PHYSICIAN SHORTAGE POSES RURAL MISSOURI HEALTH HAZARD

COLUMBIA -- Warning: Living in outstate Missouri can be hazardous to your health.

For the past several years a College of Agriculture professor at the University of Missouri has been waging a virtual one-man campaign to improve the health and longevity of residents in the 100-county rural areas of the state.

Dr. Robert Finley, an emeritus professor in the Department of Agricultural Economics, has traveled extensively around the state to promote increased medical school enrollment by high school graduates in rural counties. After several years spent compiling statistics about the health of outstate Missourians, the M.U. professor is convinced that heightened medical career interest among rural college-bound students is an important key in improving health care in 100 non-urban counties.

Actually, Dr. Finley has devoted more than two decades to rural health issues, serving as one of the original founders of the Missouri Office of Rural Health in 1979 and then as a member of its first executive committee. He also serves on the Telehealth Subcommittee of the M.U. board of curators and recruitment task force for the state's Department of Health. He has been assisted by his wife, Gloria Finley, who was an adviser to former Gov. Joe Teasdale and was instrumental in advising him in the creation of the first Office of Rural Health.

Dr. Finley's decades-long statistics on rural health provide a mountain of information for community and health leaders in rural counties, which the M.U. faculty member has broken down into two categories: very rural, which includes 52 counties with less than 15,000 population and rural, which encompasses 48 counties with 15,000 to 50,000 population. The state's remaining 14 counties and the City of St. Louis are classified as urban and have populations over 50,000.

These statistics translate into Dr. Finley's principal thesis on outstate medical care: while the Very Rural and Rural counties contain 34 percent of Missouri's population, they have only 13 percent of the state's physicians. About 40 percent of the state's annual high school graduates are from very rural and rural counties. In a study that began back in 1981, Dr. Finley found that primary-care physicians increased 13 percent statewide, but actually decreased by the same percentage in the very rural counties.

Tying these statistics to current enrollment at the University of Missouri Medical School, Dr. Finley discovered that entrants into this college from 1989 through 1993 numbered 459, with only 19 coming from very rural counties and 61 from rural counties. Urban counties and the City of St. Louis furnished 379 students during the same period.

From 1989 to 1993, 50 of Missouri's 114 counties had no medical school enrollees and 80 counties had either one or no enrollees. "Thus on a population basis," Dr. Finley points out, "our rural students are applying to medical school at about 50 percent of the state average." Some possible answers, he believes, may be found in the absence of role models, rural high school curricula, inadequate counseling, lack of information and lack of confidence.

"Solutions," he insists, "must be found and soon." The urgency is immediate, Dr. Finley believes. "We are at a critical time in rural health care in Missouri and rural provides will mostly come from the rural setting. Future federal and state programs will give direction and aid, but Missouri, alone, can put the professionals in the field."

The M.U. professor has spent long hours correlating the absence of care providers in outstate Missouri to the general health of rural-county residents. He discovered that 37 percent of all rural-county Missouri adults, ages 18 to 64, were diagnosed with at least one chronic condition, compared to 31 percent in urban areas of the state. In addition:

-- About 19 percent suffered from rheumatism or arthritis, compared to 15 percent in urban areas;

-- The percentage of rural adults diagnosed with cancer is 4.5 percent, versus 3 percent in urban areas;

-- Rural residents are twice as likely to travel more than 30 minutes to reach their usual source of medical care;

-- The U.S. agricultural occupational death rate is 4 times that of all other industries.

The per capita rates of both primary care and OBGYN-pediatric physicians in various regions of Missouri are also startling, Dr. Finley has discovered. For example, the rate of population to primary care physicians in counties with under 15,000 population is 2,507 to 1, while for OBGYN-pediatric doctors, the rate is 70,213 residents to 1. In contrast, the urban ratio is 1,043 residents to every primary care physician and the rate for OBGYN-pediatric is 2,908 to 1.

Projecting his statistics to the year 2000, Finley predicts that less than 20 percent of new physicians will be in primary care by the beginning of the next century.

Dr. Finley outlines a five-part program to improve the health of outstate Missourians. These include:

-- Develop an awareness by high school student of careers in rural medicine.

-- Target those students who have rural backgrounds.

-- Develop and support a college curriculum that will build on multiple interests of young women/men while completing requirements for medical/osteopathic school.

-- Include and increase linkages among area colleges and community colleges in establishing programs for youth interested in rural medicine.

-- Foster a positive attitude toward rural medical practice throughout the Legislature and medical and osteopathic schools.

"With the crisis in rural health care, something must be done," Dr. Finley says. "This program would set forth alternate pre-med curricula for our rural students. Rural begets rural when it comes to doctors returning to rural areas." He admits that his recommendations "will not solve this long running and worsening problem, but it may be a small step."