They hit a bunch of factors, but of course the AMA doesn't want to talk about one factor that is present in rural KY, possibly in the rural areas of the other three states singled out as well: piss-poor medical care. The lack of access to preventative care and specialized treatment for serious conditions in rural areas absolutely has to be a factor, imo.
To put it simply, no doctor with any viable career options wants to go slum away in podunk KY. We get the scrubs, and the weird Pakistani doctors who can't speak English and don't give a damn about the ignorant infidel hillbillies they treat. There is no preventative medicine, no health care education, no specialized medicine. Instead we get a bored, bitter muslim throwing hydrocodones at us.
I really don't think an urbanite has any idea what it is like to be ill and have to go to a rural health clinic for treatment.
Add in the bean counters at insurance companies determining what tests and treatments people get and when they can get them. My recent foray into sleep apnea has been an eye opener...
