Access to medical care is a major issue in the United States, where there are great disparities in the level of quality health care dependent on where people live. While these differences can sometimes be due to the state one lives in, most often they can be correlated to the size of the local population. Consequently, people living in rural areas have significantly less access to medical professionals. Moreover, not only are the hospitals few and far between in rural counties, but the size of these hospitals is also much smaller.

An insight into hospitals located in the state of New York can be seen as a microcosm for the country as a whole. This report will analyze Mount Sinai Hospital in urban Manhattan and Lewis County General Hospital in a rural town in upstate New York called Lowville.

Mount Sinai Hospital was ranked the 16th best hospital in the country by US News and World Report, as well as being ranked the best hospital in the country for patients over 75 years old [1]. This is largely due to the extensive surgical staff available to patients at the hospital. There are hundreds of surgeons who are Mount Sinai physicians, meaning they are employees under Mount Sinai hospital, and there are hundreds more that are Mount Sinai affiliates, meaning they “contribute to the Health System's mission of providing excellent patient care” by performing their surgeries at Mount Sinai Hospital despite not being employees [2]. Many of these physicians attended top-ranked medical schools and trained at top medical institutions as well.

Along with a large staff of surgeons come many more specialties. The hospital contains surgeons from dozens of specialties, and each specialty contains many physicians. Having many physicians within each specialty is very important. Not only does this prevent one single physician from being overscheduled, but it also allows for physicians within each specialty to have a subspecialty. For example, out of the 28 listed Mount Sinai Hospital neurosurgeons, some of the surgeons are listed as specialists in spinal surgery or pediatric neurosurgery [2]. Patients are able to see a surgeon that specializes in the specific medical condition they need help with, allowing them to be more confident in their physician.

Lewis County Hospital is a much smaller operation than Mount Sinai. This hospital has only five employed surgeons: one neurosurgeon, one ophthalmologist, and three general surgeons, with one specializing in colon and rectal surgery [3]. These five surgeons cannot possibly meet all of the medical needs of their community. As a public hospital, Lewis County Hospital receives their funding through taxpayer money, and with fewer taxpayers in the county, it is much more difficult to pay hundreds of employees and purchase state-of-the-art equipment. While it is true that Lewis County Hospital serves fewer people, since the county has a population of about 26,000 people which is much less than the population of New York City, that is by no means an indication that these people deserve inferior quality medical treatment than people living in New York City [4]. For example, if someone living in Lowville, NY needs emergency cardiovascular surgery, they may have to drive for hours until they reach a hospital with a properly trained surgeon. This is occurring in New York, which is the 10th-ranked state in health care access [5]. In states ranked at the bottom of the USA, it may be impossible to find the right surgeon. Rural areas also contain less public transportation options. If the patient does not own their own form of transport, it can become extremely difficult to reach a hospital, which is very serious in emergency situations.

Outside of the surgeons and surgical services offered, there are many other reasons why Mount Sinai provides higher-quality health care. Mount Sinai Hospital’s surgeons speak 24 different languages, allowing for non-English speakers to still communicate effectively with physicians. This factor helps generate both trust between patients and physicians and health literacy among patients, allowing them to make more informed decisions about their care. Additionally, the Mount Sinai website lists 43 different insurance companies whose health insurance they accept [6]. The corresponding number is not listed on Lewis County Hospital’s website, but, due to its size, the number is likely smaller. There is an immense difference in technology as well, as the increased funding of Mount Sinai allows them to buy state-of-the-art surgical robots and medical devices that small-scale hospitals simply cannot afford. Even simple things, such as having a more informative website, set the two hospitals apart, with the Mount Sinai website containing more information that can be easily found by patients.

Solutions to this issue are complex, as small hospitals cannot afford to pay hundreds of surgeons when the demand for their work is not the same as in urban settings. Yet motivations to provide equitable care can drive interventions, despite the fact that they require sometimes costly investments. Such initiatives should be evidence- and community-based, and they should aim to meet individuals where they are. They should also consider local contexts — including cultural, political, and geographic factors — to ensure that they are properly suited for the target community. Employing these strategies will help to ensure that all people have access to the best possible health care.