, people in rural communities are more likely than urban or suburban residents to have one or more chronic health conditions and have an increased risk of death due to cancer, heart disease, stroke and suicide. Two prominent issues adding to these concerning trends are lack of access to primary care and difficulty recruiting and retaining highly qualified medical professionals. Meeting these needs is a challenge. Still, challenges can be met. The St. Luke’s Health-Memorial leadership team, in partnership with others in East Texas, is developing and implementing innovative programs to respond to the unique health care needs of the rural communities and residents we serve.

With 1 in 7 Americans living in rural areas according to the National Conference of State Legislatures, the shortage of high-quality health care isn’t due to lack of need. For example, in San Augustine County, one of 12 rural counties served by St. Luke’s Health-Memorial, one full-time physician serves nearly 8,000 residents in a roughly 530-square-mile area. These community members face the same health issues found in cities and suburbs combined with additional barriers, such as reduced access to community services, fresh food or transportation services. 

Although many rural U.S. communities face similar challenges, health care is always local. It’s essential to address issues locally to create long-term, sustainable solutions. Recruitment incentives can be an effective tool to attract skilled medical professionals. However, to retain the same people, we must also support them in building meaningful connections with the local community they serve. 

Local Solutions to National Problems

St. Luke’s Health-Memorial offers multiple initiatives and programs to attract physicians to rural areas and support them in becoming active members of our communities. One of these is the Family Rural Medicine Residency Program, a partnership between St. Luke’s Health-East Texas and Baylor College of Medicine. This program provides residents with an outstanding medical education and an opportunity to gain first-hand experience working in rural communities. 

During the first year of the three-year program, residents receive training at Baylor St. Luke’s Medical Center and two other hospitals in the Houston area. In their second and third year, training is based at St. Luke’s Health-Memorial in Lufkin. While there, medical residents can also choose to care for patients in our rural emergency hospital in San Augustine and several rural, non-hospital clinical settings. These varied experiences allow residents to gain new skills and perspectives while providing care in a breadth of rural settings, as well as some settings not easily accessible to rural residents, such as inpatient pediatric care. 

Training residents in-house offers multiple benefits. Residents develop skills necessary for success in rural settings. Patients receive increased access to care. St. Luke’s Health can add qualified physicians to our rural health care team. 

Although it’s not a foregone conclusion that residents will end up in the area where they complete their residency, we know the odds of them staying in East Texas are much higher if they’ve had a chance to be a part of our community during residency. Nearly 7 in 10 residents trained in Texas stay in Texas. 

Expanding Options for Care

While it’s crucial to have local solutions, partnerships are no longer restricted to geographical locations or traditional health care models. Although expanded access to primary care is needed in rural communities, having a full-time physician isn’t always feasible due to costs and low patient volume. Because of this, health care leaders need to question which services are essential and consider non-traditional answers to provide needed care. Two solutions proven beneficial to St. Luke’s Health-Memorial and our patients are virtual visits and adopting a rural emergency hospital (REH) care designation.

Many rural hospitals struggle to keep their doors open, with nearly 140 closing since 2010. However, the need to access emergency care and other services in these communities remains. The REH designation, established by the U.S. Congress, offered a path to continue providing care in rural East Texas. 

In April of 2023, St. Luke’s Health-Memorial Hospital-San Augustine transitioned to a REH. Although this change required cuts to certain services, such as most inpatient stays, it also allowed the community to retain essential and frequently utilized services. These include emergency, imaging, laboratory, pharmacy and physical therapy services. Additionally, we’re able to retain skilled medical professionals and continue our mission of providing care for all.

Traveling for regular maternity care is challenging for many families in East Texas and other rural areas. Through another partnership between St. Luke’s Health-Memorial and Baylor College of Medicine, we bring high-quality maternity care to rural communities through virtual visits. Patients can receive an ultrasound and other exams close to home while a maternal-fetal medicine physician joins the appointment remotely. On more than one occasion, this program has been instrumental in helping patients obtain emergency obstetrics care in potentially life-threatening situations. We’re working to develop additional opportunities for virtual care in other specialties, including behavioral health.

Reaching Our Goals for Improved Rural Health Care

Focusing on the overarching challenges facing rural health care can be tempting. However, to truly address these situations we must concentrate on solutions instead. We need to create a vision for meeting the needs of patients and health care professionals in rural communities and a plan for how to get there. Whether it’s developing a residency program, adding virtual care options or finding another solution tailored to the needs of your community, once the vision and plan are established, it’s time to move forward to implementation. It’s a big thing we're trying to solve here. Let’s just take the next step in front of us.

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