Provider Spotlight: Dr. Mandel, ER Maverick & Locum Tenens Physician

Dr. Ken’s Corner: Rural Hospitals Face Threats to Survival

Every day, thousands of Americans receive quality patient care from locum tenens physicians representing almost every specialty and sub-specialty.  The vast majority of these doctors practice in urban settings, most of them likely unaware that the idea behind locum tenens staffing had its humble origins in rural America.  It all began as a way to provide relief to overworked primary care physicians in underserved communities in Texas and the Intermountain West.

Although that was decades ago, most of the rural hospitals serving these communities are still struggling to survive, and many others no longer exist.  Since 2010 alone, 80 rural hospitals have closed nationwide.  “On top of that, 673 rural hospitals are teetering on the edge,” according to a recent report from The Chartis Center for Rural Health.

Making matters worse, rural hospitals serve populations that tend to be older, sicker, and poorer than those living in urban centers.  Despite these disparities, rural hospitals consistently outperform their non-rural counterparts in surveys on quality, clinical outcomes, and patient satisfaction.  Readmission rates for heart failure and pneumonia, for example, are found to be lower in rural hospitals when compared to non-rural hospitals (The Chartis Group).  This may be due to better discharge planning at rural hospitals.

When a rural hospital closes its door, the entire community suffers.  In rural communities, hospitals are often much more than a place to go when you’re sick or injured.  Sometimes it’s the community’s largest employer.  When the doors close, the livelihood of nurses, doctors, administrators, cleaning staff, lab and x-ray technicians, and pharmacists suffer a direct impact.  Many of them are forced to uproot their families and move elsewhere.  “You can imagine how terrifying it is in the communities if they believe that one of their hospitals is going to close,” says Terry Fulmer, president of the John A. Hartford Foundation (

Because hospital closures are a constant threat, it’s difficult to attract young physicians to rural communities.  According to The Chartis Group, “The patient-to-primary care physician ratio in rural areas is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in non-rural areas.  Further straining these rural access trends is the uneven aging of the provider work force, where there are a greater proportion of providers nearing retirement.”

Locum tenens practitioners can take pride in the role they continue to play in serving the healthcare needs of rural communities nationwide, communities called “home” by nearly 60 million Americans.

(For more detailed information on the challenges facing rural hospitals, read “Rural Relevance 2017: Assessing the State of Rural Healthcare in America”–published online by The Chartis Center for Rural Health.)