For quite a few years, I have been recording myths about rural health care. I think of myths as something easily proven false but too often assumed to be true. My list started when an urban-based executive told me, with a straight face, “Pay them less, they grow their own vegetables.” But it has been over half a century since most rural Wisconsinites lived on a farm.
I have come to recognize “they grow their own vegetables” as “rural as Lake Wobegone” myth. For my friends who never stray off of Fox News to National Public Radio, Lake Wobegone is Garrison Keillor’s fictional hometown where “all the women are strong, all the men are good looking, and all the children are above average.” Not anywhere I’ve seen.
The opposite of an overly idealized version of rural America is the equally extreme view of “rural as backwater.” Unfortunately I hear a lot more of these myths than the possibly less harmful Wobegone variety.
A good example is the myth that Wisconsin patients don’t much like the care they receive in rural community hospitals. The data supports just the opposite view. The most recent results for a national survey of patient experience of care can be found on Wisconsin Hospital Association web site. In Wisconsin, 69 percent of rural patients surveyed ranked their hospital high, 4 per cent above the score for ALL hospitals nationally. The same web site shows that both rural and urban hospitals individually score above and below state averages on a variety of other quality measures.
Another false claim that I still hear too often is that rural hospitals are just “Band-aid stations.” Nothing could be further from the truth. Rural hospitals are the backbone of health care delivery in rural communities, and providers of a broad range of services including: emergency services, comprehensive primary and selected in-patient services, in-patient surgery and day surgery, out-patient and diagnostic services, long term care services and an ever more active role in health promotion.
The source of some attitudes that one part of a state can hold about another often can’t be pinpointed but I don’t believe they arise from bad intentions. I believe it is more about differences in perspectives that come from knowing a place as home versus passing through. And its not just about urban misunderstanding rural. The myths can and do go in both directions. To hear some talk, there is a convention of liberals on every Madison street corner.
The bottom line is that when you have seen one rural community, you have seen one rural community and need to be careful about making general statements. There is probably as much diversity among rural communities and health care providers as there is between rural and urban.
But what does the data tell us? It tells me that there are challenges that we need to face in our rural communities. On average, rural Americans are older, poorer, have less education and fewer jobs. All of these conditions contribute to poorer health and drive the need for local health care. We do know that rural providers have been historically underpaid for the work they do. We do know that urban-focused academic centers can do much more than they have to date to prepare the next generation of providers for rural health care. The list goes on.
The data and my own experience tells me that rural health in Wisconsin is dominated by hard working, skilled professionals, who continuously go above and beyond the call of duty. I know that we in rural health are realistic about both our strengths and about the challenges we face. I believe we invented “doing more with less.” We know our job is to preserve what we have, while continuing to improve and celebrate the hard work and success that defines rural health.
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