Embracing the Challenges, Rewards of Rural Health Care

The physician treated young Tate’s ear infection on a Saturday afternoon and then stayed a while to talk cars with his father.

“Rural life is relational,” Hinkle said. “You have to build those relationships with people if you’re going to help them achieve a better health outcome. You have to be part of the community for them to trust you.”

Hinkle later shadowed the local family docs and rotated through their clinic while a student at the University of Alabama School of Medicine. After graduating from the University of Alabama Medical Center-Huntsville family medicine residency, he practiced in another small Alabama community, Alexander City, for more than five years.

“I decided early on in residency to go back to rural Alabama,” he said. “I saw the impact my family doc and others like him had. They were the social workers, the everything, for those communities. It’s rewarding to be such an integral part of the community. You’re often a solo doc or one of the few in town. When you’re a big fish in a small pond, your impact is bigger.”

During his rotations, Hinkle saw patients he knew from the church and schools he had attended while growing up.

“Every visit was a social visit,” he said. “It wasn’t just about their health problems. It was about, ‘How are the kids, their sports teams, the kids away at college?’ All family docs have relationships with their patients, but in rural communities it’s just different. You get things like chicken eggs, deer meat, fresh corn and tomatoes from patients just because they love you so much.”

Hinkle will offer the rural perspective in a panel discussion about different aspects of family medicine July 28 during the National Conference of Family Medicine Residents and Medical Students in Kansas City, Mo.

There are more than 8,100 designated primary care health professional shortage areas in the United States, many of them rural, affecting more than 97 million people. There are 120-plus such areas in Alabama alone.

Hinkle said rural medicine is often an overlooked practice option, although it frequently offers an opportunity to practice a broader scope of family medicine compared to many urban and suburban practices.

“You don’t have a ton of specialists and easy access to that kind of care,” he said. “That can put pressure on you as a rural physician because there are more struggles with things like food deserts and transportation limitations. Many rural people struggle with the same social determinants of health that people in urban areas do, but access to resources is significantly less. A lot of that falls on their family doc to figure out.”

Hinkle recalled one older patient of his who was distraught because she could not afford her medications.

“You can’t just say, ‘I’m sorry. I don’t know,’” said Hinkle, who spent time that day trying to help the woman find better benefits and later brought her back to successfully resolve her coverage issues. “She was someone who really wanted to take care of herself, but she couldn’t navigate the system. It’s hard and confusing.”

Last fall, Hinkle took on the role of chief medical officer for Main Street Health in Alabama. The organization supports rural primary care in 20 states.

“One of the main things that drew me to it is that rural primary care in general is really struggling,” he said. “Rural communities have a higher prevalence of Medicare patients who are sicker than their urban counterparts. We don’t have a lot of doctors going back to rural areas to practice. If we don’t do something now, there won’t be a system left to fix in rural America.”

Main Street Health doesn’t own practices but rather partners with them and employs community health workers who help patients with issues that affect their health, such as transportation, food insecurity and access to affordable medications. The company assists practices with transitioning to value-based care by taking on the associated risks.

“CMS wants all Medicare beneficiaries in a value-based model by 2030,” Hinkle said. “But you can’t just turn a key and make it happen. It’s difficult for rural hospitals and clinics because they don’t have the ability to put themselves at risk. We bear all the risk, and we pay them every month.”

Partner clinics also have the option of joining Main Street Health’s accountable care organization.

“We drive better health outcomes by utilizing value-based care and helping practices navigate the system,” he said. “We came up with way to provide predictable revenue and extra hands to do it.”

Hinkle also is a medical director at a rural health clinic in Dadeville, where he continues to see patients, and is medical director of a hospice in Alexander City. He has served in a number of local, state and national leadership positions, including current roles on the AAFP’s Commission on Quality and Practice and the Alabama AFP Board of Directors. Hinkle, who served as the medical student member of the AAFP Board of Directors in 2013-14 and was a new physician delegate to the Congress of Delegates in 2022, urged students and residents to take advantage of leadership opportunities available to them in family medicine, including roles that will be voted on during National Conference.

“Students might think, ‘Why do they care what I think? I’m just a student,’” he said. “The AAFP and policymakers do care because they see that these people are going to be the doctors of the future.

“If you want to impact the system and specialty you’re going to be practicing in, don’t wait until you’re mid-career to say, ‘This isn’t the health care system I want to practice in.’ Your voice needs to be heard because it’s going to shape what the system and specialty look like in the next 20 to 30 years.”