Third in a series on the Texas Triangles.
Texas faces significant healthcare access disparities between its rural and urban communities. According to Health Care that Works for All Americans, rural Texans (roughly 16% of the state’s population) experience difficulty obtaining medical care due to provider shortages, lower insurance coverage, transportation barriers and infrastructure gaps. These disparities contribute to worse health outcomes in rural areas, including higher rates of chronic illness and mortality.
Several factors contribute to rural disparities, such as fewer healthcare providers, specialists and residents needing to travel long distances for care. According to the U.S. Census Bureau, there is one physician for every 3,307 people in the megaregion and 3,576 people in West Texas. Remarkably, 1 in 5 counties in the “healthcare desert” don’t have a primary healthcare provider. Likewise, Nurse Practitioners are in short supply in both triangles, although 35% of Texas rural counties have more NPs than primary care physicians. In counties lacking local access to health care, limited public transportation in rural areas can make it difficult for residents to reach medical facilities, especially for those who do not own a vehicle or cannot drive. Rural areas often have higher rates of poverty and unemployment, which affect residents’ ability to afford healthcare services and health insurance. Interestingly, in West Texas, the per capita contribution to the Gross Domestic Product of Texas is $1,442.35, while in Central Texas, it is $1,447.04. A scant difference.
Texas has one of the highest uninsured resident rates in the U.S., which is more pronounced in rural regions. Rural residents are older and have higher rates of chronic conditions like diabetes, heart ailments and skin cancer, which worsen with limited healthcare access. The average life expectancy in West Texas is 73 compared to 77 in the megaregion. Telehealth has emerged to improve access, but not all rural areas have broadband infrastructure to support telehealth.
According to the Association of American Medical Colleges, the debt load of medical school graduates helps determine where physicians practice. According to the Journal of the American Medical Association, attractive loan forgiveness programs encouraging physicians to relocate to rural regions have steadily declined. Urban Texans benefit from denser healthcare networks, more hospitals, specialists and insured patients, leading to comparatively easier access to care. As noted, 21% of the West Texas counties do not have a single primary care provider compared to only one county in the Megaregion Triangle that does not have a physician.
Statewide, 64 counties in Texas are considered “frontier” (less than seven people per square mile) with few rural hospitals. While rural populations are sparse and scattered, they produce the food, fuel and fiber that feeds, powers and clothes our state and nation. Per capita, rural Texans make a nearly similar contribution to the state’s GDP as the megaregion. Yet, BMC Health Services Research reports that nearly three times more rural Texas counties are Primary Care Health Professional Shortage Areas than urban counties. For example, a 2024 study found 196 of the 254 Texas counties had no cardiologist, pulmonologist or endocrinologist within a 50-mile radius, according to a National Library of Medicine study recording “Physicians Deserts.” Again, a 2022 analysis found 26% of Texas rural hospitals at high risk of closure, up from 16% in 2020, according to the Texas Hospital Association, leading to cutting services. Only 40% of rural hospitals deliver babies. In West Texas, 25% of the residents have no health insurance. The Texas Tribune has reported extensively on health insurance differences in Texas, noting that Texas has the highest uninsured rate (17%) in the nation.
A January 2023 survey found that roughly 75% of Texas physicians use telemedicine. Unfortunately, vast expanses of the food, fuel and fiber triangle lack reliable high-speed internet. A single case reported by the Texas Tribune in Ralls (Crosby County) reports, “With no hospital or specialist in town, residents rely on facilities in nearby cities. As noted, the closest full-service hospital is in Lubbock, about 30 miles away. This distance creates a heavy burden: residents like Kathylynn Sedgwick must drive her 83-year-old mother (and other relatives) to Lubbock multiple times a week for various doctor appointments.” When I visited Ralls High School on November 16, 2019, the superintendent shared his observation that many folks were leaving the area because of the lack of access to health care. Nurse Practitioners are helping bridge the gap at The Ralls Family Medicine Clinic.
The Texas Legislature has committed approximately $160 million in funding to the Panhandle State Hospital in Amarillo—the first in the Panhandle. In response, WT’s College of Nursing and Health Science has added behavioral health nursing specializations and advanced practice nursing programs to assist graduates in serving Texas’s food, fuel and fiber-producing region.
Rural Texans face many healthcare obstacles: too few providers, too little insurance coverage, long distances to care and inadequate infrastructure such as broadband. The tragic reality is that rural Texans suffer higher rates of preventable disease and mortality. The Texas Triangle people who produce food, fuel and fiber deserve access to health care. It is not only right; it is good business. WT is taking the challenge seriously.
Walter V. Wendler is the President of West Texas A&M University. His weekly columns, with hyperlinks, are available at https://walterwendler.com/.
