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Small Cities Weekly | 08.25.2023
Traveling Sales, Healthcare Shortages, & Small City Culture
As part of the work we are doing on the Small City Segment, we send out a brief weekly post of thoughts, links, and research in progress that reflect the week’s work. I’d love to hear from you if you have any thoughts, questions, disagreements, or things to add. Please forward this on to people you think might enjoy reading it.
As you’ll see if you make it to the What I’m Working on Section below, one of the things I’m researching is the weird industry niches of small cities and how they came about. I’ve dug into a few in Indiana already and they are all great stories of happenstance and ingenuity.
One theme across the three cities I’ve looked at so far is they all had a tie to a “traveling salesman” of some sort (all in wildly different ways!). I’m curious if this is going to be a theme with others as well. In a lot of ways in makes sense - the traveling sales mechanism created a lot of opportunities for weird capabilities to run into unmet needs.
As that strategy has waned and sales and marketing technologies have moved online and become more optimized and targeted, it seems we’ve lost some of the happenstance that allowed these smaller cities to be the inspiration for unpredictable industries. In the era of the internet, I wonder what new mechanisms we can create that bring some of this magic and randomness back.
According to a 2022 Indiana University report, 52 of Indiana's 92 counties are designated as dental health professional shortage areas. Crawford, Warren and Union have no dentist practicing at all and Union has no dental hygienists as well. Several counties have fewer than five dentists or dental hygienists, according to the report from IU’s Bowen Center for Health Workforce Research & Policy.
None of the counties in the Indianapolis metro area falls into this category, according to the report.
The situation will likely intensify as Indiana is projected to need more dentists in the coming years, due in part to older dentists retiring. The Indiana Department of Workforce Development forecasts a 20% increased demand for dentists in the coming decade, compared with 6% on national basis.
As I dig deeper into healthcare access in small cities, I’m running across all sorts of interesting dynamics. In the dental care case covered above, of the 9 small cities in Indiana, 8 of them are designated as a Dental Healthcare Professional Shortage Area (HPSA). Not only that, but they are increasingly not accepting Medicare patients because the reimbursement rates make it not financially viable. When you add professional shortages to a decrease in access because of the economics, it becomes bleak quick. Stay tuned for a deeper dive on this.
SimilarityIndex | Markets, Trilliant Health
SimilarityIndex™ | Markets is an application that allows you to determine which U.S. metropolitan markets are most similar by the following Index Categories:
This is a pretty cool tool I came across this week in my research. For a certain set of MSAs, you can compare the healthcare landscape with other MSAs and see which are most and least similar on the above factors. I put a few small cities in, and not surprisingly, the most similar MSAs were other small cities on our list.
This Small Ozarks Town—Home to Walmart Headquarters—Is Becoming a New Capital of Cool, Kathryn O’Shea-Evans | WSJ
Bentonville, home to 57,868 people as of July 2022, continues to grow into what feels like a company town as envisioned by Norman Rockwell and the curators of MoMA. The second annual Format Festival, from Sept. 22 to 24, will mix art and music at the Momentary, a satellite venue to Crystal Bridges. Scheduled acts include Leon Bridges, LCD Soundsystem and Alanis Morissette. Bentonville, it turns out, is a bit of a Coolsville but, so far as I could see, without a whiff of pretension.
This article was well-timed as I’m currently reading Sam Walton’s autobiography, Made in America, published 30 years ago. I’m interested in the Wal-Mart story because of its focus on small cities. Started in a small city and specifically serving small cities, it is the largest company in the world by revenue.
It was cool to see the scene around food, art, and family that is being built in Bentonville. Small cities often catch the “but there’s nothing to do” criticism by default. As this article shows, it doesn’t take millions of people to have an interesting place to live and visit.
What I’m Working On
These are threads I’m pulling on for future posts. I’m not sure if they will make the cut yet for a full post, but I’m trying to learn as much as I can about them to find out. Any and all resources, connections, or first-hand accounts are welcomed!
Healthcare Access: Most of my research time is being spent on this currently. My biggest questions/requests at the moment are:
MSA-level data on both insurance and provider dynamics - I have this resource from the American Medical Association, but looking for more
Any resources or people who understand the economic and reimbursement dynamics between specialty services and general services
Small City Industry Niches: After writing the More of Different post, I started to get interested in what weird industry niches exist in small cities and how they came to be. I’ve already looked into the ones mentioned in the post (speciality insurance in Fort Wayne, orthopedics in Warsaw, and RVs in Elkhart) and the stories are fascinating and worth sharing. If you have any other suggestions, I’d love to hear about them. I’ll definitely be putting a post (or many) together on this topic.
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