May 19, 2021

Rural Texans Left in Dust Without Adequate Healthcare

Reporting Texas

On their way to suburbia, Texas, the moving vans of more than 500,000 people who relocated here from out-of-state in 2019 likely passed through small towns in the boggy thicket of rural East Texas or along the dust-blown western highways that stretch as far as the sky above is wide.

These rural communities may not lure as many newcomers as the areas surrounding metropolitan Dallas, Houston, San Antonio or Austin, but they are integral to Texas’ rugged culture and booming economy that have attracted over 4 million people to the state over the last decade. Outside the city, oil workers, cattle ranchers and farmers have worked Texas to its status as the lead producer of commodities like beef, crude oil and cotton, but they are falling behind fellow Texans in access to critical services like physical and mental healthcare.

Almost 70% of Texas’ 254 counties are rural, but over 80% of the state’s population live in metropolitan areas. Texas leads the nation in hospital closures too, as its rural communities have lost over half of their hospitals since 1960, and 27 have closed since 2010. Sixty-four counties have no hospital at all, and 25 lack a primary care physician.

This is particularly concerning, given that rural Texans are generally less healthy than the rest of the state. Rural communities experience higher rates of substance abuse, obesity, suicide and unintentional deaths from car accidents and machinery work – especially prevalent on ranches and oilfields that span Texas east to west.

Through UT’s Forty Acres Founders Pre-Accelerator Program, senior neuroscience major Sydney Fischer researched the specific effects of Texas’ physician shortage on access to clinical trials. Clinical trials are a critical stage in the research and development of a new drug, and are often a choice for ill patients that have exhausted other treatment options. According to, there are currently 142,000 trials being conducted in the United States, and without doctors, most patients are unlikely to find trials for which they qualify.

If they do qualify, rural patients may spend significant amounts of time travelling to research centers in large cities.

“Usually, if a clinical trial were an option for you, we’d naturally expect to hear about it from our doctors,” Fischer said. “But the reality is … your doctor in West Texas isn’t likely to bring that up as a treatment option, whereas if you were in Dallas, that probably would be presented to you. The opportunities that are open for you really do depend on where you live and what you have access to.”

Nearly 75% of the state’s counties are designated Heath Professional Shortage Areas and/or Medically-Underserved Areas, defined as geographic areas or populations, such as people experiencing homelessness, low-income communities, Native Americans and migrant farm workers, with lack of access to primary care services. Without access to clinical trials, these groups are disproportionately unrepresented in the research process.

“We don’t want things that are getting FDA approved if they weren’t tested for a whole range of people,” Fischer said. “You want to be represented so you know that this works for other people like you.”

As Texas’ population grows and concentrates in urban areas, the Texas Department of Health and Human Services predicts that the demand for primary care physicians and psychiatrists will increase by 67% by 2030, creating a deficit of 3, 375 providers.

In an article from the Texas Tech University Health Science Center School of Medicine, Dean Steven Berk says medical programs must encourage its graduates to complete residencies in underserved communities rather than head for urban areas.

“We need to produce not only more primary care physicians, but more physicians who might settle in rural areas,” Berk said in the article. “Medical school admission committees can select for students who might choose family medicine as a career and who are from rural areas and might want to return to rural communities.”

But increasing rural residencies has a hefty price tag – the average residency slot costs at least $100,000 per year, and a residency program can only be approved if its location includes a patient population with a variety of illnesses and diseases large enough to properly prepare a healthcare professional.

The University of Texas System has most recently addressed rural Texas’ physician shortage by opening UT Health Science Center at Tyler’s School of Community and Rural Health in Sept. 2019.

Last year, the system announced its approval of a proposal to establish the first medical school in East Texas to “provide a pathway for students to receive a comprehensive medical education…and extend access to patient care, especially for individuals living in rural areas of the region.”

“A medical school in Tyler will have a cascade of positive multiplier effects,” said UT Tyler President Kirk A. Calhoun after the announcement. “There’s a growing awareness about both the challenges and the potential of East Texas, and it’s exciting to see momentum build to support and invest in our region.” The school hopes to welcome its first class by the summer of 2023.