Everyone knows that cities have a strong need for medical professionals. After all, we've all seen ER. On television shows, city emergency rooms (and hospitals in general) are always understaffed, with doctors and nurses and other medical professionals scrambling to keep up with an ever-increasing patient load. All of this might make for interesting drama, but the truth is that rural areas have a far greater shortage of medical personnel than urban areas.
In addition, factors such as a lower rate of employer-provided health care, a higher poverty rate, and a greater proportion of elderly residents add up to a health care crisis in rural America . Enter the National Rural Health Association (NRHA). Headquartered in Kansas City , Mo. , the NRHA is working to improve the “health and health care of rural America .” Through legislative initiatives, education, communication and research, NRHA has made some significant progress since it was established in 1977. But there is still a long way to go. Diversity: Allied Health Careers talked with NRHA's executive director, Steven Wilhide, to learn a bit about the association's present initiatives and plans for the future.
Can you tell us a little bit about your background? When did you first start working for NRHA?
“After receiving my bachelor's degree from Frostburg State College in Maryland , I became a VISTA volunteer and served in Cherokee, N.C. In 1967 I was drafted into the Army. After a tour in Vietnam , I attended the University of Maryland School of Social Work where I received a Master of Social Work in community organization. After working in a rural community health center in Wilkes Barre, Pa., I accepted a fellowship to the University of Pittsburgh where I received a Master of Public Health in 1976. In the fall of 1976, I accepted a position as executive director of the Southern Ohio Health Services Network (SOHSN), a newly formed community health center serving four Appalachian counties. Today SOHSN operates 12 primary care clinics with a staff of over 250 and a budget of over $17 million. In January 2002, I came on as the Executive Director of the National Rural Health Association.”
What programs and initiatives does NRHA currently have in place to recruit allied health professionals to rural communities?
“NRHA started a Migrant Health Care Fellowship Program to train allied health professionals to work with rural underserved populations; primarily migrant and seasonal farm workers. This program is now being administered by the Migrant Clinicians Network. NRHA has also started a job bank that currently targets opportunities for administrators seeking positions in rural community health centers. However, we plan on expanding this job bank to include positions for allied health professionals later this year. You can find this resource on our Web site (www.nrharural.org) by clicking on the ‘Rural Health Job Bank' link.”
What is the NRHA doing to help improve the quality of health care in rural America ?
“NRHA has many legislative and policy initiatives to improve the quality of health care in rural America . The NRHA's mission is ‘to assure quality, equity, and access for all rural Americans.' Our policy and legislative positions are too exhaustive to go into detail here, but you can view them all on our Web site. We also work to provide assistance to our members on a variety of recruitment and retention (R/R) issues through advocacy work in Washington, D.C. , disseminating R/R research, and providing an opportunity to learn about R/R initiatives from peers at our annual conference.
“In addition, we are involved in efforts to inform rural residents that local care is high quality care. When rural residents start bypassing the local hospital for their health care, the economic impact of those health care dollars leaving the community can have adverse affects on hospital resources.”
What is the quality of the health care provided to minority populations in rural areas? What is NRHA doing to help improve the quality of health care received by rural minority populations?
“Minority populations in both rural and urban areas have greater problems accessing health care services. They receive fewer preventative services and have greater disparities in health outcomes than their white counterparts. Is there a discernable difference in the quality of services provided to minority and multicultural populations in rural areas? No. The problems that face all rural residents are just magnified for minority and multicultural populations. However, one area that is more of a challenge in rural areas is availability of appropriate interpreters for non-English speaking patients.
“In 1988, NRHA launched the Rural Minority Health Advisory Committee, which encourages national rural- and minority-responsive associations to work to improve health care services and access to rural minority and multicultural populations. On May 13, 2003, we held our 9th Annual Rural Minority and Multicultural Health Conference in Salt Lake City . This conference brought together rural health care providers; private sector organizations; federal, state, tribal and local government employees; allied health professionals and anyone else concerned with improving the quality of health care for rural racial and ethnic minority and multicultural populations. Session topics included health disparities between the general populations and rural minority and multicultural populations; HIV/AIDS; disaster planning; community preparedness, bioterrorism, and emerging populations.
“In addition, if you click on the ‘Minority Affairs' link on our Web site, you will also find a list of print and Web resources that we have created to help medical personnel improve the quality of care to rural minority and multicultural populations.”
What are some of the advantages and disadvantages for allied health professionals who chose to work in a rural community?
“Rural communities are a different way of life. People who chose to live and work in rural areas are generally more socially self-sufficient. They rely upon friends and family and small social gatherings for entertainment more so than the cultural amenities one may find in the urban areas such as the symphony, ballet or opera.
“Allied health professionals can expect more autonomy and the opportunity to fully practice their professional skills. There is less competition from physicians and other health care professionals and these other health care professionals rely upon the allied health professionals in order to extend their services to more patients. Many rural communities rely exclusively upon allied health professionals for their routine care with backup from other providers such as physicians. Also, the care you give is often much more personal, and rural people tend to be very appreciative of the care they receive. Therefore, professional satisfaction may be greater.”
What's the future of NHRA? Where do you think the association will be ten years from now?
“I envision NRHA having three to four times the current membership and having a lot more rural consumers as members. We just published our first quarterly magazine that will highlight people and rural communities that are making a difference in health care in their respective communities. Many of these will be allied health professionals. The stories are beginning to pour in and they are very heartwarming. There are many good things going on in rural America and we want people to know. Rural communities tend to be very creative and collaborative in coming together to solve problems or to improve their communities. We hope to tell the world about these unsung heroes.
“NRHA is currently highly respected in the government and Congress for our knowledge of rural health, the expertise of our members and for our educational efforts. As NRHA continues to grow we will become an even greater force politically and in advocacy and education. We are determined to eliminate the health disparities between urban and rural residents, and will work tirelessly to assure ‘quality, access and equity' for all of rural America .”