Medical schools try to fill the need for specialists in rural communities by creating programs with that aim

   

Some medical schools are looking for students willing to
locate in rural communities. (Javia Truba via Sunsplash)

Looking beyond the overall shortage of healthcare professionals in rural America, some medical schools are focusing on producing and placing specialists, reports Liz Carey in The Daily Yonder. The report notes that even in communities with a primary care physician, there is likely no cardiologist, surgeon, or even a dentist.

Medical schools serving those areas also recognize a growing elderly population, Carey reports. “Research has shown that rural areas already have more residents 65 and older (19%) than urban areas (15%), and that share is growing. Researchers expect the percentage of older people in rural communities to grow by more than 40% by 2034, making the disparities in care a larger concern.”

Medical schools from coast to coast are focused on addressing this issue. Carey’s report mentions the Quillen College of Medicine at East Tennessee State University, The University of Washington (with a program serving five states), The University of New Mexico School of Medicine, and the University of Minnesota Medical School, all of which have programs aimed at sending their graduates to rural, underserved areas.

Dr. Bill Block, dean of the Quillen College of Medicine at ETSU, told Carey: “Our surgical residency is designed specifically to prepare physicians for practice in rural and underserved communities, where access to subspecialists is often limited. … In rural areas, general surgeons must be prepared to manage a broader scope of cases independently.”

As much as the training needs to be focused on rural needs, funding is needed to provide incentives for students to go to rural areas. Some of the programs created by Congress for that purpose have expired, and new proposals have been stalled. And it is difficult to find students willing to locate in rural areas.

The Daily Yonder story cites a 2026 Medicus Firms survey: “Among physicians under 40, zero percent indicate a preference for rural practice,” the survey said, “while 12.5% of physicians age 60 and older express interest in rural settings. This generational gap is one of the most consequential physician recruitment challenges organizations face in 2026.”

Opinion: Rural Americans rely on immigrant physicians for care, but new restrictions will leave them with fewer doctors

Rural hospitals have relied on foreign-born doctors
to provide care for decades. (MedPage Today photo)

Rural communities already struggle to staff their hospitals and clinics with physicians of all types, from specialists to family practitioners. The Trump administration's failure to make progress on immigration changes and the newly established $100,000 fee for each new H-1B visa application, which has no exemption for health care workers, will leave rural Americans with far fewer doctors to treat them, writes Manav Midha in his opinion for MedPage Today.

The difference in the number of physicians and the availability of specialists between urban and rural locations is stark. Midha writes, "There are approximately 263 specialists for every 100,000 people in urban areas compared to 30 for every 100,000 people in rural areas, and 46% of counties (and 86% of rural counties) have not a single cardiologist."

For decades, rural communities have relied on immigrant doctors for their care. Midha explains, "Foreign-born physicians are uniquely willing to serve rural communities even when few others move there. Immigration restrictions risk cutting off one of the last remaining lifelines for rural healthcare access."

Immigrant doctors who came to the U.S. in the 1980s and 1990s were able to obtain J-1 visas, which "allow for a path to permanent residency if a doctor works for at least 3 years in an area with underserved healthcare needs," Midha adds. They cared for patients in "rural Indiana, deep Appalachia, coastal Louisiana, and parts of Texas, hours from the closest city," where few American graduates wanted to live.

Congress could expand the Conrad 30 program to add some physicians with J-1 waivers who can treat in rural communities. "The bipartisan Conrad State 30 and Physician Access Reauthorization Act would have expanded (albeit slightly) the number of spots and extended the program. It was initially introduced in Congress in 2023 and again in 2025 but has seen little movement," Midha writes.

In the face of the current shortage, some states are developing their own approaches to help rural communities secure access to doctors. Midha writes, "At least 18 states, led by Tennessee, have enacted laws permitting internationally-trained physicians with appropriate experience to practice medicine without having to repeat medical residency."

Meanwhile, some rural communities may face a more severe shortage of physicians, and residents will have to travel longer distances for care. Expanding and developing paths for immigrant physicians "is not merely a moral imperative -- it is an economic one," Midha adds. "And it is one that can address one of the greatest challenges to equitable care."

Emergency departments in some rural areas don't have 24/7 on-site physician coverage

A hospital in Ekalaka, Mont., sits at the intersection of two dirt roads. 
(Photo by Arielle Zionts, KFF Health News) 

Many rural emergency rooms are no longer run by attending physicians, but instead depend on care by nurse practitioners and physician assistants. "A recent study found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7," reports Arielle Zionts for KFF Health News. "More than 90% were in low-volume or critical access hospitals — a federal designation for small, rural hospitals."

The 2022 report represents "82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government," Zionts writes. "The study is the first of its kind, so there isn’t proof that such staffing arrangements are increasing, said Carlos Camargo, the lead author and a professor of emergency medicine at Harvard Medical School."

