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.”

In N.C., the $50 billion federal Rural Health Transformation Program won't eliminate health care deserts

North Carolina plans to use its RHTP money on hospitals
and clinics that are open. (KFF photo)

The $50 billion Rural Health Transformation Program Congress created in 2025 to ensure the passage of President Donald Trump's One Big Beautiful Bill Act may sound like it's made to help closed rural hospitals or hospitals on the brink of shuttering, but in reality, the act strictly limits the amount of RHTP grant money struggling hospitals can use to stay afloat.

The RHTP funding restrictions haven't stopped midterm-stumping politicians in North Carolina from touting the program as a salve for rural hospitals in financial straits, report Sarah Jane Tribble and Amanda Seitz of KFF Health News. "Republican candidates in competitive midterm elections are casting the fund as a lifeline that will shore up critical rural health services across America."

In Martin County, N.C., where lawmakers face competitive midterm elections, some residents believe RHTP funds will help reopen their shuttered hospital, Tribble and Seitz report. "Martin County won’t get direct relief from Trump’s rural health fund — because its hospital isn’t open." The state plans to use its $213 million in RHTP funds on "existing health and social service organizations."

Without rural hospitals, residents in states like North Carolina, where most citizens live in rural counties, are especially vulnerable. During a medical emergency, when every second counts, rural residents must survive the travel distance to get medical care. Some don't make it. Tribble and Seitz explain, "Martin County does not have paramedics on its ambulances, and it can be 20 miles or more to the closest — and often overcrowded — emergency rooms."

Brian Floyd, the chief operating officer for ECU Health, which operates out of Greenville, N.C., told KFF, "It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost. They just want to not die because there’s nowhere to go when you have an emergency."

Babies delivered at rural hospitals can receive specialized neonatal care through a unique telehealth program

A newborn baby's care team can get live, immediate help
from a neonatologist with TeleICN. (Dartmouth photo)

A pregnancy delivery in a rural hospital far away from specialized care poses significant risks for a baby born with complex needs. In Vermont and New Hampshire, Dartmouth Health created TeleICN, a unique telehealth program that connects rural medical providers to neonatologists who can help manage a baby's health during and after delivery, reports Christopher Cheney for Healthleaders.

As more rural hospitals have cut services to save money, many have shuttered their labor and delivery units. In the case of an emergency delivery, EMS will take a pregnant patient to the nearest emergency department, where a rural care team can "connect to the TeleICN program using an iPad or making a phone call," Cheney explains.

Tapping into TeleICN is similar to using FaceTime. The program allows a neonatologist to "talk with the local teams, look at the baby via video, and work with the mom and their family members to make decisions about the next steps in care for babies," Cheney reports. TeleICN can "connect local care teams to a neonatologist virtually on a 24/7 basis, and it serves 16 rural hospitals in New Hampshire and Vermont."

Katelyn Darling, a director at Dartmouth Health, shared the varying levels of care TeleICN often provides, saying, "Sometimes, they know a mom in labor is on the way to their hospital, and they want us to help them prep the care room. Sometimes, they want us in the background to support them. Sometimes, they want us on the frontline making decisions about care."

Because the TeleICN has been so successful, Dartmouth expanded its virtual obstetrics care with its new TeleMFM program. Cheney explains, "The focus is on high-risk obstetrics care and fetal-maternal medicine services, with the goal of reducing the need for patients to travel long distances. … Patients can go to a clinic associated with a rural hospital and get connected to a TeleMFM provider."

Jessica Clem, TeleICN's medical director, told Healthleaders, "What we are trying to do is provide equitable care in New Hampshire and Vermont, particularly for rural communities."

Medicare offers pilot program that covers GLP-1 weight loss drugs

A recent Medicare change offers older Americans with obesity concerns a chance at affordable and possibly life-changing weight-loss drugs. The shift is particularly good news for rural Americans, who tend to be older and have higher obesity rates than their urban counterparts.

Beginning in July, Medicare beneficiaries "may be able to get a GLP-1 prescription for weight loss for $50 a month," reports Jackie Fortiér of KFF Health News. "It’s a notable shift for Medicare, which has long been barred from covering weight loss treatments."

