One in 3 U.S. rural hospitals are at risk of closure, according to a January analysis. And nearly 70% of rural counties across the country are designated as health professional shortage areas, according to the National Rural Health Association.
These trends are accelerating the need for transformation in rural healthcare delivery. At the same time, hospital leaders are making key decisions today — particularly around care delivery and workforce — that reflect how they believe healthcare must operate differently in the next five years.
David Jones serves as critical access market president for Chicago-based CommonSpirit Health’s Central Region, where he oversees 16 owned critical access hospitals across four states, three managed hospitals and more than 20 network hospitals. He told Becker’s the future of rural healthcare will depend on stronger integration with larger health systems.
System affiliation is already widespread: 68% of U.S. hospitals are part of a health system. Of the nation’s 6,093 hospitals, 4,157 belong to a system, and 53% have fewer than 1,000 beds, according to the American Hospital Association.
At CommonSpirit’s Central Region critical access hospitals, leaders are prioritizing care models that keep recovery local while improving how patients transition between care settings.
“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,” 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.”
Other rural healthcare leaders are also reevaluating service lines to strengthen long-term viability. Rick Smith, CEO of Troy (Ala.) Regional Medical Center, told Becker’s in January that the hospital has focused on right-sizing and redesigning key services rather than maintaining traditional structures.
The organization prioritized high-demand core services, such as emergency care and outpatient diagnostics, while restructuring lower-volume or higher-cost offerings to improve sustainability. Efforts included expanding outpatient care and aligning staffing models more closely with patient demand — changes that led to improved operating margins, shorter lengths of stay and better throughput, Mr. Smith said.
Workforce investments
Workforce shortages remain a persistent challenge nationwide but are especially acute in rural areas. 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.
Federal policymakers are also targeting the issue. HRSA announced April 7 that it will dedicate more than $135 million to address rural healthcare workforce shortages and expand nutrition services. The funding includes $11.25 million for the Rural Residency Planning and Development Program, which will support up to 15 new rural residency programs in high-need specialties.
Soniya Fidler, president of UCHealth Yampa Valley Medical Center in Steamboat Springs, Colo., said workforce stability will be one of its biggest constraints over the next five years. In response, leaders are prioritizing investments in employee well-being and long-term sustainability.
“In order to maintain operations and continuity of care, and do so successfully, we must take care of our people with the same level of safety, quality and accountability that we give our patients,” Ms. Fidler told Becker’s. “Our teams face increasing pressures every day — from workplace violence and job burnout to rising costs of housing and access to childcare. As an employer, we’re constantly looking at not only the physical environment in which our staff work but also the psychological safety of the workplace.”
In addition to retention efforts, rural healthcare leaders are investing in long-term workforce pipelines. Health systems nationwide — including those in rural markets — are expanding partnerships with academic institutions to strengthen recruitment.
For example, Georgetown, S.C.-based Tidelands Health partnered with a local school district and technical college to build a pipeline starting in high school. Students can take health science courses as juniors, receive free tuition for their first two years of college and secure employment with the system after graduation, CHRO Jeremy Stephens told Becker’s in November.
“Georgetown County, where our hospital is located, has an underserved population,” Mr. Stephens said. “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.”
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