Sunshine, Ocean Views, & Not Enough Doctors

The Florida Keys usually conjures up images of sunshine, ocean breezes, and copious cocktails. But beyond the vacationers paradise, there is the reality of life in the Keys – and needing access to health care.

Across the 137 square mile archipelago, there are only 266 health care providers for 74,000 residents (and 2.25 million annual visitors). The Florida Keys has a serious shortage of health care providers and services.

There are two main types of shortage designations, as determined by the Health Resources & Services Administration (HRSA).

HPSAs and MUA/MUPs can be found in both urban and rural areas, but the problem is particularly acute in rural areas.

The federal government now designates 80% of rural America as medically underserved. It is home to 20% of the U.S. population but fewer than 10% of its physicians. Texas provides a critical example of the problem. According to a Washington Post article, “In Texas alone, 159 of the state’s 254 counties have no general surgeons, 121 counties have no medical specialists, and 35 counties have no doctors at all. Thirty more counties are each forced to rely on just a single doctor…”.

In addition to an ongoing and increasing physician shortage, there is a clear pattern of physician maldistribution. In the U.S., physicians have significant control after training about where they want to practice. And disproportionately practice in urban and suburban areas for various reasons.

Encouraging students to pursue primary care can certainly have an impact on this issue – family physicians comprise only 15% of U.S. outpatient providers, but they provide 42% of care in rural areas. There are many challenges to recruiting and retaining providers in underserved areas, but the National Health Service Corps does award scholarships and loan repayment to primary care providers who commit to working in underserved communities. Nearly 14 million people receive care from NHSC members around the country, including in the Florida Keys.

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