As a physician who grew up in a small town in central Illinois, I’ve witnessed firsthand the decline of rural health care in America. The hospital where I first became interested in medicine is now half its original size, merged with a larger health system, and struggling to stay afloat. This story is all too common across rural America, where health care access is becoming increasingly scarce, and the challenges for providers are mounting.
The rural health care crisis
The statistics paint a stark picture: while roughly 20 percent of Americans live in rural areas, only about 10 percent of physicians practice there. By 2025, the country is facing a projected shortage of 20,000 primary care physicians in rural communities. This disparity extends beyond primary care to subspecialists, hospitalists, and emergency physicians.
Financial pressures are exacerbating the problem. As COVID-19 subsidies expire and reimbursements decline, rural hospitals are struggling to keep their doors open. A new study by the health analytics company Chartis reveals the dire financial situation of small, rural hospitals. The report shows that 50 percent of these facilities operated at a loss in the most recent year, an increase from 43 percent in the prior year. Furthermore, the analysis identified 418 rural hospitals across the country that are at risk of shutting down due to financial instability.
This financial instability creates a vicious cycle, making it harder to recruit and retain health care professionals, invest in necessary technology, maintain quality care, and remain independent. According to the Chartis study, financial pressures are pushing rural hospitals to merge with or be acquired by larger health care networks. The report indicates that approximately 60 percent of rural medical facilities are now connected to major health systems.
The unique challenges of rural health care
Rural health care providers face a trifecta of pain points: limited access to care, difficulty in delivering high-quality services, and financial constraints. The shortage of health care professionals is particularly acute, with nurses and physicians often drawn to urban areas by higher salaries and more resources.
From a resource perspective, rural hospitals often lack the financial strength to invest in cutting-edge technology and related assets. This technological gap widens the divide between rural and urban health care capabilities, potentially compromising patient care and operational efficiency.
To address these challenges, we need a multi-faceted approach involving policy changes and technological innovation.
Policy interventions:
- Enhanced reimbursement rates for rural health care providers to ensure financial viability
- Expansion of loan forgiveness programs for medical and nursing students who commit to practicing in rural areas
- Increased federal and state funding for rural health care infrastructure and technology
Technology opportunities:
- Telemedicine: COVID-19 demonstrated that telehealth can provide quality care and improve access to specialists. We must continue to invest in and expand these services.
- Interoperability: Seamless sharing of medical data is crucial for coordinating care between rural providers and urban specialists.
- Cloud-based technologies: These can help rural hospitals access specialized care and augment services, even with limited budgets.
- AI and ambient listening tools: While potentially beneficial, these must be implemented thoughtfully to ensure they truly save time for clinicians.
Addressing the shortage of clinicians in rural areas also requires a multifaceted approach to education and training. It is essential to provide support for medical schools that offer programs specifically tailored to rural health care needs. To build a sustainable pipeline of clinicians who understand and are committed to serving rural populations, we need a concerted effort to recruit students from these communities and create incentives for them to return to and practice in these areas.
Specialization and focused care strategies encourage rural hospitals to concentrate their resources on areas where they excel. To ensure access to a broader range of specialties, these hospitals can form partnerships and utilize technology (such as remote patient monitoring and virtual nursing), optimizing their offerings while maintaining care coverage and independence.
The role of health IT
Technology has the potential to be a game-changer for rural health care, but only if it’s designed with rural providers in mind. Too often, rural hospitals are left with scaled-down versions of systems designed for large urban centers. These systems can be difficult to use, implement, and train on, especially without dedicated IT support staff.
We need to advocate for health information technology solutions that address the unique challenges faced by rural health care providers. These solutions should be user-friendly and straightforward to implement — specifically designed to accommodate rural workflows and requirements. The focus should be on enhancing operational efficiency and minimizing administrative overhead. These technologies must be cost-effective and within reach for health care facilities operating with limited financial resources. By prioritizing these aspects, we can ensure that rural hospitals and clinics have access to the technological tools they need to improve patient care and maintain financial stability.
IT leaders in rural hospitals must vocalize their unique needs and demand better solutions from vendors. They deserve tools that enable them to provide the best possible care for their communities, not afterthoughts or hand-me-downs from larger systems.
With 60 million Americans living in rural areas and an aging population, the need for quality rural health care will only increase, and the time to act is now. We must work to prevent further hospital closures and ensure that rural communities have access to the care they need and deserve.
This call to action applies to all stakeholders in the health care ecosystem. Health care providers must advocate for themselves and their patients by making their needs known. Policymakers need to acknowledge the unique challenges of rural health care and enact policies that promote its sustainability. Technology vendors should tailor their offerings to meet the needs of rural providers, focusing on creating efficient, easy-to-use, and affordable solutions. Patients must speak up and engage with local and federal representatives to emphasize the importance of access to rural health care.
Rural health care can be revitalized and made more sustainable by working together and leveraging policy changes, technological innovations, and community engagement. The health of millions of Americans depends on our collective ability to bridge the urban-rural health care divide.
Jay Anders is a physician executive.
