This September, 2018 will be 28 years as a rural solo FP in MN.
I'd love to provide another 10 years of service, but government, insurance industry, and pharmaceutical decisions and regulations are making this a literal impossibility...
A hospital system from 90 miles away has been attempting to recruit for over two years. FEW physicians (very few) desire to come to rural America to then be hounded and beat down by these outside forces. Medicare is presently financially penalizing me for not having EMR. Who would have thought, the very entity I pay taxes to....and for who I am out here serving its 'clients' (Medicare patients)...penalizes me financially for not having EMR. Discouraging.
If we are to ever again see residency trained FPs desire to come to rural America as private practitioners, we will need to support and encourage them not control, regulate, and penalize them.
Exempt them from the MIPS, MACRA, PQRS, EMR penalties, etc.,...and perhaps even provide them with a 10% increase in reimbursements as a thank you and encouragement for their willingness to live the 24/7 rural practice life. And hey, while we are at it, how about we add some legitimate tort reform to the rural practice equation?
As for health care coverage....many rural folks not yet on Medicare or under MA are single family policies, not groups. The insurance industry needs to address their approach to coverage of these families, not drop single policy plans!
There are things which CAN be done to greatly improve rural health care and physician retention/recruitment... These changes simply need to be put into place.