Forty-three million Americans live in rural areas with primary care shortages. For the hospitals and health systems serving them, workforce instability is one of the top strategic challenges. Physician and clinician shortfalls, burnout and thin talent pipelines limit access and stretch already-lean operations. The strain is especially acute in markets hit by closures and consolidations.
While short-term interventions offer temporary relief, leaders increasingly recognize that lasting stability requires more than recruitment incentives. Chris Gallagher, MD, founder and chief strategy officer at Access TeleCare — an athenahealth customer — pointed to an aging workforce, employed-physician churn and the waning returns of fixes like locum tenens staffing.
“The idea that you could pop in a locums cover for a few months and then bring in a full-timer — it’s just very challenging,” he told Becker’s Healthcare. “These locum assignments are getting longer and longer, so rural systems and hospitals are starting to look for options.”
Instead, executives are investing in long-term solutions rooted in education, partnerships and structural alignment, alongside care-model redesign. This article, the third in a four-part series, “Rural healthcare excellence in 2026: 26 lessons in making less do more,” explores seven ways rural healthcare leaders are strengthening the workforce through long-range planning and cross-sector collaboration.
1. Compete on culture, not compensation
For rural healthcare organizations that often can’t match urban pay, culture is the rare retention lever that costs nothing — built through small, everyday choices: mutual respect, front-line empowerment and protected well-being.
Kevin Stansbury, CEO of Lincoln Health in Hugo, Colo., credits that approach for going nearly two decades without relying on agency nurses. “I can foster an environment where our medical staff is very respectful to other clinical staff, and that our service and support staff feel empowered to do the right thing,” he told Becker’s. “Those are the kinds of things we can do, and it doesn’t cost me any money to do that.”
Sourcing matters too. Mr. Stansbury’s team works with an immigration law firm to recruit international nurses, then screens thoroughly for clinicians who actually want to live in a remote community, which is a trait culture can’t manufacture after the fact. His bottom line: “We can’t compete financially, but we can whip the urban systems with our culture.”
Across rural systems, that culture is increasingly built on well-being. Soniya Fidler, president of UCHealth Yampa Valley Medical Center in Steamboat Springs, Colo., believes protecting staff is a core employer duty amid pressures that range from workplace violence and burnout to housing and childcare costs. “We must take care of our people with the same level of safety, quality and accountability that we give our patients,” she said.
2. Grow your own — and keep talent local
The longest-range workforce strategy begins well before a job application: grow-your-own pipelines that recruit students from local schools.
Georgetown, S.C.-based Tidelands Health teamed with the county school district and a technical college to enroll high school juniors in health science courses, cover two years of college tuition and guarantee a job after graduation. Its first cohort drew 15 students, with a goal of 50 a year across nursing, medical assisting and EKG technician roles.
“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,” Jeremy Stephens, Tidelands’ CHRO, told Becker’s.
Other systems start even earlier. Sky Lakes Medical Center in Klamath Falls, Ore., built a career and technical education center with its school district and community college, letting high schoolers work in its facilities.
“We started that two years ago because students were saying, ‘I want a healthcare career, but I don’t know where to go,'” CHRO Bryan Fix told Becker’s. “We wanted to support them while they were still in focused career and tech ed programs in high school.”
3. Put every clinician at the top of their license
With physicians scarce, the highest-leverage move is often structural: redesigning teams so every clinician works to the full extent of their training. Policy is pushing the same way. Signaling that shortages can’t be solved by physician supply alone, CMS built scope-of-practice into its $50 billion Rural Health Transformation Program, rewarding states that grant nurse practitioners, physician assistants and pharmacists fuller practice authority, especially in primary care.
Redesign also means reassessing who does what as virtual and in-person care blend. Dr. Gallagher of Access TeleCare said organizations are getting honest about where virtual care’s “ceiling” lies — which capabilities translate to a screen and which don’t. Some specialties, like infectious disease, can be handled almost entirely from afar; others, like behavioral health, still benefit from a clinician walking the halls to observe patients.
Making those virtual care assessments helps organizations “define the role of the virtual team and the role of the in-person team,” Dr. Gallagher said. “It’s important to decide who does what, where the value is created for each.”
4. Make telehealth a ‘force multiplier,’ not a stopgap
The clearest reframe is treating virtual care not as an emergency patch but as permanent infrastructure that augments a scarce workforce. Rural leaders are investing accordingly: in a Black Book Research survey 63% of rural and critical access hospital stakeholders said they were prioritizing telehealth and remote-monitoring expansion under the RHT Program.
