Better Texas rural health care access depends on collaboration, experts say

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As more rural hospitals shut down nationwide and a physician shortage continues, medical experts in Texas are rethinking the state’s approach to health care, particularly in smaller communities far from urban centers.

Here, the distance between residents’ homes and clinics and doctor’s offices is greater, forcing rural Texans to make harder choices.

“[People say,] ‘Actually, I want to see my doctor but I'm having struggles figuring out where I'm going to use my funding this month,” said Kristina Childress, administrator of Angelina County and Cities Health District, one of three speakers discussing the future of health care in rural communities at the University of Texas at Tyler. “Do I buy groceries or, is that a tank of gas to get to the clinic?”

Bringing in more and better employment options in rural areas, helps bring more health care options into smaller communities.

Childress, along with University of Tyler at Texas president Kirk Calhoun and Dr. Doug Curran, a family practice physician at the East Texas Community Clinic and former president of the Texas Medical Association, stressed the importance of nonprofits and community leaders working together to meet residents’ growing needs and create healthier communities. The conversation was moderated by the Tribune’s East Texas reporter, Jess Huff.

“We can talk all day about our challenges, and [we’re] kind of beating a dead horse at some point," Childress said. “But really, there are so many strengths in the rural areas — we have the opportunity to talk to folks in our churches, in our communities at our schools, and we get to partner with organizations that are doing the work on the ground.”

Texas has long led the nation in rural hospital closures, but the COVID-19 pandemic caused a rural health care crisis. The percent of Texas hospitals at risk of shutting down nearly doubled from 2020 to 2022, as understaffed facilities struggled with high patient volumes.

One bright spot is UT Tyler’s new School of Medicine — East Texas’ first medical school. Its first class begins this fall and the hope is it will bring more physicians and better quality health care to rural areas. Texas has more uninsured residents than any other state, and low reimbursement rates make it difficult for hospitals to keep their doors open — especially in rural areas.

Increasing access to health care 

Across the country, 35 rural hospitals have closed in the last three years. To fill these gaps in Texas, panelists said, the state has to bring more physicians to rural areas.

Calhoun, UT Tyler’s president who recently announced his plans to retire, said Texas should expand medical education options to produce as many nurses and doctors as possible. UT Tyler’s medical school will also act as a research center to help foster better relationships with rural communities, he said.

“What we wanted to do with the medical school in particular, but really across all of our health professions, is use the strength of the University to help meet the challenges confronting our communities,” Calhoun said.

Finding the root of the problem 

But fighting physician shortages is not enough, panelists said. Texas also has to address root causes of sickness, like food insecurity, homelessness and mental health care deserts.

“The best thing we could do for people who live in rural communities is keep them from getting sick in the first place,” Calhoun said.

Rural communities face some of the highest rates of poverty in the state. Increasing access to workforce reentry programs that help people retrain for in-demand jobs creates healthier communities — with more income, people can better prioritize their health, panelists said.

Looking to the future 

Many rural communities are introducing new solutions to health care deserts, including mobile health clinics and telehealth centers. But in order to succeed, they need more state and federal funding, Childress said.

State funding could mean more federally qualified health centers, Curran said. These centers provide comprehensive care in underserved communities to both insured and uninsured patients, through federal funding and state grants.

In Texas, one of ten states that has not expanded Medicaid access, the centers provide crucial services to people in need. In order to serve their purpose, Curran said, people need to know about the centers and understand the importance of their work.

“We have to continue to share the message,” he said. “It’s not a complicated message — it’s just about caring for your neighbor.”

Ultimately, panelists said, the strength of rural communities is their closeness. Different organizations in rural areas must partner up to decrease poverty, increase mental health care access and outreach, and bring in more physicians, they said.

“Working together, collaborating — it’s what it's all about,” Curran said. “Resources from public health, from educational institutions, from the doctor on the ground, the nurse on the ground, that caregiver in the home — listen to them. Empower them. That's what we’ve got to do.”

Disclosure: The Texas Medical Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.