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."

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.

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."

Opinion: The Rural Health Transformation Program challenges states to build and overhaul systems

R.J. Marse

When the Centers for Medicare & Medicaid Services announced $50 billion in funding for the Rural Health Transformation Program, many Americans may have assumed the money would help struggling rural hospitals shore up their finances and stay open. 

But RHTP program dollars aren't meant to prop up declining systems by helping them maintain the status quo of rural health care, writes R.J. Marse, General Counsel at Sprinter Health, in his opinion for Healthcare IT Today. "At $50 billion over five years. . . the amount is significant, but more noteworthy is the program’s intent."

The program aims to change how rural health care is approached and practiced by incentivizing innovation, technology and successful outcomes across a system.

RHTP challenges rural health systems to go beyond traditional health care infrastructure by designing and launching treatment that includes "telehealth and remote monitoring. . . technology-enabled solutions that allow providers to practice at the top of their license," Marse writes. "It even allows states to invest in early-stage healthcare companies, a signal that the ultimate goal is innovation."

Marse explains, "Funding is conditioned on outcomes, so while the aim is to reach more rural patients in more rural communities, interventions will need to do so in ways that measurably improve health and lower long-term costs."

RHTP structural demands push rural health care systems to combine modern medical treatment models with the inherent challenges of working with a rural population. Marse writes, "RHTP demands confronting the fact that many rural patients will not engage with care unless it comes to them – or, at least, closer to them. . . . Rural care transformation must, by necessity, be hybrid. It should deliver care virtually when appropriate, and physically when and where it’s needed."

"Rural health doesn’t need another bailout. It needs fundamentally different operating models that can endure when federal dollars dissipate," Marse explains. "Five years from now, RHTP will be judged not by how much money was spent, but by what was built." 

Lawmakers and health groups pushback on Rural Health Transformation Program plans and limits

Nebraska State Capitol in Lincoln
(Photo by Pieter van de Sande, Unsplash)

The excitement and energy that was first attached to millions of federal dollars in awards to states for the Rural Health Transformation Program has already started to fade. Some legislatures and health groups are resisting their state's proposals and pushing for more input on how the money is spent, report Arielle Zionts and Sarah Jane Tribble of KFF Health News.

The awards, which are funded through the Centers for Medicare & Medicaid Services, impose strict timelines and rules on the use and implementation of millions of dollars. Lawmakers, who must work quickly to pass bills needed to use the funds, and rural health groups are finding themselves at odds with award restrictions.

Much of the disconnect stems from what many lawmakers thought they could use RHTP money for, based on how the program was marketed, versus what CMS will allow.

The White House promoted RHTP awards as a way to "shore up rural health care," but their use isn't aimed at saving struggling rural hospitals. Instead, the funds are to be used for "seeding innovative projects and technologies," Zionts and Tribble explain. "States can use only up to 15% of their funding to pay providers for patient care."

Some state Republican lawmakers — especially those representing more rural regions — as well as rural hospital advocates, "are upset that the political rhetoric doesn’t match what they see," KFF reports. "They’re also lobbing criticisms at specific aspects of their states’ plans, including the proposed projects, what’s not included, and the spending approval process."

State lawmakers from Wyoming, Ohio, North Dakota, Michigan, North Carolina, Nebraska and Colorado all face conflicts and competing needs to get the work done so their states can spend the money and then decide who gets it, KFF reports.

Jed Hansen, executive director of the Nebraska Rural Health Association, told KFF, "Rural Health Transformation will not save a single hospital in our state. I don’t think it will save a hospital nationally.”

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."

Analysis: Nursing home patient capacities have shrunk, with rural areas posting the greatest decreases

Rural areas had the greatest declines in available nursing
home beds since 2019. (Pixabay photo via Medical Express) 

Despite the rapidly aging U.S. population, nursing home capacity has shrunk nationwide since 2019. According to Sadie Harley for the University of Rochester Medical Center, a recently published study in JAMA Internal Medicine showed that 25% of U.S. counties "experienced decreases in the number of supported nursing home spots by 15% or more," with rural areas reporting the greatest declines.

The dwindling number of nursing home placements for older Americans translates into "nearly 4,000 fewer beds available for new patients each day," Harley writes. "But this decline was not felt by all communities equally. It varied widely across geographic regions, with rural counties more likely to face declines of 25% or more."

Rural communities are already grappling with fewer physicians, hospital closures and strained emergency medical services. The loss of nursing home spots presents another challenge, leaving more rural residents with few other options than to travel farther for ongoing care.

