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Rural pediatricians struggle during pandemic but remain resilient

March 1, 2021

The pandemic hit the world like a rock hits the calm surface of a pond. Big waves in large cities seemed far from the rural towns already experienced with socially distanced life. News images of barren streets were novel for many Americans yet commonplace in the heartland.

Rural pediatricians continued serving their communities with good measures of reassurance, proactive education and science, while the pandemic raged closer to seemingly insulated towns far from the source.

The U.S. has a paucity of rural pediatricians. They are challenged by fewer community resources, longer work hours, more patient visits and more Medicaid patients than their peers in urban settings. Not surprisingly, these factors have been shown to influence burnout and job satisfaction.

In a survey of rural pediatricians, Lavanchy and colleagues found that 80% reported emotional exhaustion; 61%, depersonalization; 44%, moderate to low levels of personal accomplishment; and 31%, mild to severe depression (Soc Indic Res. 2004;69:93-101).

Haggerty and colleagues analyzed the literature to identify general, personal and community factors associated with rural physician retention (Int J Psychiatry Med. 2013;46:303-313). These factors included the presence of other physicians, diverse and broad scope of practice, opportunity for growth, adequate administrative support, family satisfaction and feeling connected to the community. They speak to the unique challenges rural pediatricians face in everyday practice as well as during the pandemic.

As president of the AAP Missouri Chapter, I know how pediatricians are experiencing the stages of the pandemic across our diverse state. We are rising to the challenge, like we always do, with resiliency, determination and advocacy for our patients and our community. 

Support from peers also is an important connection for rural pediatricians during the pandemic. For example, colleagues from larger communities are shipping personal protective equipment and other essential supplies to pediatricians with less access. Collaborative professional interventions can help rural physicians maintain professional wellness and linkages. 

We learned quickly that pediatrics is not front of mind in a health care crisis. Staunch local and state advocacy continues to be required to ensure the health and well-being of children and the professionals serving them, and to maintain access to critical financial support and supplies. The efforts are making our state stronger and bridging the rural/urban perspective gap as we all experience disparities in ways we never imagined. Each of us is digging deep to find the silver linings in our “new normal.” 

Yet, what are we learning about physicians at this critical moment? What are physicians learning about their communities? 

As the ripple of the virus found its way into the recesses of rural communities, pediatricians balanced pressure to ignore the reality of science with the need to persistently trumpet evidence-based infection prevention strategies. This daily reality fell on the backdrop of staff furloughs, pediatrician pay cuts and declining patient volumes. The pressure to increase productivity with fewer supports while under the duress of an invisible foe presented monumental challenges. While the world seemed to be celebrating health care heroes at every turn, these heroes experienced indescribable loss and despair. 

Many physicians are realizing an unspoken societal contract was broken. A contract where they dedicate endless hours to studying about diseases and caring for others while believing the system would be there when they needed support. Instead, physicians were met with limited protective supplies, pay reductions, furloughs and worse, mistrust from their communities about their knowledge and advocacy to protect them. 

Fortunately, pediatricians know how to rise. We watch children rise every day from cancer, abuse, poverty. We draw hope, love and comfort from their innocence, bravery and tenacity. They are our inspiration to keep serving our communities, big and small. 

As new, unanticipated rocks hit the surface of the water, rural pediatricians are adjusting to the challenges. Some days, we are more well than others, but each day we have the opportunity to rise. I encourage pediatricians to reach out to their rural colleagues and forge collaborative interventions. These connections will improve pediatricians’ wellness during the pandemic and beyond. 

Dr. Sohl is president of the AAP Missouri Chapter, executive director of ECHO Autism and professor of pediatrics at the University of Missouri School of Medicine. 

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