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Bisbee, Ariz., is a former mining town of about 6,700 people, some 12 miles north of the Mexican border and nearly two hours southeast of Tucson. Built in the hills of the red-rock Mule Mountains, it's now known as an enclave of sorts for artists and hippies and was even a one-time runner-up as the "quirkiest" town in America. But while it has attracted galleries and coffeehouses, it has struggled to find healthcare providers.
"We're having a harder time this year than last year," says Jim Dickson, CEO of 14-bed Copper Queen Community Hospital in Bisbee. "I think there's a bidding war going on for physicians."
The heightened demand means Copper Queen's starting salary for primary-care doctors has increased to $225,000, up from first $150,000, then $175,000, and it may need to rise to $250,000 to keep up with local competitors, Dickson says. But because the hospital can't bill enough to justify lucrative pay packages, it relies on assistance from National Health Service Corps, an HHS agency that provides incentives including loan repayment for doctors willing to practice in underserved regions.
It also sponsors foreign doctors with J1 visas, though Dickson notes that they tend to have higher turnover rates.
The investments are critical to Copper Queen's survival. Less than a decade ago, "We had no private doctors left in town," says Dickson, who since 2007 has grown the medical practice from four physicians to 11, as well as four mid-level providers. "The hospital would have imploded without these doctors."
Copper Queen's challenges are not unique. The doctor shortage in rural America is widespread and projected to get worse. Medicaid expansion and insurance exchanges are expected to provide coverage to about 30 million Americans--but many in rural and underserved communities may have to drive hundreds of miles for care if it isn't available locally.
A 2009 policy brief from the federal Office of Rural Health Policy highlighted that 77% of rural counties are facing a shortage of primary-care providers, and 8% don't even have a single primary-care physician.
"It's pervasive," says Brock Slabach, senior vice president for member services at the National Rural Health Association. "There's just a significant need for workforce."
The number of general surgeons practicing in rural communities decreased 21% between 1981...