Although weight-loss drugs, such as Zepbound and Wegovy, offer chronically overweight patients a way to lose weight that may cause other health issues, their prices have often put them out of reach for many Medicare patients. Fortiér explains, "They’re available in injection or pill form. Even with discounts, current cash prices typically range from $149 to $699 per month."

In an effort to address Medicare enrollees' obesity-driven health problems and budgetary restraints, the Centers for Medicare & Medicaid Services announced a "short-term pilot program known as the Medicare GLP-1 Bridge. It will run from July 1, 2026, through Dec. 31, 2027," Fortiér writes. "It’s meant to 'bridge' the gap before a longer-term program that might — or might not — begin in 2028."

The pilot program will cover most GLP-1 weight loss medicines, including the pill and injectable formulations of Wegovy, the KwikPen formulation of Zepbound, and the Foundayo pill, Fortiér reports.

Medicare enrollees should know that Medicare's GLP-1 Bridge is "not your typical Medicare benefit. Even though Part D enrollment is required, the Bridge program itself works differently," Fortiér explains. "Instead of going through your regular Part D plan, you will need prior authorization" which your doctor can send to CMS for processing. Physicians prescribing GLP-1 to Medicare patients don't have to be, or become, registered Medicare providers.

Read all the requirements and rules for Medicare GLP-1 Bridge coverage here.

Robotics in rural Alabama obstetrics care gets mixed reviews

36 of Alabama's 54 counties lack any obstetrics care.
(Photo by Volodymyr Hryshchenko, Unsplash)

People are conflicted about part of the Alabama Rural Health Transformation Program, which aims to add robotic ultrasound machines in rural areas of the state, reports Liz Carey for The Daily Yonder. Many experts agree that the state's biggest obstacles to ensuring healthy pregnancies, babies and moms is access.

Alabama has the highest maternal mortality rate in the U.S., with 41 of its 54 counties lacking labor and delivery services and 36 counties without any obstetrics care.

While the new robots address a lack of technical support in rural healthcare, the real issue, medical care access, isn't addressed by robot-providing ultrasounds, according to an OB/GYN in Jasper, Alabama.

“There may be a case where a mom may have low fluid, and that patient needs to go to a hospital,”  LoRissa Autery told Fox54 News. “But if you’re in a part of the county that doesn’t have a hospital that has obstetrical services, now you have to drive an hour to an hour and a half to receive those services from a physician that did not do the ultrasound.”

New technology can help provide access to care, but to do so, it requires basic healthcare infrastructure and reliable broadband internet access, Katy Kozhimannil, a professor and co-director of a rural health research center at the University of Minnesota, told the Yonder.

The Alabama's plan also outlines programs to supply emergency labor and delivery carts to rural hospitals, pair patients with specialty providers, and distribute equipment upgrades and minor building renovations, reports Carey.

Some state and federal officials have praised the plan, while others have given it mixed reviews, Carey adds.

Policy experts say 10 rural hospitals in Virginia are 'at risk' of closure. What does that mean?

A rural hospital can be listed as 'at risk' and never close.
(Canva photo via Cardinal News)

As rural hospitals across the U.S. grapple with fewer federal Medicaid reimbursement dollars, some, including 10 in Virginia, have been flagged as "at risk" of closure, reports Emily Schabacker of Cardinal News. But the formulas used by policy centers to determine financially strained hospitals can't predict which hospitals will close.

For instance, the Public Citizen, a non-profit that tends to lean left, released an analysis that looked specifically at "Medicaid policy changes tied to the federal funding bill," Schabacker explains. Based on their focus, Public Citizen policy experts "identified 10 Virginia hospitals as at risk of closure," including six in Southwest and Southside Virginia:

• Buchanan General Hospital, Grundy
• Carilion Tazewell Community Hospital, Tazewell
• Twin County Regional Hospital, Galax
• Dickenson Community Hospital, Clintwood
• Sentara Halifax Regional Hospital, South Boston
• Centra Southside Community Hospital, Farmville
• VCU Health Tappahannock Hospital, Tappahannock
• Bon Secours Southern Virginia Regional Medical Center, Emporia
• Sentara Northern Virginia Medical Center, Woodbridge
• VCU Health Community Memorial Hospital, South Hill

While not all policy centers will focus on Medicaid payment changes to determine a hospital's future financial difficulties, most centers will consider past financial standing, operating margins, and whether the hospital was already operating at a deficit before the Medicaid cuts were announced. 

