[Omniusaspirer]

Modern educated young people generally don't stay in their small rural towns devoid of opportunity, so the supply of willing healthcare workers dwindles and the population of these towns trends older and sicker. 30 years ago I suspect people had more kids and they had a greater propensity to stick around due to sheer ignorance of outside opportunity/QoL pre-internet age.

Traveling nurses like myself can fill the holes, but we don't come cheaply as we give up a lot to work away from friends and family in undesirable locations. Traveling docs (locums) feel the same, and are even more expensive- 20k to work a weekend in an ER isn't unheard of.

My personal opinion having driven all across America over the last few years and working in a bunch of these small to mid size cities is that they really have no reason to exist and would fade away without government welfare prolonging the misery. Most were founded near a mine or factory that has long since left and is extremely unlikely to ever return. In the past you'd quickly get a ghost town, today you get an economically depressed meth town that stumbles along for decades consuming lives.

[deelowe]

That's not what's going on. Things didn't start going downhill until the bill hospital outfit in our state started buying everything up. Now that they own all the doctors offices, immediate meds, and hospitals, they've started shutting down anything they feel is redundant. This has caused medical professionals to leave the area as the increased competition for jobs has driven wages down and, more importantly, work hours up. All in all, everything has gone to crap. There are few facilities left in the area and the ones that are near by have TERRIBLE reviews as the constant turnover has taken it's tole on the practices.

[Clubber]

This. It's called block scheduling. They want every minute of every resource every day to be filled or even overbooked. Rural medical centers are difficult to do this with, so they get shut down, forcing people to drive further. A single rural medical center can't be full, but if you close down 5 of them and force everyone near those 5 locations to drive an hour or three to a bigger one, it's much easier to fill. It's corporate consolidation and greed.

[deelowe]

And every single diagnosis is reduced to rote procedure. I have no less than 3 lingering issues that I've been dealing with for YEARS that I cannot seem to get cleared up. I'm pretty sure more costly diagnostics (cat scan or colonoscopy) will pinpoint the issue, but they refuse order them and instead shrug off the problem because "all of the lab work looks healthy."