Research in Rural Health Care

Studying the Impact of Maternity Ward Closures

Why are small New Hampshire hospitals closing their maternity wards at an alarming rate? How are these closures affecting pregnant women, babies, and hospital emergency departments? And what can be done to mitigate the impact of these closures on rural communities?

Addressing these questions is crucial because as rural populations age, birthrates decline, and the medical costs of pregnancy and childbirth rise, it’s becoming more difficult for mothers and babies in rural New England to get the care they need, putting their health—and their lives—at risk.

Timothy J. Fisher, MD, director of the Obstetrics and Gynecology Residency Program at Dartmouth-Hitchcock and assistant professor at the Geisel School of Medicine, along with two researchers from the Urban Institute in Washington, D.C., has been awarded a three-year, $350,000 grant from the Robert Wood Johnson Foundation to study this trend and suggest practical, affordable solutions. The Northern New England Perinatal Quality Improvement Network will also be a partner in the study. 

“More than half of all U.S. counties do not have ob-gyn doctors to serve pregnant women,” Fisher says. “It’s important that we have the resources in every county that can support the care and education of women where they live.”

The study is one of 15 projects in the Foundation’s state-based Interdisciplinary Research Leaders program, which is examining problematic rural health trends in 21st-century America and developing potential solutions.

“As we gather results and make our findings, we plan to be in touch with the major stakeholders who control maternal care: the insurance companies who pay for many of these services and the legislators and policy makers who regulate health systems,” Fisher says. “We need to be sure they understand the importance of what we must do in the future to guarantee that mothers and babies in New Hampshire have the care needed to live long, safe, productive lives.”

Examining the Aging Rural Physician Workforce

Geisel School of Medicine student Lucy Skinner ’22 plans to practice rural medicine and is co-leader of Geisel’s Rural Health Scholars program. She’s also the lead author on a paper published earlier this year in the New England Journal of Medicine that examines the aging of the physician workforce in rural areas.

Working with Doug Staiger, PhD, adjunct professor at The Dartmouth Institute for Health Policy and Clinical Practice, and Montana State University faculty Peter Buerhaus, PhD, and David Auerbach, PhD, Skinner found that while the number of rural physicians had been stable over the past 20 years, the rural physician workforce is aging—and not being replaced with younger doctors. 

This demographic shift forecasts a troubling future for rural residents who’ll have increasingly limited access to physicians. “The supply of physicians in rural areas is going to decline in the next 10 years by 23 percent as older physicians retire,” explains Skinner. “If nothing is done, the already large disparity in access to physicians between rural and urban populations is going to widen.”

The supply of physicians in rural areas is going to decline in the next 10 years by 23 percent as older physicians retire,” explains Skinner. “If nothing is done, the already large disparity in access to physicians between rural and urban populations is going to widen.”

Skinner and her colleagues acknowledge that initiatives involving focused training for medical students likely to practice in underserved rural communities have slowed the decline of rural physicians, but they’re unlikely to narrow the care delivery gaps. To break this cycle, the researchers offer strategies such as expanding graduate medical education programs in rural hospitals, increasing access to care through mobile health vans, and furthering the adoption of telehealth services. They also suggest the rapidly growing nurse practitioner workforce could be part of a solution to narrow gaps in health care delivery.