According to Michael Shepherd, an assistant professor with the Department of Health Management and Policy at the University of Michigan, "Each research group uses slightly different methods to evaluate hospital finances," Schabacker reports.

Shepherd said he’s "concerned that reports like the one from Public Citizen border on being alarmist," Schabacker adds, "signaling with too high a degree of certainty that hospitals with negative operating margins will close as Medicaid changes take shape."

Financial vulnerability doesn't mean that "the hospital is going to close tomorrow, but it could over the next few years," Shepherd told Cardinal News. "There is some uncertainty there. Not every hospital that’s at risk of closing will close. The truth is somewhere in the middle.”

When dialysis treatment centers close, rural patients have no choice but to drive further for care

After the Chadron dialysis center closed, Pieper's 
treatment travel time tripled. (KFF Health News photo)

Rural residents who require dialysis treatment to stay alive are having to drive longer distances for care as smaller hospitals and clinics shed unprofitable services to stay afloat, reports Ariella Zionts of KFF Health News.

When Chadron Hospital shuttered its dialysis center, which served Nebraska residents in the state's far western panhandle, Mark Pieper became one of the many displaced patients who would have to find another dialysis center for treatment.

Because the human body cannot survive without kidney-like functions that filter toxins, remove excess fluid and balance electrolytes, dialysis cannot be rescheduled or skipped. When faced with the closure of their dialysis center, renal patients like Pieper have two choices: Travel for treatment or die.

"Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region," Zionts writes. "The hour-and-a-half drive will triple his time on the road to more than nine hours each week."

Chadron Hospital discontinued its dialysis service despite the $219 million in federal money Nebraska will receive this year from the Rural Health Transformation Program. But RHTP awards aren't meant to "help existing services stay afloat," Zionts explains. Instead, they are earmarked to help rural medical centers "explore new, creative ways to improve rural health." Only 15% of RHTP funds can be used to pay for patient care.

Chadron Hospital was "losing $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs," Zionts reports. Nephrologist Mark Unruh said the "dialysis closure in Chadron reflects a wider trend of staffing and funding challenges."

Preventing kidney failure is one of the best ways rural areas can change what rural dialysis patients like Pieper are facing now, Unruh told KFF Health News. "He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure."

Kansas fitness centers focus on providing exercise care to rural residents with Parkinson's disease

Kansas has the second-highest rate of 
Parkinson's disease cases in the U.S.

Among the nearly 1 million Americans living with Parkinson's disease, rural residents face more challenges accessing the exercise and support programs that could improve their quality of life.

In rural Kansas, some fitness centers have opened or expanded care to help area patients work out more regularly, according to Bek Shackelford of NPR. Regular exercise is one of the few proven ways Parkinson's disease sufferers can lessen the muscle stiffness, tremors, sleep problems and brain-health issues that often accompany the disease.

The Parkinson's Exercise and Wellness Center in Leawood, Kansas, which offers "gym services to around 280 people and offers classes ranging from Pilates and boxing to theater" serves as an example, Shackelford adds. The head coach and co-founder of the center, Sarrisa Curry, told Shackelford that the center's enrollment has been on the rise as more baby boomers are diagnosed with the disease.

Medical scientists are still unsure what causes Parkinson's disease to develop. Some studies indicate that the disease may have a genetic basis. Other research suggests that exposure to pesticides, such as those encountered in rural farming communities, could be partially to blame. Shackelford reports, "Recent data shows Kansas has some of the highest rates of Parkinson's diagnosis in the country." Only Nebraska has a higher rate.

Elaine Ptacek, who founded the Parkinson's Families of Northwest Kansas, a nonprofit that "offers things like physical therapy and art classes, says about 90% of her group's participants live on farms and are exposed to pesticides," Shackelford adds. "Ptacek's organization serves a rural area she says desperately needs Parkinson's support."

To reach as many patients as possible, Parkinson's Families of Northwest Kansas offers exercise classes to "groups in eight counties [who can] join Zoom calls and follow along with a fitness instructor," Shackelford adds.

