Original Research

Barriers to rural health care from the provider perspective


name here
Avinash Maganty
1 MD, Clinical Instructor *

name here
Mary E Byrnes
2 PhD, MUP, Assistant Research Scientist

name here
Megan Hamm
3 PhD, Assistant Professor

name here
Rachel Wasilko
4 BA, Research Assistant

name here
Lindsay M Sabik
5 PhD, Associate Professor

name here
Benjamin J Davies
6 MD, Professor

name here
Bruce L Jacobs
7 MD, MPH, Assistant Professor


1 Department of Urology, Dow Division of Health Services Research, School of Medicine, University of Michigan, Ann Arbor, MI, USA

2 Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI, USA

3, 4 Qualitative, Evaluation, and Stakeholder Engagement Research Services, Center for Research on Healthcare’s Data Center, University of Pittsburgh, PA, USA

5 Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

6, 7 Department of Urology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

ACCEPTED: 19 December 2022

early abstract:

Introduction: Rural populations routinely rank poorly on common health indicators. While it is understood that rural residents face barriers to healthcare, the exact nature of these barriers remains unclear. To further define these barriers, we performed a qualitative study of primary care physicians practicing in rural communities.  
Methods: We conducted semi-structured interviews with primary care physicians practicing in rural areas within western Pennsylvania, the third largest rural population within the United States, using purposively sampling. Data was then transcribed, coded, and analyzed via thematic analysis.
Results: Three key themes emerged from the analysis addressing barriers to rural healthcare: 1) cost and insurance; 2) geographic dispersion; and 3) provider shortage and burnout. Providers mentioned strategies that either they employed, or thought would be beneficial for their rural communities: 1) subsidize services; 2) establish mobile and satellite clinics (particularly for specialty care); 3) increase utilization of telehealth; 4) improve infrastructure for ancillary patient support (i.e., social work services); and 5) increase utilization of advanced practice providers.
Conclusion: There are numerous barriers to providing rural communities with quality healthcare. Barriers that are encountered are multidimensional. Patients are unable to obtain the care they need due to cost-related barriers. More providers need to be recruited to rural areas to combat the shortage and burnout. Advanced care delivery methods such as telehealth, satellite clinics, or advanced practice providers can help bridge the gaps caused by geographic dispersion. Policy efforts should target all these aspects in order to appropriately address rural healthcare needs.