When Rural Hospitals Close, The Physician Workforce Goes

Hayley Drew Germack 1, Ryan Kandrack 2, Grant R Martsolf 3

Affiliations

PMID: 31794309
DOI: 10.1377/hlthaff.2019.00916

Abstract

Rates of rural hospital closures have been increasing over the past decade. Closures will almost certainly restrict rural residents' access to important inpatient services, and they could also be related in important ways to the supply of physicians in the local health care system. We used data from the Area Health Resources Files for the period 1997-2016 to examine the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure. We observed significant annual reductions of up to 8.3 percent in the supply of general surgeons in the years leading up to a closure. We also found that rural hospital closures were associated with immediate and persistent decreases in the supply of surgical specialists and long-term decreases in the supply of physicians across multiple specialties-including an average annual 8.2 percent decrease in the supply of primary care physicians in the six years after a closure and beyond. This dynamic relationship could lead to reduced access to care for rural residents. Future policy efforts must focus on supporting and maintaining health care delivery models that do not depend on hospitals.

Keywords: Access to Care; General practitioner; Health policy; Hospital closures; Physician workforce; Physicians; Rural health care; Surgeons.