Telehealth hub addresses lack of care in rural Texas

The Davis Mountain Clinic offers an exam room
for patients. (Photo by Carol Brewer, Daily Yonder)

In the midst of rural West Texas, a shipping container is giving residents of Jeff Davis County access to telehealth through reliable connectivity and a local registered nurse, reports Madeline de Figueiredo for the Daily Yonder.

The Davis Mountain Clinic was created by Texas A&M and Texas Tech universities to bring remote medical and mental health care to the area’s aging population, explains Figueiredo.

One in five residents in this mountainous county don’t have reliable broadband, and the only doctor is semi-retired, causing most of the population to drive 30 minutes for care, Figueiredo reports.

As the county has a median age of 58, the telehealth hub offers not just reliable broadband, but “digital literacy for older residents, trusted community health workers, and practical ways for clinicians to weave virtual visits into everyday care.”

The director and local registered nurse for the clinic, Carol Brewer, can monitor vital signs, execute physical exams and help patients navigate their virtual telehealth appointments. She told the Yonder, "The advantage is, when they come here to see the doctor, I manage the technology on my end, they don’t have to deal with that at all…I’m the hands of the physician via telehealth.” 

This is not the only area of Texas that struggles with internet connectivity and access to nearby health care. Communities in Erath, Hockley and Reeves counties are working on bridging the gap in services by offering private telehealth rooms, medical monitoring equipment and guidance from staff through local libraries, Figueiredo reports.

A small infusion clinic in rural Texas helps cancer patients not have to drive hundreds of miles a week for care

New Jersey and Rhode Island do not have rural hospitals and are excluded from the analysis.

(Map by Deidre McPhillips, CNN, from Chartis data)

Rural cancer patients often drive hundreds of miles for treatments only bigger cities can offer, but a smaller hospital that chose to add an infusion clinic in a rural area shows that cancer care can move closer to home, reports Caleb Hellerman of CNN News.

Childress Regional Medical Center, which serves roughly 30,000 people in a 5-county region of North Texas, did the opposite of what many smaller hospitals have been doing. They added services instead of shrinking them. Hellerman writes, "Childress [began with] opening a small infusion center in 2013 and steadily expanding its capabilities in order to serve patients."

When it comes to diagnosis, treatment and survival rates, rural cancer patients are already at a disadvantage. Hellerman reports, "Rural cancer patients tend to be diagnosed later and have worse outcomes. . . . Rural patients are also less likely to receive treatment that meets the standard of care."

Although the Childress infusion clinic started small, the need for it quickly became apparent, and its provider count grew to meet the needs of rural patients. Hellerman explains, "The infusion center started with two chairs but has since grown to encompass 10 spots for patients, three full-time pharmacists and three full-time oncology nurses."

Residents in the region are luckier than many of their rural peers. The medical consulting group Chartis "found that 448 rural hospitals – nearly a quarter of the nation’s total – stopped offering chemotherapy services between 2014 and 2024," Hellerman writes. Out of all the states, Texas lost the most.

Beyond the transportation issues, rural cancer patients will continue to face a dwindling number of oncologists willing to practice in rural regions. Some of that shortage is attributed to younger specialists preferring to live and work in more urban areas. But, according to Hellerman, the high cost of cutting-edge cancer drugs is also preventing younger oncologists from considering rural-leaning positions. 

"Oncologists and hospital administrators say pressures are likely to worsen over the next few years as provisions of the 'Big Beautiful Bill' kick in," Hellerman reports. Most of those cuts are slated to come from reducing the number of Americans who receive Medicaid.

After being dropped by their Medicare Advantage Plan, millions of seniors were left scrambling for health insurance

Some rural residents can no longer enroll in Medicare
Advantage Plans.

Privatized Medicare coverage, also known as Medicare Advantage Plans, stopped providing health insurance to residents in counties where profits were too slim or nonexistent. The shift in coverage options has disproportionately affected rural residents, reports Christopher Rowland of The Washington Post.

Over the past 20 years, Medicare Advantage Plans have grown exponentially by offering extra perks and low premiums to seniors seeking health care coverage that provides more benefits than traditional Medicare, but that trend has reversed. Rowland explains, "Insurers sharply retreated from the plans in some regions, saying rising health care costs and reduced government reimbursements have hurt profitability. . . . Hardest hit were a half-dozen rural states from New England to Idaho."