Within the U.S. medical system, nursing homes provide vital care to seniors who need regular medical treatment but don't require the expertise of hospital services. They also offer interim care for patients leaving the hospital who aren't yet ready to care for themselves at home. Harley explains, "The reduction in nursing home capacity was linked to longer hospital stays, especially extended stays of 28 days or more."

The decline in nursing home care spots isn't a reflection of the number of beds a facility has. Harley adds, "This study estimated nursing homes' operating capacity by taking other resource constraints into account." Study author Brian McGarry, told Harley, "The facility may not have the staff or other resources to fill every bed."

Study: How independent pharmacy challenges and closures impact rural pharmacists

Harris Pharmacy serves Rocky Ford, Colorado.
(University of Colorado photo)

Many studies on the closure of independent pharmacies focus on what happens to patients when a pharmacy closes. A new study by Michael J. DiStefano, PhD, at the University of Colorado, examines how those closures impact pharmacists. The study also explores how independent pharmacists navigate the current reimbursement model and what some states are doing to help them stay solvent. 

In interviews with pharmacists, DiStefano and his colleagues "heard palpable frustration, stories of mental health impacts and examples of how pharmacy closures touch entire communities," reports Matthew Hastings for the University of Colorado. 

DiStefano told Hastings, “It’s a series of ripple effects. When a pharmacy closes, not only do you see the impacts to medication access and job losses in that community; surrounding pharmacies will experience a series of stressors. All those patients impacted by the closure need to be added to your system, with new patient histories and records.” 

Study interviewees stressed that independent rural pharmacists should always have a succession plan that ideally includes a younger pharmacist who could take over the business, rather than a rural community having to recruit a new pharmacist who may not have the experience to navigate the financial demands of running a rural pharmacy. 

At Harris Pharmacy in Rocky Ford, Colorado, which serves a rural southeastern part of the state, owner Ky Davis believes running his pharmacy is all about problem-solving because there isn't another nearby pharmacy to refer patients to if his pharmacy runs out of a particular medication.

The current insurance reimbursement model for medications also means rural pharmacists can lose money caring for their patients. Davis told Hastings, "You're losing $80 to fill a prescription, and there's definitely a temptation to be like. We're not going to do that. We're not going to stock this drug."

At least in Colorado, lawmakers have eased some burdens on rural pharmacists, allowing them to approve prescriptions remotely. Davis told Hastings, "The bill passed this year has helped a lot. I’m able to leave the pharmacy open and remotely verify or have another one of our pharmacists remotely verify a prescription if I step away.” 

Tribal lands need broadband to improve health care access, but progress is slow

Shoshone-Bannock tribal lands are vast with a rocky terrain, which poses a challenge in building fiber-optic cable lines for high-speed internet to homes. (Photo by Sarah Jane Tribble, KFF Health News)

The lands of the Shoshone-Bannock Tribes in Idaho span seemingly endless miles. But the beauty of this vast tribal expanse comes with a cost: Profound broadband gaps that limit health care for Native Americans throughout the region. "Tribal members are historically underserved and, on average, live with the highest rates of chronic illnesses and die 6.5 years earlier than the average U.S. resident," reports Sarah Jane Tribble of KFF Health News.

Accessing medical treatment without broadband connectivity presents a range of challenges. Tribal members have to drive to medical appointments because telehealth isn't an option. "Tribal field nurses update charts in paper notebooks at patients’ homes, then drive back to the clinic to pull up records, send orders, or check prescriptions," Tribble writes. Getting care and medicine all takes longer.

All the while, millions in federal dollars have been set aside to address tribal broadband infrastructure. "Three years ago, the Shoshone-Bannock Tribes were awarded more than $22 million during the first round of the federal Tribal Broadband Connectivity Program," Tribble explains. "But tribes that were awarded millions in a second round of funding saw their payments held up under the Trump administration."

Shoshone-Bannock Tribes Broadband Infrastructure Deployment project
(Map by Lydia Zuraw and Sarah Jane Tribble, KFF Health News)

For some tribal members, waiting for fiber isn't an option. Instead, they pay for Starlink, which uses low-earth-orbit satellites and costs between $80 and $120 a month. "For 53-year-old Carol Cervantes Osborne, who lives with constant pain from severe rheumatoid arthritis, having internet is a necessity," Tribble explains. "She signed up for Starlink so that she can connect with doctors remotely through telehealth appointments." 