Dr. Gallagher described the payoff of telehealth investments as a “force multiplier.”
“If we’re doing it right, we’re hitting on all four at once,” he said, referring to access, staff stability, outcomes and finances. The staffing relief is immediate; when a remote team covers the ICU every night, it can help eliminate the overnight coverage gap, and with it the late-night transfers it once forced.
Virtual care can also extend the clinicians a hospital already has. Rather than replace a retiring specialist, virtual coverage can lighten the load enough to keep them on staff for years longer, according to Dr. Gallagher. With half the rural physician workforce over age 55, that kind of partial support is becoming essential.
5. Redesign and right-size the model, not just the staffing
Stabilizing the workforce also means reenvisioning the model it staffs — keeping care local, matching services to demand and leaning on system affiliation, now common to 68% of U.S. hospitals.
At Chicago-based CommonSpirit Health’s Central Region, leaders are keeping recovery local. “We’re expanding our use of swing bed programs across our critical access hospitals to create a more coordinated care model — reducing the length of stay at tertiary hospitals while allowing patients to recover closer to home,” David Jones, critical access market president, told Becker’s, citing a 25% year-over-year increase in swing bed days.
At Troy (Ala.) Regional Medical Center, CEO Rick Smith has right-sized service lines to prioritize high-demand core services like emergency care and outpatient diagnostics while matching staffing to demand. The effort has improved operating margins, length of stay and throughput, he told Becker’s.
6. Tame the red tape that flexibility creates
Multi-site and virtual care coverage unlock flexibility, but they also pile on regulatory work that thinly staffed rural organizations struggle to absorb. The federal government is trying to ease that friction: CMS weighted participation in interstate licensure compacts when scoring states for RHT Program funding.
The scale is daunting. A single physician practicing across state lines may juggle dozens of hospital privileges, multiple state licenses and payer enrollments — and Access TeleCare’s roughly 800-clinician group processes some 1,200 hospital privileges and 200 state licenses a month.
For rural hospitals, the practical answer is often a partner that absorbs the paperwork. “We take all that risk on ourselves,” Dr. Gallagher said. “Our goal is to de-risk this and make this super complex process as simplistic as we possibly can for the hospitals, so that the burden is as light as possible for them.” That extends to getting paid. Access TeleCare runs claim submission, denial management and payment posting for those encounters on athenahealth’s revenue cycle technology — the back-office engine that keeps distributed, virtual-heavy care financially viable1
7. Forge partnerships beyond your walls
No rural system solves its workforce challenges alone, so the most durable strategies are increasingly collaborative. Named its state’s center of excellence for rural healthcare development, the University of Tennessee Health Science Center uses state grants to lead rural training but sees partnership, not its own footprint, as the engine.
“We can’t do it by ourselves…we work with hospitals across the state,” Raaj Kurapati, the center’s executive vice chancellor and COO, told Becker’s, describing efforts to extend those ties to rural hospitals and clinics.
Others are scaling the pipeline itself. The University of New Mexico Health Sciences Center in Albuquerque is preparing to break ground on a new school of medicine designed to double its graduating class over the next decade — a project it has driven from concept to design in roughly two years, propelled by strong state support. That pace, said Rebecca Napier, its vice president of finance and administration, depends on partnership reaching well beyond the institution.
“In order to be able to do this type of large-scale project in an area like this, at such a fast pace, it has become incredibly important to not just have that alignment internally, but also externally as well,” she said.
Reframing scarcity as operational discipline
Culture and education pathways deepen the local talent pool; top-of-license teams, telehealth, care-model redesign and lighter administrative loads stretch the clinicians already in place, increasingly enabled by technology that strips out friction. Together, they reframe scarcity not as a ceiling but as a discipline.
Technology is the quiet through line — the infrastructure a scarce, distributed workforce runs on. It’s a role athenahealth fills across thousands of practices, rural and community health centers among them, and the revenue-cycle backbone behind Access TeleCare’s model.
For all the technology, the stakes remain human. “Do not give up on rural health. It is an incredibly important piece of the healthcare fabric,” Dr. Gallagher said of rural areas. “It’s a big deal for those 20% of Americans that live there — 60 million people. It’s the size of France or England. It’s a country upon itself. It’s important that we’re serious about making sure care stays open and available.”
1 These results reflect the experience of one particular practice and are not necessarily what every athenahealth client should expect.
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