The sudden change "highlights one of the risks for Medicare Advantage beneficiaries, especially in rural areas where options tend to be meager: plans are under no obligation to offer coverage year-to-year," Rowland reports. "When profit margins are threatened, insurance companies can suddenly withdraw coverage."

Many rural counties have been the first to be cut off, leaving residents with traditional Medicare Part B, which has an 80/20 split, as their only option. Many seniors fear their 20% share will leave them with large medical bills.

In 2026, nearly 3 million people, or 10% of Medicare Advantage Plan beneficiaries, were dropped and forced to find other health care coverage, Rowland reports. "That’s a big jump from 2018 to 2024, when the rate of involuntary terminations was below 2% each year."

Quick hits: Mississippi bans lab-grown dairy; Lawyers for Reporters; pay phones help boomers and zoomers connect

State-level bans like Mississippi's can restrict access to the 
 lab-grown dairy industry. (Photo by A. Chaudhary, Unsplash)

Mississippi is the first state to ban lab-grown dairy after passing a bill effective July 1, reports Karen Bohnert for Dairy Herd Management. Lab-grown dairy is "produced through precision fermentation or cell-culturing techniques" and often referred to as "fake milk," Bohnert explains. The bill, HB 1153, requires strict labeling requirements and updated authority to state inspectors to prevent the manufacture, sale and distribution of cell-cultured dairy throughout the state, Bohnert reports.

Lawyers for Reporters, created by the Cyrus R. Vance Center for International Justice, is a free resource for American local and public-interest journalism organizations needing legal services, reports Tandy Lau for E&P Magazine. There's a five-person in-house legal team based in New York offering assistance, and they partner with outside counsel for extra support in farther areas. Managing Attorney Kay Murray told E&P they "really guide [journalists] to ensure that they've got the backup to get it right, that they are confident about getting it right [and] that their understanding with their sources is something that everybody is on the same page about." They hope to soon provide more support for investigative reporting and coverage of immigration issues as well. "If I was trying to quantify the value of [Lawyers for Reporter's assistance], it would add up to easily tens of thousands of dollars if not well into the six figures," Warwick Sabin, CEO and president of Deep South Today, told E&P.

A new study found a long-term shift in cancer death trends, with rural areas facing higher cancer death rates than urban areas in recent years, reports Dennis Thompson for U.S. News & World Report. Previously, between 1969 and 1971, “large cities had the highest overall cancer death rates, followed by small- to medium-sized cities.” However, rural areas had the highest rates in 2021 to 2023, and large cities had the lowest rates. Specifically, lung cancer deaths among rural men were 26% lower than city dwellers in 1969 to 1971, but 55% higher in 2021 to 2023. Researchers said the shift and continuously widening gap is “likely driven by limited access to health care, lower cancer screening rates, higher poverty, more smoking and other lifestyle and environmental factors” in rural communities.

In a new social experiment by Matter Neuroscience, two old payphones set up at a nursing home in Nevada and near Boston University allow "zoomers" and "boomers" to call each other from 3,000 miles apart, reports Scottie Andrew for CNN. Designed to help people feel less lonely, this pilot project will last at least a month, according to Matter Neuroscience. "Friendship could come in all ages. Wisdom can come in all forms, and we just want people to get out of their comfort zone and have a conversation," Matter Neuroscience social strategist Calla Kessler said.

GM announced it will be adding a day of factory
production to it heavy-duty truck line. 

General Motors is increasing its heavy-duty truck production, as consumer demand remains strong despite rising gas and diesel prices, reports Christopher Otts for The Wall Street Journal. GM's Flint Assembly plant in Michigan will operate six days a week now, rather than five, producing more heavy-duty versions of the Chevrolet Silverado and GMC Sierra pickups, Otts reports. Workers will be "mandated into overtime hours to cover the additional day of production," explains Otts. As gas prices have risen by about one-third since the beginning of the Iran war, GM's stock has declined about 10% so far this year, and forecasters predict new-vehicle sales to fall 6.5% in the first quarter.

