Rural Physicians and Community Leadership: Skills for Building Health Infrastructure in Rural Communities

Abstract

ew physicians at the beginning stage of their careers are so audacious as to describe themselves as “community health leaders.” Nevertheless, nearly every physician who finds him/herself practicing in a rural community will often be inexorably drawn into discussions about greater health-related needs in the broader community. Once a healthcare professional is able to step back and take a panoramic view of the “health” of the community in which his/her practice is located, he/she often realizes that there are many health needs and barriers to care, and he/she quickly learns that it takes more than individual effort to meet these needs. Whether through the initiative of practicing physicians or others, community-wide initiatives to define existing problems, to plan a range of options for meeting these needs, and the effort to fund and then administer these emerging programs will usually require physician involvement … and even leadership. This commentary addresses some reasons why rural physicians need to become involved in solving some of these rural health problems, and how they can effectively provide needed clinical leadership even if they haven’t previously thought of themselves in such a role. The status of rural healthcare in North Carolina can be described as precarious at best. Many rural communities continue to be plagued by shortages of resources to serve the growing needs of a rural population that is increasingly aged and uninsured. The shortage of physicians in rural communities remains a chronic problem. 1 Despite some progress in the last decade in dealing with this maldistribution, significant disparities persist between metropolitan and rural areas. 2 Although most counties in North Carolina from 1998 to 2003 experienced an increase in the ratio of primary care physicians to 10,000 population, 38 of the state’s 100 counties lost ground. Of the counties with increasing primary care shortages, about half were due to loss of physicians, and about half were due to rapid population growth that outpaced the supply of physicians. 3 Furthermore,