I am an ear, nose and throat physician – an otolaryngologist – at Rush University in Chicago, where I lead efforts to provide health care to underserved communities. The focus of our work spans a wide spectrum, as we provide otolaryngology care to homeless communities in Chicago, overseas in the Dominican Republic and to rural communities in Illinois.
In this role, I have been privileged to gain a unique perspective by working both at a large academic medical center and at a smaller hospital in rural central Illinois. Similar to Simard’s observations about trees, I have come to realize that quality hospital care is also very much interdependent, with the well-being of patients and communities often linked to the collaborative efforts between rural community hospitals and larger urban centers.
Over the past five years, I have seen patients from various small towns who often drive one hour each way for a clinic appointment. They may be seeking help and care management for an ENT issue, a procedure such as nasal or sinus surgery, the excision of skin or neck cancer, or the insertion of an ear tube. Typically, these patients are more comfortable seeking care in their own communities rather than traveling to a distant hospital.
Yet disparities in the distribution of specialists such as ear, nose and throat physicians abound. Past research found that about two-thirds of U.S. counties – with an average population of about 21,000 – lacked a practicing otolaryngologist. In Illinois, we recently found that 38 rural counties with more than 620,000 residents between them had zero registered otolaryngologists.
I witness these disparities in care on a frequent basis. There are many areas within the realm of otolaryngology – such as sleep medicine, facial plastics, and head and neck surgery – that feature newer advances in treatment that are not readily available to those residing in rural communities. At the same time, it’s quite common for a resident of Chicago who lives in the proximity of various medical centers to seek care from multiple otolaryngologists who sub-specialize in different areas, giving them access to the most comprehensive care possible.
These gaps between urban and rural health care extend well beyond Illinois and across most rural communities in the U.S. To bridge them, it is essential to educate medical students and residents about the inequities in health care experienced by rural communities, and to develop collaborative initiatives between rural hospitals and urban academic medical centers that provide easier access to complex otolaryngological care.
As part of these initiatives, ENT surgeons visiting rural communities can help provide services to address basic needs, while patients who may require complex care can be referred to larger urban medical centers. Simply being present and available to see patients in rural communities allows for increased access to care. It also enables patients to receive treatment in a timely fashion, preventing further complications secondary to their illness.
Urban-rural partnerships may particularly benefit older patients, many of whom are very reluctant to travel to distant hospitals to seek care. I recall seeing an older patient with skin cancer on his face that required surgery. He lived in a rural town, Gibson City, and refused to drive long distances for care. Since I see patients at an area hospital, I was able to take care of him in his local community where he felt most comfortable.
Just as Simard’s research has shown that acts of sharing between trees help the forest thrive as one being, a symbiotic relationship between rural hospitals and larger medical centers is vital for the well-being of these respective institutions – and for the communities they serve.