A rural Ohio pharmacy school embraces pharmacists' expanded 'provider status' by deploying a mobile care unit

Mobile Health Clinics staffed by student pharmacists and 
supervising faculty provided health care in rural Ohio.

Dozens of states across the U.S. allow pharmacists to have expanded care status similar to the role a primary care medical professional would fill. In 2019, the Ohio legislature granted pharmacists "provider status," which means they are "recognized healthcare providers in the state insurance code and allowed to be reimbursed for services like chronic disease management and immunizations."

Using their change to "provider status" as a launching pad, leadership at Ohio Northern University's Raabe College of Pharmacy in rural Hardin County, Ohio, challenged themselves to reenvisioned how they could use their existing "HealthWise" service, which was originally intended for ONU employees, to address health care deficiencies throughout rural Hardin County and its rural county neighbors, reports Kay Miller Temple for Rural Health Information Hub.

During a Hardin County health needs planning meeting, Michael Rush, PharmD, who teaches residents and is the director of operations at ONU HealthWise, was inspired by a food truck he saw outside; he thought a mobile HealthWise might be the answer.

Location of ONU in Ohio

Once shared, Rush's idea gained traction, and numerous funding awards and grants led to Raabe College hiring a pharmacist and purchasing a bus, which "built out ONU HealthWise into the ONU HealthWise Mobile Health Clinic," Temple writes.

Today, ONU student pharmacists and their supervising faculty aboard the HealthWise Mobile unit provide a broad spectrum of health care, including "preventive health education, medication reconciliation, medication therapy management, and chronic disease state management," Temple reports. Health screenings, immunizations and specialty care are also addressed on-site.

The Healthwise Mobile unit services have continued to expand to meet their community's needs. When two rural pharmacies closed in 2024, the traveling care team filled the gaps. 

Michelle Musser, director of ONU's Rural and Underserved Health Scholars Program, told Temple, "The students need those experiences of working in a pharmacy, different from the mobile outreach experiences. This closure allowed them to experience firsthand what a rural pharmacy closure actually does to rural communities."

Building on the first Healthwise Mobile Clinic's success, Raabe College is investing in a second van. Temple adds, "HealthWise will eventually be present in Hardin, Allen, Auglaize, Hancock, and Wyandot Counties."

Independent primary care doctors see banding together as one way to remain solvent and keep their autonomy

Valley Medical Group joined an IPA to help regain its
financial footing. (New England Public Media photo)

As the number of primary care doctors in the U.S. continues to decrease, the number of independent primary care practices has also fallen. A practice in the Connecticut River Valley, Valley Medical Group, has sought to maintain its independence while boosting its bottom line by joining with other independent primary physicians, reports Karen Brown of New England Public Media.

Founded during the 1990s, Valley Medical Group has become one of the "largest independent practices in western Massachusetts," Brown writes. But the practice's patient volume and focus on quality family medical care haven't shielded it from the financial pitfalls of the American insurance payment system, which rewards specialists and physicians who perform procedures over primary care.

Valley Medical Group owners found themselves stuck in insurance contracts that didn't pay well or accurately. "In January, the practice laid off 40 employees — 10% of its 400-person staff — mostly in support positions," Brown writes. "Thousands of primary care practices, a key gateway to the medical system, are fighting to remain financially viable — and independent."

VMG doctors also wanted to avoid selling their practice to a hospital, which would likely take away some of their clinical autonomy. Instead, the group opted to join an Independent Physician Association. Brown explains, "Like a union, an IPA combines individual primary care offices, giving them power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies."

While not all IPAs are equal -- some are owned by hospitals or private equity funds -- most help level the financial playing field for smaller practices. According to Brown, when independent practices band together, they can accept insurance contracts that pay them a per-patient allotment rather than billing for each visit or procedure.

Chris Kryder, CEO of Arches Medical IPA in Cambridge, Massachusetts, told Brown, "If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system. . . And we create more income for the primary care providers, which is dreadfully needed."

Rural hospitals will be hurt the most from Minnesota Medicaid cuts

Government action, such as cuts to Medicaid in Minnesota, has an “outsized impact” on rural residents, Sarah Melotte reports for the Daily Yonder.