Despite the wait for broadband and the current lack of care access on their lands, tribal leaders say Starlink is too expensive for most of their members.

This year, the Shoshone-Bannock Tribes started work on their high-speed internet installation, but progress will be slow. "To build fiber-optic cables underground, the tribes must navigate lava rock and work with the Bureau of Indian Affairs to get permits," Tribble explains. "Eventually, the old radio station will be central to operations, with fiber-optic cable lines that web out over about 800 square miles to reach the reservation’s five district lodges."

A rural hospital in California closes after federal officials strip 'critical access' designation it has held since 2000

Glenn Medical Center in Willows, California 
(Glenn Medical Center photo)

After more than 70 years of serving its rural community in Willows, California, Glenn Medical Center closed its doors following the loss of its "critical access" designation, which had allowed the hospital to receive higher federal reimbursements that helped it remain open.

To qualify as a "critical access" hospital, a medical center needs to be at least 35 miles from the next closest hospital. Glenn Medical Center was 32 miles from "the nearest neighboring hospital under a route mapped by federal officials," reports Jessica Garrison of the L.A. Times. "Though that distance hasn’t changed, the federal government has now decided to enforce its rules." The hospital was awarded its critical access status in 2000.

The loss of Glenn Medical Center leaves the surrounding farming community without emergency care, "eliminates 150 jobs and puts rural residents at risk of preventable deaths," Garrison writes.

Rural hospitals across the state are already at risk of closure. Peggy Wheeler, vice president of policy of the California Hospital Association, told Garrison, "It’s like the beginning of a tidal wave. I’m concerned we will lose several rural hospitals, and then the whole system may be at risk.”

Before Glenn Medical Center's designation was stripped, Glenn County officials and hospital administrators worked for months to persuade federal officials to grant an exception.

Now that the hospital is closed, many community members fear what will happen to older residents in need of immediate care, injured farm workers or victims of car accidents along nearby Interstate 5. Glenn County Supervisor Monica Rossman told Garrison, "People are going to die."

Report: Rural primary care physician shortages will persist for at least another 12 years

Graph by Celli Horstman and Arnav Shah, State of Rural Primary Care in the United States, Commonwealth Fund

Rural residents will continue to grapple with a shortage of primary care doctors for at least another 12 years, according to a report issued last week by the nonprofit Commonwealth Fund.

Using federal health workforce data, researchers concluded that "rural areas will continue to have only about two-thirds of the primary care physicians they need," reports Nada Hassanein for the Wisconsin Examiner. Report authors noted that the persistent shortage of primary care doctors leaves million of rural residents "with fewer options for routine and preventive care."

The report's release came just days after the window closed for hospitals to apply for a share of the $50 billion federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services. Hassanein writes, "Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one."

Nearly all of the more than 40 million rural Americans live in areas with primary care physician shortages, according to the report. "Forty-five percent of rural counties had five or fewer primary care doctors in 2023," Hassanein adds. "Roughly 200 rural counties lacked one altogether."

The report found that doctor shortages in rural areas vary by region. Hassanein writes, "States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician."

Although rural areas will continue to lack enough primary care physicians, some of the gap will be filled by rural nurse practitioners. Hassanein adds, "Nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the report authors wrote."

New $100K skilled-worker H-1B visa fee could mean fewer Indian doctors to treat rural residents

One in five immigrant doctors in the U.S. is of 
Indian origin. (Photo via BBC News)

The Trump administration's new $100,000 skilled-worker H-1B visa fee could leave fewer Indian doctors to treat rural populations. "One in four doctors providing care in the U.S. are foreign-trained, and recent data shows that most of them practice in the vast, underserved rural areas where American graduates are reluctant to work," reports Savita Patel of BBC News.

For the roughly 50,000 India-trained physicians currently working in the U.S., the new visa fee does not apply; however, there are worries around "whether the steady supply of Indian medical professionals to the U.S. would continue in the future," Patel explains. "According to research, one in five immigrant doctors in the U.S. is of Indian origin."

And while the administration may eventually decide to exempt medically trained workers from the new fee, currently, "there is no indication that any category of workers, including those in the medical field, has been exempted," Patel reports.

The American Medical Association asked the Secretary of Homeland Security, Kristin Noem, to reconsider the new fee, "emphasizing that the fee hike could discourage hospitals from hiring H-1B doctors, affecting future supply pipelines and limiting patients' access to care in communities that need it the most," Patel adds.

