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The Dartmouth
July 26, 2025 | Latest Issue
The Dartmouth

Shipman finds rural communities lack adequate health care

Many rural communities lack adequate pediatric health care services despite an increase in the number of general pediatricians that outpaces the increase in the number of children in the United States, according to a study conducted by members of The Dartmouth Institute for Health Policy and Clinical Practice and the department of pediatrics at Dartmouth Medical School. The study, published in this month's issue of Pediatrics, compared available data on the physician workforce with national census data on children.

There was a 51 percent increase in the number of general pediatricians and a 35 percent increase in the number of family physicians between 1996 and 2006, the study found. During the same period, the national child population increased by only 9 percent.

Approximately 15 million children, or 20 percent of the adolescent population, reside in areas greatly lacking resources, where the ratio of children to physician can reach 4,400 children per doctor, according to the study. The average American ratio is 1,420 children per doctor.

The study's findings bring to light the failures of the current system for training doctors, Scott Shipman, the lead author of the paper and an assistant professor at the Center for Health Policy Research at DMS, said in an interview with The Dartmouth.

"The status quo approach that had been used to train more doctors has resulted in a substantial maldistribution or inequitable distribution of primary care physicians for children," Shipman said.

Simply training more doctors will not solve the problem, according to Shipman. Instead, a variety of approaches should be attempted, including admitting a greater number of qualified applicants from rural areas into medical school.

"It's been shown that doctors from rural areas are more likely to go back to rural areas once they finish their training," he said, adding that a similar pattern exists for students from disadvantaged backgrounds.

Medical schools should also consider how they train doctors, Shipman said. Many students become accustomed to having access to the best resources, a fact that Shipman said he believes makes it difficult for them to consider going to an under-served rural area or inner-city area where those facilities are not available.

The government should also use new incentives to attract doctors to work in such areas, Shipman said. The National Health Service Corps, a program run through the United States Department of Health and Human Services, currently pays back medical school student loans and provides scholarships in exchange for service in areas where health care coverage is scarce. NHSC clinicians provide over 7 million individuals with health care through more than 10,000 sites, according to the organization's website. The Affordable Care Act, signed last March by President Barack Obama, allocated funds to the NHSC to expand the program, according to the Act's website.

Shipman said that although he is "optimistic" that the expansion of the NHSC will have a positive national effect, the service corps alone will be an insufficient mechanism.

While there are areas in New Hampshire with an insufficient supply of doctors, individuals can access adequately serviced areas without long drives, Shipman said. This is not typically the case in large Western states, he said.

DMS has ensured that students are exposed to diverse populations and has sent many of its medical students to work in inner-city areas across the country, according to Shipman. DMS, however, could work to broaden its efforts and increase the diversity of its student body, he added.

TDI researchers Jia Lan, Chiang-hua Chang and David Goodman also authored the study, which began the project in 2007. The study was funded in part by the Robert Wood Johnson Foundation, a private organization that focuses on improving health care distribution, according to its website.

Staff writer Lindsay Brewer contributed reporting to this article.