The Trump administration recently announced its intent to withhold $259 million from Minnesota’s Medicaid reimbursements due to fraud concerns. CMS Administrator Mehmet Oz said Medicaid funds in Minnesota were going to "bogus" centers for autistic children and a behavioral health organization that had bills showing doctors working 24 hours a day for more than 450 days.

Percentage of hospital revenue coming from low-income health insurance programs. (Map by Sarah Melotte, Daily Yonder, data from the Center for Healthcare Quality and Payment Reform, Click to enlarge)

Rural hospitals are disproportionately affected by these cuts. Melotte explains that rural hospitals are more likely to operate with negative profit margins than urban hospitals, and 39 of Minnesota’s 98 rural hospitals have negative operating margins. This means the rate of uncompensated care will increase even more in these rural hospitals.

Some of these hospitals are able to stay open using non-operating revenue, such as taxes or philanthropy, but this isn’t the case for all of them, reports Melotte. More than 100 rural hospitals throughout the U.S. have had to close in the last decade, causing rural residents to have to travel farther to access the care that they need.

One nonprofit in Minnesota that houses people with disabilities reported to Minnesota Public Radio that “any cuts to Medicaid funding will directly result in reduced services.”

Medicaid now accounts for around 19% of discharges in rural hospitals nationwide, Melotte writes. “In communities where hospitals operate on thin margins, even small cuts in federal spending can destabilize entire systems of care.”

A startling look at the lack of dialysis treatment options for rural Americans experiencing kidney failure

For the roughly 240,000 rural Americans suffering from kidney failure, or End-Stage Renal Disease (ESRD), getting to a dialysis center that can deliver consistent, quality care is a struggle. The lack of reliable dialysis for rural ESRD patients has been exacerbated by too few providers within a drivable distance, with some rural residents facing travel across several counties to access dialysis.

The most common dialysis clinics near rural ESRD patients are often owned by DaVita, a "for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges," reports Sarah Melotte of The Daily Yonder. Involuntary discharges are supposed to be extremely rare and regulated by the Centers for Medicare and Medicaid Services.

About 22.8 rural Americans – just over half of the total rural population – live in a county where either DaVita is the only clinic, or there is no clinic at all. (Map by Sarah Melotte, Daily Yonder, from CMS data)

In fact, for 6.1 million rural Americans, DaVita is the only Medicare-certified dialysis clinic in their county, according to Melotte's analysis of CMS data. Melotte reports. "Another 16.5 million rural Americans live in a county with no facility at all."

Overall, DaVita and its German competitor, Fresenius, "tend to have worse health outcomes compared to independent, non-profit clinics," Melotte writes. "Duke University’s research found that, after dialysis clinics were acquired by large, for-profit, companies, the likelihood of each patient being hospitalized each month increased by 4.5%."

Using a CMS dialysis facilities dataset, in 300 counties, 190 of which are non-metropolitan, or rural, "DaVita runs the only clinics in the county," according to Melotte's anaysis. "In rural counties, about 31% of clinics are owned by DaVita."

In some rural regions, the lack of dialysis centers is even more dire. "About 59% of rural counties don’t have a single Medicare-certified dialysis clinic," Melotte writes. "In places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic."

Report: Pesticides may be driving Midwestern cancer crisis

Map by Ben Felder, IM, sources from Cancer: National Cancer Institute and the CDC, Pesticides: Pesticide National Synthesis Project, from the U.S. Geological Survey

As cancer diagnosis rates among Midwesterners continue to be higher than the national average, a "growing body of research indicates that pesticides are partly to blame," reports Ben Felder of Investigate Midwest. Pesticide use helped U.S. agriculture become an international commodity powerhouse, but that success may be coming at the expense of Midwestern communities.

Because more than half of U.S. cropland is in the Midwest, Midwesterners who don't live in a major metro area are likely to live near a farm that uses pesticides. Felder explains, "Sprayed from airplanes, drones, tractors and handheld devices, these chemicals can drift through the air or run off into nearby rivers and streams."

"Most of the 500 counties with the highest pesticide use per square mile are located in the Midwest," Felder reports. "Sixty percent of those counties also had cancer rates higher than the national average of 460 cases per 100,000 people, according to an analysis of data from both the U.S. Geological Survey and the National Cancer Institute."