Supporters of the fee hike insist it will keep "American jobs for Americans," Patel adds. But research on which jobs foreign medical workers take shows they are filling positions that American doctors don't want -- in regions that are "remote and low-income."

Given the financial straits many rural hospitals are already in, "any hike in the fee would make it harder to bring in new clinicians from abroad," Patel writes. Dr. Bobby Mukkamala, president of the AMA, told Patel, "We have heard from health systems who say this fee would be devastating."

Despite a shortage of medical care in rural America, some residents insult and undermine their doctors

Dr. Banu Symington is an board-
certified oncologist. 

Dr. Banu Symington treats patients in Rock Springs, Wyo., a town of about 24,500 people, where she was treated with kindness and respect until Covid masking battles and conspiracy theories began to enter her conversations with patients.

Symington's experience is mirrored by many other doctors "who say political attacks on science and medicine are affecting their relationships with patients, particularly in rural communities, where physician recruitment already poses a chronic challenge," reports Yuki Noguchi of NPR.

Some of Symington's cancer patients have sworn at her for "suggesting they vaccinate or wear masks to protect their weakened immune systems while undergoing chemotherapy," Noguchi adds. Symington told Noguchi, "It's very difficult, helping someone who scorns your help, or diminishes the value of it."

Some residents have consumed enough conspiracy theories that they believe physicians are trying to poison them for profit or that medical providers are somehow profiting alongside pharmaceutical companies at the expense of patients. 

Dr. Jennifer Bacani McKenney 
practices in her hometown. 

Dr. Jennifer Bacani McKenney practices family medicine in the tiny town of Fredonia, Kansas, where she was born and raised. McKenney's parents had emigrated from the Philippines to Fredonia, where her father started working as a surgeon. For years, McKenney enjoyed community trust as a "home-grown" physician, but "the spread of Covid-19 also revealed how some of her patients perceive outsiders," Noguchi writes.

McKenney told Noguchi, "My patients were calling Covid the China flu and Kung flu — that kind of thing — and saying about 'Asians needing to go back,' and they would say it to my face."

McKenney has continued her work in Fredonia, but acknowledges that today's political climate has made treating patients more challenging. She still recommends treatments, such as vaccines, that some patients push against. She told Noguchi, "But if I don't have those conversations, I'm not doing my job."

Rural hospitals tap into high schools to meet ongoing staffing challenges

Ballad Health is one of several rural-serving 
hospitals training high school students.

Ballad Health is a rural hospital system in Tennessee that, like many rural hospitals, spends millions of dollars a year paying traveling nurses to cover staffing shortages. To address its recruitment woes, Ballad is working with area high schools to train its next generation of medical care workers, reports Te-Ping Chen of The Wall Street Journal. 

Ballad's high school training academy includes students from "five northeast Tennessee school districts," Chen writes, "The first batch of 200 students will graduate in 2029, with their licensed practical nurse credentials and be eligible to work right away at Ballad, earning $23 an hour." 

Building and implementing a medical training academy for high school students is time-intensive and expensive, so Ballad Health partnered with Bloomberg Philanthropies, which "last year announced it was pumping $250 million into 10 programs in states including Tennessee, Texas and North Carolina to create a high school-to-healthcare pipeline," Chen explains. 

Ballad isn't alone in its staffing struggles, and as the baby boomer generation ages, demand for medical care staffing is expected to grow. Chen reports, "Human resources advisory firm Mercer projects a deficit of 100,000 healthcare workers by 2028."

Since 2006, Baystate Health system, which serves rural populations in western Massachusetts, has invested in a "high-school career program for jobs such as respiratory therapist and sterile processing technician," Chen adds. "Many participants have gone on to pursue additional training, and more than 900 have ended up working for Baystate in the past decade."

To avoid closures, mergers or reduced services, some rural hospitals are banding together

A mobile MRI machine services and costs can be
shared by a network of hospitals. (KFF Health photo)

A growing number of independent rural hospitals are joining networks that allow them to meet their community's health care needs without operating in the red or being pushed into a merger, reports Arielle Zionts of KFF Health News. While such medical networks have existed for decades, their popularity as a lifeline for rural hospitals is relatively new.

In North Dakota, 22 hospitals banded together to form the Rough Rider Network, which "used its members' combined patient rolls to negotiate better prices," Zionts writes. "The networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system."

The Rough Rider Network was formed with the help of an independent company, Cibolo, which worked on hospital partnerships. Zionts writes, "Cibolo Health has helped start networks in Minnesota, Nebraska, Montana, and Ohio."

