By Jordan A. Rothacker

The metropolitan areas of Georgia sprawl so far and wide that sometimes it’s easy to forget that there are rural, more isolated parts of the state that are not all connected to urban or suburban masses. Rural, small towns in Georgia often have their own flavors, identities, and industries that can draw newcomers looking for more land, quiet evenings, and a slower speed of life. 

Unfortunately, there are costs that come with rural living in Georgia, and often the feelings that these small towns are being left behind. Unemployment is only slightly higher (3.3% in rural counties vs 3.2% metro), but average median income is over $20k higher in metro counties than rural as well as poverty rates being seven percent higher as of 2024, according to the US Census.

Another significant difference we see in this Census data is related to health. According to the US Census Small Area Health Insurance Estimates, nonmetropolitan counties have a higher rate of uninsured people under age sixty-four. This is especially difficult in rural areas where the availability of care isn’t as substantial.

Behind all of this data and statistics are real people affected by this situation. For an understanding of the reality from the inside, I turned to an Emergency Room doctor in the unique situation of working at both a small, rural “critical access hospital” and large, metropolitan hospital. 

For the last fourteen years, Dr. Lewis Earnest of St. Mary’s in Athens, Georgia has been driving down to Greensboro, a town of 3,648 people (2020 Census) in Greene County, twice a month to work ER shifts at Good Samaritan, an extension of St. Mary’s. He is one of twelve ER doctors at the St. Mary’s in Athens who make this drive to work these shifts and assist the three full-time Good Samaritan ER doctors.

Good Samaritan is a “critical access hospital,” a term coined with stipulations in 1997 as part of the Balanced Budget Act. Criteria involve 24-hour access, Medicare acceptance, and a location more than thirty-five miles from a major hospital. 

“My experience is kind of a tale of two different cities. When I go to work in Athens, I look up right in front of my computer and there’s like fifteen different specialists available for me to call at any period of time, 24 hours a day, for any question that I have regarding a patient. And that’s really important that for emergency patients, they get proper care, and that is the emergency doctor having access to call a friend, because we don’t know everything about everything.

“Whereas when I go down to Good Samaritan and I look up, there’s no piece of paper and there are no specialists. We are just kind of winging it, you know? And so, the reality is that patients who go to rural emergency departments are not getting the same level of care that they get in the cities,” Dr. Earnest said.

As with all complicated issues that involve standards of living, there is an interconnected economic component to this situation around specialists.

“Because there’s a lack of specialists there, it really complicates what happens to the patient when they leave the emergency department. Oftentimes the rural hospital is unwilling to keep the patient because they don’t have access to specialists when they go upstairs. These patients get transferred into the big city. The problem with that is, is the rural hospital loses the revenue. And so, when the rural hospitals losing the revenue, that’s one of the reasons why they go out of business and then there becomes less. It’s just a cascading cycle of less access. And the rural residents are very smart, rational actors in that they are gonna go to the place that they are gonna get the best care,” Dr. Earnest continued. 

As it’s been fourteen years, Dr. Earnest has thought about this issue a good deal. When I inquired about potential solutions, he was ready to go.

“Well, I think there should be a state level system that designates certain specialist hubs. Let’s say there’s seven to eight specialist hubs within the state of Georgia and the specialists that live in those hubs are required to be on call for the surrounding rural area. And they get reimbursed for doing that,” Dr. Earnest said.

The rural, wild, and undeveloped parts of the state are places that Georgians can pride themselves on having the ability to visit or even reside in for a life at a different speed than the sprawling metropolises. Whether by choice or circumstance, the people of these parts of the state have the same needs but uneven resources.