Rural training is an effective workforce strategy

By Emily M. Hawes

This is a lightly edited excerpt from The U.S. House Committee on Ways and Means Subcommittee on Health Care entitled, “Advancing the Next Generation of America’s Health Care Workforce.”

Compared to urban hospitals, many rural facilities face unique challenges — thin financial margins, limited subspecialty services, and less educational infrastructure. Yet with targeted support, for both start-up funding and ongoing long-term financing, they can offer highly effective training.  

There are two distinct but equally essential factors in increasing rural residency training. First, rural communities need adequate resources and expertise to effectively launch residency programs — a need that Health Resources and Services Administration (HRSA) has been addressing through the Rural Residency Planning and Development (RRPD) Program. Second, and the focus of my remarks today, is the critical role Medicare plays in ensuring the long-term sustainability of these programs. 

While the majority of my testimony will focus on policies under this committee’s jurisdiction, I will also highlight the importance of supporting the challenging and costly process of developing new residency programs. The HRSA-administered Rural Residency Planning and Development program, which provides start-up funding and technical assistance, has created 64 new rural residency programs, representing more than 794 accredited positions that are largely supported through Medicare GME financing.

One in four rural residencies nationwide were developed through this effort. RRPD exists because Congress created this program in 2018 and continues to support it.  Several states are creating similar rural residency start-up initiatives modeled on the success of this federal program, and other states are optimizing their strategies based on the research and lessons learned through RRPD. 

Medicare GME is the largest funder of physician training, and Congress making more Medicare GME financing available has been key to expanding rural residency training. Congressional reforms in the Consolidated Appropriations Act of 2021, such as resetting artificially low Medicare reimbursement to unlock rural training opportunities and streamlining accreditation processes have allowed hospitals to establish rural training more efficiently. This has led to the creation of new rural residencies such as a psychiatry program in rural Harrison County through West Virginia University. 

Additional payment slots through Section 126 have directly helped nine rural hospitals and supported several urban partners of rural training programs. Furthermore, there has been a 10-fold increase in Critical Access Hospitals participating in GME over the past decade. Not only have RRPD grants and Medicare financing flexibility contributed to growth, but changes in Medicare regulations enabling urban hospitals to receive reimbursement for Critical Access Hospitals treated as non-provider sites. With only 7 percent (96 of 1364) of Critical Access Hospitals training residents, there is potential to expand training further in these sites. 

In fact, there are 41 Critical Access Hospitals currently developing rural residencies through the RRPD program. There is substantial interest and enthusiasm in doing this. Just this past week, we had over 100 attendees on our RRPD webinar focused on how to grow training in their Critical Access Hospitals.  Taken together, rural residency programs have increased roughly fourfold since 2008, thanks to these Medicare reforms and the Rural Residency Planning and Development Program. 

Furthermore, there were 459 rural rotation experiences offered by residency programs in the academic year 2024-2025. These data show that training in rural and underserved communities is not only possible but that there is untapped capacity to train even more physicians there. Policy matters. When Congress removes barriers and provides targeted support, rural training grows. 

Read the full testimony here.

View the entire hearing here.

Emily M. Hawes, PharmD, BCPS, CPP, is a professor in the Department of Family Medicine. She serves as Director of the HRSA-funded Rural Residency Planning and Development and Teaching Health Center Technical Assistance Centers.  She also leads the North Carolina Graduate Medical Center – Technical Assistance Center, which aims to expand and sustain rural residencies in the state. She practices as a Clinical Pharmacist Practitioner providing collaborative drug therapy management in a family medicine clinic in rural North Carolina.

_{*The opinions expressed in this column are those of the author and do not necessarily reflect the views of HealthPlatform.News.}