Hospitals that team up with other hospitals can opt to share specialist providers, expensive diagnostic equipment, mobile clinic opportunities, and even "pool staffers for a network-wide employee health insurance plan," Zionts adds.

Rural health care providers are "increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices in rural western Colorado," Zionts reports. "About once a month, she said, she gets a call from health care leaders exploring similar networks and asking about her experience."

Banding together to keep small town hospitals open does more than provide nearby medical care for a community. It's also "beneficial for the economy of rural areas, where hospitals are often major employers," Zionts writes. "Some networks also invest in broadband, housing, and other community development projects that can help people stay healthy and access care."

Telemedicine provides abortion access for rural women in states where the procedure is restricted or banned

Graph by the Society of Family Planning (click to enlarge)

Women living in rural areas with abortion-restrictive state laws are using telehealth and doctors in other states to access abortion medications. State shield laws currently protect out-of-state medical professionals who prescribe abortion medications, but that protection may not remain a guarantee.

Asynchronous telemedicine abortion medication provision rates "were higher in states with abortion restrictions and poorer counties far from clinics," reports Rachael Robertson of MedPage Today. "Of the 118,338 medication abortion pill packs Aid Access provided over a 15-month period, 84% went to states with near-total restrictions or bans on telemedicine abortion," reported Abigail Aiken, PhD, at the University of Texas, in the Journal of the American Medical Association.

When the U.S. Supreme Court overturned Roe v. Wade in 2022, some states followed the decision with abortion bans; however, if the bans were meant to stop abortions, they had limited success. Robertson writes, "Some data suggest that abortion rates remained steady despite these challenges."

Aiken's research points to medication abortions and the shield law as a reason abortion rates remained level, even in states with the most stringent restrictions. Aiken explains, "One plausible contributor is the rise of online asynchronous telemedicine abortion services -- particularly those operating under shield laws, which allow U.S.-licensed clinicians to provide abortion medications to patients in ban states with protection from legal liability."

"Before Roe was overturned, telehealth only accounted for 4% of abortions; that has increased to 25% as of December 2024, and disproportionately to ban states, according to Society of Family Planning data," Robertson adds.

Shield law protections will be tested by a Texas lawsuit "against a New York physician operating a nonprofit delivering telemedicine abortion," Robertson reports. "In the past, states tended to honor and assist other states' law enforcement, but the post-Roe era is different."

Many rural folks scoff at the idea that Trump-law Medicaid cuts prompted their hospital's planned closure

Community Hospital is the only health clinic in Curtis. It will close in 
September. (Community Hospital photo)

A rural Nebraska hospital will close in September, and its CEO tied the closure to President Donald Trump's new Medicaid-cutting budget. "But residents of Curtis — a one-stoplight town in deep-red farm country — aren’t buying that explanation," reports Hannah Knowles of The Washington Post. Curtis resident April Roberts told her, "Anyone who’s saying that Medicaid cuts is why they’re closing is a liar."

How Medicaid cuts are received in Curtis could indicate a broader trend in rural America "where voters vulnerable to Medicaid cuts in Trump’s One Big Beautiful Bill law are reluctant to blame the president or congressional Republicans who approved it," Knowles explains. "Many people in Curtis have directed their frustration at their hospital system instead of their representatives in Washington."

Curtis is in Frontier County, Neb.
(Wikipedia map)

Some Democrats and health care advocates say the town's hospital closure is "a model of what’s to come for rural hospitals around the country," Knowles writes. "Close to half of rural hospitals nationwide already lose money, and analysts expect Trump’s tax and spending law to add more strain."

Community Hospital, the nonprofit owner of the Curtis Medical Center, "announced on July 2 — one day before the bill’s passage — that a confluence of factors had made its Curtis outpost unsustainable," Knowles reports. "It cited years-long financial challenges, inflation and 'anticipated federal budget cuts to Medicaid,' the public health insurance program for lower-income and disabled Americans."

Many Curtis residents "know that Trump’s bill will impose work requirements for Medicaid recipients," Knowles writes. "And some think — inaccurately — that the legislation was designed to end Medicaid coverage for undocumented immigrants."

Although Community Hospital had been losing money for years, the timing of Curtis closure announcement "has stoked suspicions in the town, leaving some residents convinced their health provider was using the president as a scapegoat," Knowles reports.

"Nationwide, far more people oppose Trump’s bill than support it in polling. . . . Even in Curtis, some unease at the Medicaid cuts is percolating," Knowles reports. Brenda Wheeler, a Republican and 2016-Trump voter, told Knowles, "When we talked about making America great again, I don’t think this is what we all had in mind." 

