Barely a tenth of U.S. physicians practice in rural locations, but up to 60 million patients live in those areas, the Radiological Society of North America reported this week. This lack of access means these people often have to fork over hundreds of dollars for transportation they can’t afford, in addition to scraping enough together for health insurance every month—if they’re lucky enough to have it.
The number of radiologists in rural areas looks even bleaker, according to a Radiology study from 2016. Less than 10 percent of radiologists practice in rural America—the greatest number are concentrated in Montana, New Hampshire and Wyoming—and that figure has been decreasing steadily. Care delivery can be difficult in these areas, the RNSA said, due not only to physical distance but the inability to move expensive imaging equipment between rural communities.
Mammography vans aren’t a new concept. The University of Virginia’s mobile unit has been delivering free mammograms to women for 15 years, including those in the most remote corners of the state.
“Many rural residents have jobs that do not offer benefits or find that health insurance is unaffordable,” Jennifer Harvey, MD, a professor of radiology at UVA, said in the RSNA release. “Often, women put their family’s health needs above their own. As a university, we knew we could travel to these areas and provide women with the screenings that they need.”
The traveling unit, which has capabilities for ultrasounds and 3D tomosynthesis mammography, spends about a quarter of its time in rural Virginia, Harvey said, generally spending at least 48 hours in one area. Up to 25 women visit the van each day, she said, but even taking the time for a quick screening can be challenging for women who can’t afford to take time off work.
Harvey said her team works with patients’ schedules to increase accessibility, sometimes doling out gas cards to ensure women can make it to a screening. Imaging procedures are free of charge, and after scans are uploaded and sent to UVA, Harvey and her colleagues review them. The onsite professionals can then help explain results to patients, or, in the case that a woman needs a consultation with a university radiologist, teleconferences can be set up onboard the van.
With an average household income of nearly $140,000, residents on Nantucket Island might not struggle with health insurance costs. But living 30 miles off the east coast of Massachusetts has its downfalls, including bad weather that can block timely access.
“Nantucket can have significant weather issues,” Massachusetts General radiologist Anand M. Prabhakar, MD, said in the release. “Fog and wind are major concerns that have affected the ability of medical personnel to travel to the island and/or remove patients from the island.”
No radiologists live on Nantucket, Prabhakar said, so the 19-bed Nantucket Cottage Hospital relies on Massachusetts General Hospital experts for analysis and teleradiology readings. Once a week, though, Prabhakar and a rotating group of MGH radiology specialists fly to the island to provide fluoroscopy and minimally invasive interventional procedures.
Even with those extra steps, Prabhakar said, getting a patient off the island in an emergency can be completely dependent on the weather. Though the transfers are usually smooth, he said the Coast Guard is sometimes called in to help.
“No matter when or how we get to the island, time is well-spent there with the amazing team of physicians at the hospital and the appreciative Nantucket community, who have welcomed the imaging staff from MGH,” Prabhakar said.