Doctor shortages persist in rural America, including Kentucky, and medical residency programs are scarce in rural areas

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One of the best ways to increase the number of doctors in rural areas is to provide medical residency training there. Kentucky has seen a concerted effort to expand rural residency programs, but their number remains relatively small in the state and nation.

"Experts say expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors — including more than half of family medicine physicians — settle within 100 miles of where they train," Jazmin Orozco Rodriguez reports for KFF Health News. "And while the number of training programs has increased in rural areas during the past few years, research shows 98% of residencies nationwide are in urban areas."

In Kentucky, fewer than 20 of the state's 154 accredited residency programs, listed by specialty, are outside Lexington and Louisville. Seven of them are for family medicine and can be found in Somerset, Owensboro, Edgewood, Hazard, Glasgow, Madisonville and Morehead.  

Rodriguez tells the story of a residency training program in rural northeastern Nevada that is preparing to close, where one resident physician said she must now leave a program that she chose because she knew she would be filling a need and the patients under the care of the residents must now seek care elsewhere, often in emergency departments, 

The program, established in 2017, is shutting for a variety of reasons, including financial struggles, lack of a united support system, and a historical lack of health-care investment in the area, Rodrigue reports. 

The closure of such programs in rural areas only adds to the problem of accessing primary care, which Rodriguez reports impacts more than 100 million people in the U.S., a number that has nearly doubled since 2014.  Further, she writes that provider shortages only got worse during the pandemic, especially in rural areas, which have long struggled to recruit and retain doctors and other health professionals. 

According to the Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers. 

And, according to a January 2020 report on the primary care workforce shortage compiled by multiple authors by the University of Kentucky, "Kentucky produces and retains only about 55 new PC physicians per year, recruiting 55 to 60 more from out of state. This total of 110 – 115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the US median in the coming decade."

Members of Congress have introduced bills to address the health care provider shortage, but to no avail. Meanwhile,  rural medical training programs need more state and federal investment to grow and remain sustainable, Dr. Emily Hawes, associate professor at the University of North Carolina-Chapel Hill School of Medicine, told Rodriguez. 

A federal law fully implemented in 2019 creates more flexibility in funding and accreditation for rural hospitals wanting to establish residency programs. It has sent more than $43 million to 58 organizations in 32 states to state rural residency programs. "As of last fall, the recipients had created 32 accredited training programs in family medicine, internal medicine, psychiatry, and general surgery, and received approval for more than 400 new residency positions in rural areas," reports Rodriguez. 

But it’s not enough, Hawes said. She said a big challenge is that Medicare and Medicaid don't reimburse rural hospitals for residency programs at the same rate they do urban hospitals, despite similar or higher costs. 

Kentucky has passed legislation toward improving the health care workforce in the state. In the most recent legislative session, a bill passed to create the Health Care Workforce Investment Fund, which would use private and public money to increase scholarship opportunities.  Also, a bill to let advanced practice registered nurses prescribe controlled substances on their own after four years passed, which is expected to increase health care access in rural parts of the state.