A wave of departing medical professionals in rural areas threatens to leave gaping holes in these health care systems and local economies, triggering a death spiral that may be hard to stop.



The virus infecting thousands of Americans a day is also attacking the country's social fabric, especially in some small towns. As Frank Morris of member station KCUR reports, the sometimes divisive politics surrounding the coronavirus is roiling rural communities and threatening to alienate some of their most critical residents - health care workers.

FRANK MORRIS, BYLINE: Ten years ago, Dr. Kristi Darnauer and her husband moved to tiny Sterling, Kan., to raise their kids steeped in small-town values.

KRISTI DARNAUER: The values of hard work, the value of community, taking care of your neighbor. Like, that's what small towns shout from the rooftops. Like, this is what we're good at. We are salt-of-the-earth people who care about each other. And here I am saying, then wear a mask because that protects your precious neighbor.

MORRIS: But Darnauer's medical advice was met with contempt from some friends, neighbors and patients. COVID cases in the county started to climb. Other small Kansas towns turned into some of the pandemic's hottest hot spots.

DARNAUER: It's heartbreaking because we say this is what we value, and then when we actually had the chance to walk it out, we did it really poorly.

MORRIS: The pushback was too much. Darnauer resigned her job as Rice County medical director. She felt disrespected, even betrayed.

DARNAUER: Hard things should bring us together. And instead, this hard thing has driven a wedge between us.

MORRIS: And that wedge is splitting off health care workers from some communities that desperately need them. More than a quarter of all public health administrators in Kansas quit, retired or got fired this year. Some got death threats. Some had to hire armed guards.

VICKI COLLIE-AKERS: These are leaders in their community, and they are leaving broken.

MORRIS: That's Vicki Collie-Akers, a population health professor at the University of Kansas. And she says they're leaving at a terrible time. The pandemic is still raging. Vaccines need to get from cities to small towns and into people's arms. And who - who is going to take the jobs that health care directors are leaving?

COLLIE-AKERS: We think it will have a profound effect on recruitment. It's not a secret that the position is open because of extreme tension between the health department director and the city commission or county commission or because the person required a guard.

MORRIS: Alan Morgan, who runs the National Rural Health Association, says this is happening across a lot of rural America.

ALAN MORGAN: It's been a terrible, an absolute terrible, no-good year for rural health.

MORRIS: Rural hospitals were in deep trouble before the pandemic. COVID made matters worse, filling hospitals with desperately sick, highly contagious patients, running staff ragged and filling the air with vitriol against medical expertise. Rural health care jobs can be hard to fill in the best of times. Now, Morgan says, many rural hospitals are downright desperate.

MORGAN: Community after community after community, all I hear about is workforce, workforce, workforce - losing clinical staff, trying to attract clinical staff into these communities. It is taking up the full time of our members right now.

MORRIS: Closing rural hospitals cuts access to health care in places where more residents are older, sicker and poorer. It also undermines the rural economy. Hospitals are often the biggest employers in small towns that have them. And Chris Merrett, director of the Illinois Institute for Rural Affairs, says the people they employ are absolutely vital.

CHRIS MERRETT: They are really the lifeblood of any community, and a rural community in particular.

MORRIS: Well-paid, life-saving experts in extremely short supply, Merrett says towns that let pandemic politics drive medical professionals away are choosing rugged individualism over the common good. For NPR News, I'm Frank Morris.

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