Lisa Lawler from Hardin County, Iowa, believes that pesticides are the primary driver of cancer diagnoses in her community, including her mother's and her own. Felder writes, "The county is home to around 800 farms, has a pesticide use rate more than four times the national average and a cancer rate among the highest in the state."

Lawler had extensive testing completed to see if her cancer was hereditary. She told Felder, "The genetic test they ran for me was one that covered 81 genes that are typically related to breast cancer. . . .They told me my cancer is likely not genetic, but likely environmental, based on these 81 genes."

Pesticide manufacturers have continued to reject claims that pesticides have any part in regional cancer diagnosis trends. "But scientific research linking pesticides with certain types of cancers has been growing," Felder writes. A 2024 study published in Frontiers in Cancer Control and Society linked "pesticides to prostate, lung, pancreas and colon cancers. Pesticides have also been associated with lymphoma and Parkinson’s disease."

Wyoming officials aim to keep the state's Rural Health Transformation Program award going in 'perpetuity'

Wyoming is the most sparsely populated state in
the U.S. (Photo by Karsten Koehn, Unsplash)

As Wyoming's rural hospitals struggle to make ends meet and hire enough medical providers, state officials have hatched a plan using money from its Rural Health Transformation Program funds to buffer losses, create more robust provider training and incentives, while using investments to help the money stretch for decades, reports Arial Zionts of KFF Health News.

If Wyoming's plan receives federal approval to invest a substantial portion of its $205 million award, the state's "Rural Health Transformation Perpetuity fund could provide $28.5 million for the state to spend every year," Zionts explains. "Wyoming would spend the money on scholarships for health students and incentive payments to help keep small hospitals and rural ambulance services afloat."

The federal RHTP program requires states to spend their awards by established deadlines, or the money will be shelled out to other states. The question is, will the Centers for Medicare & Medicaid Services, which manages RHTP, see placing the money in an investment account as "spending it."

Stefan Johansson, the director of Wyoming’s health department, thinks it will. "He said that CMS called in December to specifically ask questions about the fund and that he believes the agency has formally approved it," Zionts reports. "But 'the devil’s always in the details,' he said, as the state works with CMS during the budget review period."

CMA has already told some states that RHTP grants "cannot be used to 'generate income.'" Zionts adds. "Wyoming officials wrote in the state’s application that the perpetuity fund won’t be making or keeping any profit. . . .Other states proposed funds in their applications, but Wyoming’s appears unique, according to a KFF Health News review of state applications."

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."

A 'Nursery to Nursing Home' campaign for a rural Wisconsin community could help the well-being of children, older adults

Members of Groundswell Collective advocate for their 
'Nursery to Nursing Home' campaign (Photo The Yonder)

In Walworth County, Wisconsin, a local community group called Groundswell Collective proposed to turn a vacant wing of the county’s nursing home into a combined childcare center and senior-living space, reports Madeline de Figueiredo for The Daily Yonder.

Like many rural communities, this county has faced challenges such as a lack of child care and senior care, as well as the loneliness and isolation that can come with living in a rural area with long winters.

Abriana Krause, who lives and works in the area as a childcare provider, told the Yonder, "In Walworth County, all 2,240 licensed childcare slots, spread across the 35 active centers listed on the DCF [Department of Children and Families] website, are already full. That leaves nearly 2,680 children without stable care." Similarly, Wisconsin is projected to need 33,000 long-term care beds by 2030.

To support their proposal, the Groundswell Collective has relied on research that shows the benefits of intergenerational care, such as "boosting the well-being of both children and older people, reducing isolation, improving cognitive and physical health for older people, and cultivating empathy and connection in young children," Figueiredo explains. Intergenerational care has also been linked to dispelling age stereotypes and a renewed sense of care that affects entire communities and fosters lasting relationships.

Research also shows that the benefits intergenerational spaces offer can "extend to the caregiving staff," Figueiredo reports. "Daily interaction with both children and older adults can enhance the work environment and make intergenerational centers more rewarding for staff." There’s hope that this initiative will help the county retain nursing staff.

After almost a year of the community organizing around the proposal, the Walworth County Board approved funding in November for a feasibility study on the intergenerational care center.