Opinion: A rural hospital administrator considers what will become of his center if Congress cuts Medicaid

When a rural hospital closes, many residents drive hours to
see a provider or receive specialized care. (Adobe photo)

Over the past 15 years, rural hospitals have struggled to stay afloat, but their already precarious financial state could become a full-blown crisis should Congress slash Medicaid spending. Kevin Stansbury, the chief executive of Lincoln Health in tiny Hugo, Colorado, writes in his opinion for The New York Times, "Congress is considering cuts to Medicaid that could wreak havoc on rural America’s fragile health care system. I worry about our future."

Cuts to federal Medicaid support will be hard on most medical centers, but "rural hospitals will be particularly affected," Stansbury explains. "This is because rural patients are more likely to have health coverage from the government than from commercial insurers. (Nearly three-quarters of our revenue, for example, is from Medicaid and Medicare.)"

In Colorado, almost half of all rural hospitals operate in the red and many have closed services such as labor and delivery units because they are too expensive to run. Stansbury writes, "We also serve fewer patients than big city hospitals but still have fixed costs to stay operational. The result is that we run on minimal or negative operating margins."

When a rural hospital closes, the health of its immediate and surrounding communities suffers. If a severe auto accident happens, victims have to wait longer for emergency services to arrive, or brave traveling to the closest medical center. Residents with chronic conditions are more likely to skip regular care because they must drive hours for a checkup or specialty treatment.

"I know the financial peril my hospital will face if our Medicaid lifeline is severed. But the real damage — the kind that keeps me up at night — will be done to the hardworking people in my rural community," Stansbury adds. "I worry about the residents of our nursing home who just want to grow old here. I worry about the people in Hugo who might forgo care entirely because they can’t get the time off work to visit a Denver hospital. . . .The list goes on."

Cutting Medicaid waste and fraud is one thing "but the cuts on the table go far beyond that," Stansbury writes. "I don’t see waste in Hugo. Rather, Medicaid ensures that primary and emergency care is still accessible here, and that drivers along I-70 will see the blue H on the highway sign and know that help is nearby."

Rural areas struggling to provide local Emergency Medical Services use creative solutions to fill the void

Southern Henry Ambulance Service’s new hub is a barn in
Knightstown. (Photo by Grayson Joslin, Indiana Capital Chronicle)

The safety net local Emergency Medical Services provides to rural communities has been faltering, leaving some areas without an EMS team to respond to urgent calls. The shortage has some areas creating their own EMS solutions.

Residents of Knightstown, Indiana, have lived without an ambulance service since January 2023, when the regional ambulance service closed due to financial losses and a lack of volunteers. "The town, situated in the southern portion of Henry County, is 25 minutes away from the county seat, New Castle, which has their own EMS services and hospital," reports Grayson Joslin of the Indiana Capital Chronicle. "But sometimes the New Castle EMS may have other calls to answer, so it could be anywhere from 45 minutes to an hour for EMS to get to Knightstown."

Knightstown resident and EMT volunteer Kevin Richey decided to explore how Knightstown might develop its own EMS service. Joslin writes, "Richey asked around the Knightstown community to see if there would be support to create a new nonprofit from scratch for providing EMS resources. . . . Southern Henry Ambulance Service was approved as a 501(c)3 nonprofit in early 2023, and started a fundraising effort across Knightstown and on GoFundMe to get the service off of the ground."

Just east of Henry County lies Fayetteville County, Indiana, where over half of the population lives in a rural area. The county has its own ambulance service, but still struggles to meet its call volume. "The county lost its only hospital in 2019," Joslin explains. "This has put an additional strain on its existing EMS operations. Runs that used to take two to three minutes to make now take about 30 to 35 minutes."

Increasing local taxes proved to be a solution to some of Fayetteville's staffing problems. "In 2024, both the Connersville City Council and the Fayette County Council approved a 0.25% public safety tax on income to go toward providing more funds to the county’s various public safety services," Joslin reports. "Fayette County EMS chief Clint Hardin said the funding from the tax allowed him to give his employees a $5,000 raise."

While tax increases are often unpopular, they can finance local needs that most residents support. Hardin told Joslin, "What people kinda lose sight of is property taxes is the only tax that we pay that is 99% local. That funds police, fire, EMS, your streets, your parks, your libraries, your schools. You get to see the benefit of your tax dollars.”