Rural communities in Western North Carolina often struggle to retain and attract health care professionals. Filling a practice left by a retiring or relocating physician can take months, sometimes years. And the high turnover rate for new doctors in rural mountain counties prompts some community leaders to ask, “Can we even AFFORD a doctor?”

A recent economic impact analysis of the medical services sector in Swain County conducted with the support of the Center for Regional Development at Western Carolina University reveals that a community earns far more from a vibrant medical community than the dollars spent building it.

Results from the study, conducted in cooperation with WestCare Health System, reveal that on average one rural physician employs 3.75 workers in the office and creates four additional jobs in the community. In Swain County, the total impact on employment is estimated at 407 jobs, a net increase of 29 jobs in five years. These are “sustainable” jobs that enable citizens to stay in Swain County, rather than seek employment in neighboring counties or states.

In the fiscal year 2005, the study projects that Swain County will generate $10,818,500 in total health care sector income, a net increase of $707,100 from 2000. Total health care impact is the sum of initial dollar spending — the direct impact — by the health care sector within the local economy plus secondary dollar spending, which is the indirect impact.

The projected total health care sector sales tax for Swain County for 2005 is $132,130, up $8,630 from the 2000 level. Retail sales amounts from the net direct and secondary impacts from the health care sector will increase by $345,500 to a total of $5,284,800 in 2005.

Other contributors of local health care dollars include private insurance companies, consumer out-of-pocket payments and public insurance. When these dollars leave the community, jobs and income go with them.

More than health sector jobs and indirect income are at stake, however. Health care employers and employees purchase goods and services that support local business establishments. Physicians, dentists, pharmacists, nursing home workers, technologists and therapists impact the housing market, retail establishments, restaurants and tourist attractions. Hospitals and other health care providers purchase utility, waste management and other local services.

Health care and health services generate substantial revenues, both in new business activity and in job creation. Jobs in the nation’s health care sector have increased every month since 1993, evidence that the industry is virtually recession proof. Last year alone, the U.S. economy added 300,000 new health-related jobs.

It is obvious that medical facilities and services have a tremendous economic impact on communities. In an era when rural communities are struggling to keep pace with their urban counterparts and retain jobs in the county, the health care sector is a significant “engine” for economic development, one that local and state policy makers should consider in crafting policies to promote sustainable economic growth in rural regions of the state.

Simply put, while recruiting physicians to set up practice in a small community is dependent upon numerous factors, the numbers indicate that the effort is well worth it. Community leaders may ask, “Can we afford a doctor?” The real question should be, “Can we afford not to have a doctor?”

(Scott Higgins is professor of health sciences at Western Carolina University, where he directs the Master of Health Sciences Program. Higgins and graduate student Kristy Karl conducted the study “Measuring the Impact of the Health Care Sector on Swain County, N.C.”)