New Rural Health director notes challenges ahead for rural populations

Regardless of which direction health care reform takes in the coming years, its impact on rural populations must be closely monitored says L. Gary Hart, director of the Center of Rural Health (CRH) at the School of Medicine and Health Sciences.

“We need to stay in a position that prevents adverse things from happening that affect rural providers and rural people, or at least be able to figure out what’s going wrong before it goes too wrong,” explains Hart, who became the center’s director last August. He succeeded Mary Wakefield, who left in 2009 to serve as administrator of the Health Resources and Services Administration in Washington, D.C.

“Over the last few years, health care reform has come up. What does that mean to rural places? How is it going to affect them?” he asks. “The law probably isn’t going to stay as it’s written. We still have to be there listening, knowing and trying to stay ahead of the curve so we can give feedback about how it affects rural areas.”

Even without the changes caused by health care reform, Hart says the nation’s rural areas have challenges to face.

“At the state and federal level, there’s going to be a lot of emphasis on workforce issues, no matter what happens to health care reform,” Hart says. “There are already shortages of rural health care providers, so that’s going to continue, no matter what.”

Hart says the need for centers dedicated to studying rural health care was highlighted in the 1980s when a change in how hospitals were paid had the unintended consequence of shutting 10 percent of the nation’s rural hospitals over a two-year period.

“It happened because nobody was looking at rural policy,” he explains. ”We need to stay in a position that prevents adverse things from happening that affect rural providers and rural people, or at least be able to figure out what’s going wrong before it goes too wrong.”

As CRH director, Hart guides more than 50 faculty and staff working to improve health opportunities and outcomes for rural Americans, with emphasis on North Dakota’s rural population. The center provides rural health services research, community development, program evaluation, public policy studies, information dissemination, and education and training.

“There are at least 50 funded projects here right now covering many different topics,” Hart says. “One priority is providing service to help with quality assurance in small hospitals. Another is the research on educational programs aimed at finding out how to get the most value for our buck. How do we train health care professionals so that they stay here instead of ending up somewhere else?”

The problem of attracting and retaining health care professionals is a major issue for rural America. Hart was involved in a study which showed that while more than 20 percent of the population lives in rural areas, 7 percent of all training of family medicine residents takes place there.

“We’re trying different approaches to get family physicians to practice in rural areas, but we’re not only losing them, we’re not even training them,” he says. “People stay where they’re trained. One piece of health care reform is aimed at feeding more money to provide more primary care rural training.”

Hart, who grew up in Utah and earned his bachelor’s and master’s degrees from the University of Utah, received his Ph.D. in medical geography from the University of Washington. From 1988 to 2007, he was director of one of the first national rural health research centers at University of Washington, which has a regionalized medical school program serving Washington, Wyoming, Alaska, Montana and Idaho.

Before coming to UND, Hart was director and endowed professor of the Rural Health Office in the Community, Environment and Policy Division of the Mel and Enid Zuckerman College of Public Health at the University of Arizona in Tucson.

Hart’s research has been published in professional journals for medical geography, family medicine, health education and health workforce and rural health research and policy.

For more information, contact L. Gary Hart, director, Center for Rural Health, at 777-3848 or gary.hart@med.und.edu.

— PatrickMiller, writer/editor, University Relations, 777-2412, patrick.miller@und.edu.