The idea of an emergency department without a doctor on staff remains controversial, and not all states allow it. "Some doctors and their professional associations say physicians’ extensive training leads to better care, and that some hospitals are just trying to save money by not employing them," Zionts explains. Indiana, Virginia, and South Carolina have passed laws that require all their EDs to have a 24/7 physician on-site.

Even when states require their EDs to staff a round-the-clock doctor, that doesn't make finding one easy. "In the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing," Zionts reports. In response to the regional shortage, Sioux Falls-based Sanford Health launched an emergency medicine residency to help increase its ED physician numbers.

Some rural health advocates say lawmakers need to be sure that employing full-time ED physicians 24/7 is feasible for their region before passing legislation that requires it. Zionts adds, "Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it."

Two million rural Americans live in 'dead zones' that lack health care providers and reliable internet service

'Dead zone' counties have three things in common: They lack access to high-speed and reliable internet, primary care providers, and behavioral health specialists. (KFF Health News graphic)

In U.S. communities that lack both medical care providers and dependable internet service, residents tend to "live sicker and die younger than others in America," report Sarah Jane Tribble and Holly K. Hacker for KFF Health News. KFF Health News calls regions that lack both services “dead zones.” Roughly 2.7 million Americans live in dead zones, and the vast majority of those zones are rural.

"In 2023, 83% of residents in non-metropolitan, or rural, counties had access to broadband, compared to over 90% of metropolitan residents," reports Sarah Melotte of The Daily Yonder. Out of the 2.7 million Americans who live in dead zones, "two million, or 70% of them, are from rural counties. That means the rate at which rural residents live in these shortage areas is five times higher than the urban rate."

In some cases, communities leverage broadband service and telehealth care to fill in for a lack of providers; but the absence of both options leaves millions disadvantaged. "Compared with those in other regions, patients across the rural South, Appalachia, and remote West are most often unable to make a video call to their doctor or log into their patient portals," KFF reports. "Both are essential ways to participate in the U.S. medical system."

Without reliable high-speed internet, it's hard to attract and keep medical providers in more remote parts of the country. At the same time, poor connectivity means telehealth care isn't an option. "Connectivity dead zones persist in American life despite at least $115 billion lawmakers have thrown toward fixing the inequities," Tribble and Hacker explain. "Federal broadband efforts are fragmented and overlapping, with more than 133 funding programs administered by 15 agencies, according to a 2023 federal report."

The contrast between "the digital haves and have-nots" is stark. "The KFF Health News analysis found that counties with the highest rates of internet access and health care providers correlated with higher life expectancy, less chronic disease, and key lifestyle factors such as higher incomes and education levels," KFF reports. In many rural counties, the lack of reliable high-speed internet access leads to the opposite, where residents tend to live unhealthier, poorer and shorter lives."

As measles spread in west Texas, the state's 'lackluster investment' in rural health care systems is exposed

Measles is a highly contagious disease
caused by a virus. (Adobe Stock photo)

As the number of diagnosed cases of measles continues to climb, the outbreak in rural west Texas has exposed a health care system that is unprepared to handle even a smaller-scale contagion, reports Pooja Salhotra of The Texas Tribune. "Aging infrastructure, a dearth of primary care providers and long distances between testing sites and laboratories plague much of rural Texas, where the measles outbreak has concentrated."

A few years back, rural Texas was ravaged by Covid infections. Like Covid, the recent measles outbreak is "revealing how a lack of public health resources leaves rural communities vulnerable," Salhotra explains. "What’s left are local leaders forced to scrape together the few tools they have to respond to an emergency, contending with years of lackluster investment from the state and federal level to proactively prevent emerging public health threats."

A lack of hospitals, physicians and dilapidated facilities are just some of rural Texas' health care woes. "Some 64 Texas counties don’t have a hospital, and 25 lack primary care physicians," Salhotra reports. "Swaths of Texas have scant resources for public awareness campaigns. And they lack sufficient medical staff with expertise to provide the one-on-one education needed to encourage vaccination and regular visits to the doctor."

To slow the spread of measles, "rural health care teams have cordoned off spaces to conduct measles testing," Salhotra writes. They've "used social media to blast residents with information about vaccination efficacy and schlepped throat swabs across counties to ship them to a state lab in Austin — the only public state facility that was conducting measles testing until the Texas Tech University Bioterrorism Response Laboratory, part of a national network of CDC-funded labs, began measles testing" recently.

The primary goal of public health is prevention; however, "it’s emergencies that spur the most action, particularly in rural communities," Salhotra explains. "It was only after a school-aged child died from measles that state and federal support intensified."

Currently, Texas "spends less on public health per person than the vast majority of other states, according to the State Health Access Data Assistance Center, whose analysis shows Texas spent $17 per person on public health in 2023. A decade earlier, the spend was $19," Salhotra reports. "The low levels of state funding particularly hurt rural communities that have higher rates of uninsured Texans and more senior citizens with greater health needs."