Rural healthcare is entering a period of widespread change, with financial strain and workforce shortages now running up against new policies and shifting demographics that could reshape how care is delivered, according to a March 12 research summary from Brookings.
Here are four trends shaping rural healthcare, drawn from a research summary of the America’s Rural Future symposium, hosted by Brookings and the American Enterprise Institute, which convened healthcare leaders, researchers and policy experts:
1. Rural physician shortages — both current and projected — are driven by a mix of factors, including the cost and structure of medical training, where training programs are located, how few rural students enter medical school and the lifestyle considerations that influence where physicians ultimately settle, panelists said.
Pulling outside physicians into rural areas is unlikely to close workforce gaps on its own, symposium participants said. Recruiting rural students into medicine, building training pipelines in rural-serving institutions, lowering the cost of medical school and leaning more on advanced practice providers are likely to have a bigger positive effect.
By 2037, only 68% of demand for rural primary care physicians is expected to be met, compared to 73% nationwide, according to projections from the Health Resources and Services Administration.
One rural hospital tapping into local talent is Georgetown, S.C.-based Tidelands Health, which partnered with a local school district and technical college to create a healthcare pipeline starting in high school. The program gives participants free tuition for their first two years of college and guarantees employment with the organization after graduation.
“Georgetown County, where our hospital is located, has an underserved population,” CHRO Jeremy Stephens told Becker’s in November. “The hospital is by far the largest employer. It’s really important to find folks that want to stay in the area and can grow. If we do this for five years, that’s 250 people who are working for us and getting a chance at free education, which they may not have had covered otherwise.”
2. As more rural patients travel outside their communities for specialized care, participants suggested policymakers focus on keeping primary care close to home while routing more complex services through regional networks or partnerships with metropolitan health systems. Panelists noted that emergency, acute, specialty and primary care each call for different design considerations.
System affiliation is already widespread, with 68% of U.S. hospitals belonging to a health system, according to the American Hospital Association. David Jones, critical access market president for Chicago-based CommonSpirit Health’s Central region, told Becker’s in April that the future of rural healthcare will depend on stronger integration with larger systems. The region is expanding its swing bed programs to critical access hospitals to create a more coordinated model, reducing the length of stay at tertiary hospitals while allowing patients to recover closer to home, Mr. Jones said.
“We’re already seeing strong results, including a 25% year-over-year increase in swing bed days, reinforcing that this approach improves both access and long-term sustainability for rural hospitals,” he said.
3. The policy landscape is shifting on several fronts at once: Medicaid changes under HR 1, the end of enhanced ACA subsidies and the launch of the Rural Health Transformation Program. Symposium participants warned that rural residents are especially vulnerable to losing coverage, and providers will likely feel the squeeze as patients shift toward private plans — including Medicare Advantage — that carry lower reimbursement rates and tighter coverage rules.
4. The Rural Health Transformation Program could open the door to new approaches, but panelists said its effects will hinge on how flexibly it is implemented. Participants also cautioned it will not make up for coverage losses or resolve the deeper financial pressures rural systems are facing.
Rural leaders who spoke with Becker’s have also been skeptical.
“Each state is translating how to implement this Rural Health Transformation fund,” Sommer Kleweno Walley, associate vice president of medical affairs at the Seattle-based University of Washington and CEO of Harborview Medical Center, said in April. “I’m very much worried that it’s not going to be transformative in nature. There are so many hospitals that are in so much trouble from a stability standpoint. I’m not sure it’s going to do what it’s trying to do because they can’t transform right now when they can’t pay the payroll.”
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