Medical deserts are expanding across New York as its population declines and ages, leaving rural counties like Greene and Ulster among the hardest hit. For residents of the Overlook Region, just finding a doctor—or securing an appointment within a reasonable timeframe—has become a daunting challenge. An August report from State Comptroller Thomas P. DiNapoli confirms what locals have long known: health care access in rural New York is scarce, unevenly distributed, and increasingly strained.

Greene County emerged in DiNapoli’s study as one of the most underserved counties in New York, with some of the lowest numbers of primary care and specialty physicians per capita. The findings underscore what he called “an alarming lack of access to basic care in many counties”—a shortage that threatens not only health outcomes but also the viability of rural communities as places to live and work.

“The ability to access health care is an essential quality of life issue,” DiNapoli said in the report. “Without access, rural New Yorkers may have worse outcomes and have difficulty attracting people to live in these regions of the state that have so much to offer.”

Rural areas across the U.S. face similar pressures, but New York’s demographic shifts compound the crisis. Greene County’s population has fallen 5% since 2010, and Cornell University projects another 7% statewide decline by 2050. Greene’s median age is now 47, and 17% of residents are 70 or older—well above the national average of 12%.

The physician shortage is stark. Greene has fewer than five family doctors for its 48,000 residents, only one OB/GYN, and roughly two pediatricians. The county has about three primary care doctors per 10,000 people, near the bottom among rural counties. Ulster fares slightly better at six per 10,000, but both trail the national average of eight.

At Tannersville Family Care, the earliest appointment is two months away. At Bridge Street Medical in Saugerties, new patients are being booked into November. Greene County has no hospitals, forcing Hunter residents to drive nearly an hour to Hudson, Albany, or Kingston for inpatient care. In Olive, the trip is about 35 minutes to Kingston’s Health Alliance Hospital.

Specialty care is also scarce: Greene has four dentists per 10,000 residents, compared to Ulster’s seven. Physician assistants, nurse practitioners, and mental health practitioners help fill gaps, but their numbers remain below benchmarks.

For residents, the statistics translate into lived hardship.

Pat Damrow, 73,  a Glenford resident who retired in 2022, said it took six months to secure a primary care appointment. “Most practices were not taking new patients,” she said. “And many would not take our insurance that had been accepted all over Westchester County.”

Damrow added, “Our follow-up challenges have been finding specialists within a 30-mile radius. We are still working on this and realize that access to healthcare—in a timely manner and who will accept our insurance—is always going to be a challenge here.”

Saugerties resident Jo Cicale, 77, emphasized the lack of mental health services in the region, and made a direct link that when these services are lacking, people with addictions are not getting support which compound the problem and can often lead to suicide.  “We need to see much greater attention to the mental health needs of our people,”said Cicale, who has advocated for mental health services for decades.

“Primary care doctors do the best they can, but they are not equipped to take this one,” Cicale said.  She commended Ulster County Executive Jen Metzger and Sheriff Juan Figueroa for “good faith efforts” but said, “They can only do so much when medical and social work resources are limited.”

While DiNapoli described the findings as troubling, he pointed to opportunities if the state invests in rural health. “Addressing gaps in the rural health care workforce to alleviate current shortages and plan for future demand will not only positively impact the health of rural New Yorkers, but also has the potential to create new jobs and bolster rural economies,” according to the report.

David Sandman, president of the New York Health Foundation and a West Shokan resident, agreed the crisis is longstanding. “There is no single magic bullet that will solve the problem,” he said in an interview. Long travel distances, restrictive licensing rules, and underutilized telehealth compound the challenge.

Sandman urged New York to join the interstate licensing compact—now adopted by 30 states—to make it easier for doctors and nurses to practice across borders. He also pointed to programs like “Doctors Across New York” and “Nurses Across New York,” which provide recruitment funds, salary support, and student loan forgiveness.

Another barrier, he said, is New York’s “scope of practice” rules. Unlike every other state, New York does not allow medical assistants to give vaccinations, leaving only doctors and nurses to administer shots. “Removing this obstacle would free up doctors and nurses to be more available to handle more pressing patient concerns,” Sandman said.

As residents continue to navigate medical deserts, local support services include:

• Mid-Hudson Valley Health Centers | The Institute for Family Health
  
• Mental Health Association of Ulster County
  
• Greene County Rural Health Network

Scott Widmeyer is co-founder of The Overlook. Reach him at scott@theoverlooknews.com.