As a family physician with decades of experience caring for underserved communities, I have seen firsthand the challenges we face in providing high-quality, accessible care to our patients. Limited resources, geographic isolation, and a chronic shortage of clinicians often force us to do more with less — treating problems that may seem outside the purview of our specialty. Once while working in a small Maine ER, I had a patient present with multiple significant lacerations on his leg caused by a chainsaw injury. We were hours away from an available surgeon, so I used a combination of sutures and staples to do the repair myself.
Situations like these, where resources are more limited, require creative solutions. One emerging option is artificial intelligence (AI), and in particular generative AI (genAI), which learns patterns from training data and responds to human prompts to create new content. Using these tools offers new hope for revolutionizing how we practice medicine in rural settings. Whether or not we feel ready for it, AI is here, and it has the potential to transform all of heath care. It is important for rural and non-rural practitioners alike to better understand where things are now, and where we may be heading.
Expanding Access to Expert Knowledge
One of the greatest benefits of AI is its ability to provide rural physicians with instant access to the collective knowledge of the medical community. Advanced language models trained on vast medical datasets can serve as “digital consultants,” offering evidence-based answers to clinical questions and assisting with differential diagnoses. When I precept new practitioners in primary care, I keep multiple sources at my fingertips, and have found that experimental genAI tools like OpenEvidence add a valuable perspective to our more complex diagnostic questions. This perspective may be particularly valuable in rural settings where specialists are scarce. AI is increasingly being used to assist with decision support, as practitioners draw upon an expanded base of information, paired with their own clinical judgment, to explore treatment options with patients. By engaging with AI from respected sources, rural practitioners can expand their clinical acumen and provide expert-level care, regardless of location.
Enhancing Wellness and Communication
AI may also help us address the chronic shortage of rural heath care practitioners and lead to more longevity in the profession. AI can be used to monitor stress levels, identify signs of burnout, and provide personalized recommendations for self-care. By automating routine tasks and streamlining workflows, AI can free up more time for meaningful patient interactions. While this is important in all clinical settings, it is particularly important for primary care patients in rural areas, given that they may have a more limited number of visits with their practitioner.
GenAI is also useful in communicating with patients and among team members: I’ve used genAI tools for everything from creating presentations to identifying pertinent resources and customizing my writing to a specific group. I tapped into Claude.ai to generate potential titles and suggest references for this article, for instance. Last month I worked with Bing’s CoPilot and ChatGPT’s DALL-E to design Google slides when discussing team-based care with a group of fellows specializing in preventive medicine. In short, AI has helped me enhance existing skills and has served as a great place to find inspiration when planning or revising a project.
I believe it’s imperative that physicians explore the potential utility of these AI assistants. Incorporating AI training into medical education is a great place to start — doing so can give the next generation of physicians more tools for their clinical toolbox.
Promoting Digital Health Literacy and Equity
As we continue to address social determinants of health in rural areas, we also need to understand digital determinants of health, including digital health literacy and digital health access. Many of our rural patients have limited access to — and experience with — technology, and don’t fully understand how AI could positively impact their care. Rural family medicine practitioners have a unique opportunity to educate patients about AI and empower them to become active participants in their digital health journey. By promoting digital literacy, we can help bridge the digital divide and ensure that all patients, regardless of location or socioeconomic status, benefit from AI-assisted health care.
As we integrate AI into rural practice, we must prioritize digital health equity. This means ensuring that AI tools are developed and deployed in a way that does not exacerbate existing health disparities. When we are given the opportunity to engage in AI-related pilot projects, or work remotely with technology innovators, we can demonstrate our willingness to be involved on behalf of our patients. We must advocate for inclusive AI that takes into account the unique needs and challenges of the populations we serve. Rural practitioners have a deep understanding of their communities and can provide valuable input to ensure that AI is designed for the benefit of all.
Becoming Digital Citizens
A lack of inclusivity is one of many possible risks when it comes to AI. GenAI relies on large datasets and human-built algorithms that represent a potential source of bias, and that have prompted ongoing ethical conversations. AI experts in the realms of health, health care, and biomedical science suggest that AI should be “engaged, safe, effective, equitable, efficient, accessible, transparent, accountable, secure, and adaptive.” It is our responsibility as medical practitioners to become digital citizens, and to actively engage with AI technology. This means seeking out training opportunities, staying up to date with the latest AI advancements, and being willing to integrate AI into our practice. Digital tools that are created by others on our behalf are not as useful as those we co-create with experts in the digital health space. By embracing our role as digital citizens, we can not only improve patient care but also serve as role models for our communities in navigating the digital health landscape.
Addressing Concerns and Building Trust
One aspect of being a digital citizen is exploring the barriers to the use of AI. Some have voiced concerns regarding job displacement and the loss of human touch in medicine. AI is not meant to replace practitioners, but rather to augment our capabilities and help us provide better care. We must be transparent about how AI is being used in our practices and involve patients in decision-making around its use. As more AI-assisted digital transcription and clinical decision tools are incorporated into our EHRs and workflows, we can make sure that our patients understand how this impacts the conversation around their health. By building trust and fostering open communication, we can help alleviate fears and ensure that AI is embraced as a valuable aid in rural health care.
AI is quickly being recognized as an essential tool for addressing clinical concerns on the frontiers of medicine. Rural medical practitioners have always utilized their resources creatively, by necessity. By leveraging AI to expand our capabilities, enhance our clinical decision-making, promote digital health literacy and equity, and combat burnout, we can transform rural health care for the better. The future of rural health is in our hands — let us rise to the challenge and lead the way forward.
What potential do you see for AI in your own clinic or practice? Share in the comments!
Dr. Lisa Belisle is a family physician and associate chief medical officer with a rural Maine health care system. She loves running the wooded trails on the island where she lives, and boating the nearby waters with her husband and their six grown children. Watch her weekly video podcast on radiomaine.com. Dr. Belisle is a 2023–2024 Doximity Op-Med Fellow.
Illustration by April Brust
