Posted by Bill Sandweg on 23 October 2023.
Many Americans have an idealized view of country living. Peace, quiet, nearby nature, a refuge from the stresses of the big city. It sounds very inviting. Many of those things do exist in the country, but there is a reason so many people live in the big city or its suburbs. One of the advantages of urban or suburban living is access to good quality health care. This can make a huge difference in your health and that of your family.
Health care is provided primarily by doctors and hospitals. It takes a substantial amount of money to build and staff a hospital. The more people who live around a hospital, the more business the hospital will have and the more likely it is that it will be profitable. Unprofitable hospitals close their doors. The smaller the population in an area, the further apart the hospitals will be and the further residents may have to travel when they need to be hospitalized or need emergency health care. In an emergency, every minute counts.
For exactly the same reasons, doctors need to be where they can make enough money to support their families. The larger the population in the area, the more likely it is that a doctor will have enough patients to have a successful medical practice. This is particularly true of specialists, who need a larger population base than family medicine doctors. You want to have access to medical specialists.
Even when the local hospital stays open, it may limit its services. A growing phenomenon in the United States is the “maternity desert.” These are areas in which there is no nearby hospital offering labor and delivery services. Because babies have the annoying habit of demanding to be born at all hours of the day and night, a hospital with a labor and delivery department must have delivery staff and an obstetrician available at all times. If the number of likely births in an area is too small to support the practice of an obstetrician, the local hospital may have no choice but to close its labor and delivery department.
I see cases from all over Arizona. Even though there are a lot more people in Phoenix and its neighboring cities than there are in Kingman or other places in rural Arizona, I see a lot of cases from rural counties. Why is that you might ask? The answer, as it so often is, is money. There is simply a lot more of it in the cities than in the rural areas.
Money determines the size of the hospital and the services it can offer. It also indirectly determines the quality of the doctors practicing in an area. While there are many good doctors practicing in the rural counties of Arizona, there are also many doctors who could not get jobs at the big hospitals in Maricopa County or Pima County and who were forced to go the the rural counties to find work.
Another effect of smaller populations is that even good doctors will have hard time keeping their skills sharp, if they cannot use those skills very often. This is particularly true when it comes to surgery. Study after study has shown that surgeons who do the same procedure over and over for weeks or months at a time get the best results. The best surgeon in the world will have a hard time matching even an average surgeon, if the best surgeon cannot do the procedure very often and the average surgeon does it every day.
The problem of rusty or seldom used surgical skills is aggravated when the surgery is a complex one requiring great skill and technique. So, if you are contemplating a serious surgery, give strong consideration to coming to the nearest big city and finding a surgeon who does your operation so often, she can do it in her sleep.
Also keep in mind that there is really no such thing as minor surgery. I have lost count of the so-called minor surgeries I have seen that have resulted in terrible injuries to the patient. Minor surgery is the operation they do on your neighbor. If they are doing it on you, it is major surgery and you want to be sure it is done right.
Finally, there is the problem of what happens when something goes badly wrong during a surgery, as it certainly will from time to time through no fault of the surgeon. Who is available to come to the operating room on short notice to help fix the problem? In the big city, a great surgeon may be just outside the door and ready to scrub in and help. In a rural hospital, they may have to do what they can to stabilize the situation and transport the patient by air to Phoenix where a higher level of care is available.
Country life may be wonderful but it does have some drawbacks, especially when it comes to getting quality medical care.