As rural America faces ‘a dire health crisis,’ urgent action is needed, ACP says

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Population health and health care is lacking in rural areas of the United States, and it will take a group effort to correct those disparities, according to the American College of Physicians (ACP).

The College’s Committees on Health and Public Policy and on Medical Practice and Quality collaborated on “Improving Health and Health Care in Rural Communities: A Position Paper From the American College of Physicians,” published in Annals of Internal Medicine.

In short: “Rural communities throughout the United States experience disparities in health and access to health care.” Interventions are needed, and quickly, to counter hospital closures, lack of physicians and other clinicians, and the excess mortality and chronic diseases that plague people who live outside major metropolitan areas of the nation.

There may not be a rural health care panacea. “While similar in some regards, the differences in characteristics of rural communities and settings presents challenges in understanding and meeting the needs of these communities through a one-size-fits-all approach,” the paper said.

The state of rural health care

ACP listed a number of factors that place rural residents at disadvantages for health and health care. Compared with urban dwellers, rural residents have higher risks of death from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke, along with “disease of despair” such as opioid misuse, suicide and nonfatal self-harm. Rural residents tend to be older, with all the health problems that age brings.

Hospitals, which can be centers of health and the local economy for rural communities, have closed: 150 gone from 2010 to 2025, with a record 19 closures in 2020. Researchers argue rural health suffers from “structural urbanism,” by which public health efforts and health systems in a profit-driven economy prioritize large consumer bases in cities and ignore rural needs, according to ACP.

The position paper came out the day before another new report quantified a decline in the numbers of rural physicians and independent practices from 2019 to 2024. The Physicians Advocacy Institute commissioned Avalere to track those losses.

Getting better

More investment in programming, education, staff and technology all could enhance rural health, the ACP authors said. The ACP paper recommended eight position statements and recommendations for improvement.

• Public policy efforts must identify, research and address rural health care challenges.
• Policymakers must address underlying social drivers of health that disproportionately affect rural communities.
• Adequate funding is vital for rural communities to have high-quality coverage and health care provided by physician-led teams.
• The nation needs more rural residency slots to expose physicians, to rural medicine, and undergraduate and graduate educational institutions should partner with medical societies to recruit students in rural communities.
• Targeted programs are needed to recruit, retain and increase the rural physician workforce.
• International medical graduates should get expanded opportunities to serve in rural communities.
• Policymakers should collaborate with public and commercial payers to pilot population-based reimbursement strategies, along with incentives for physician recruitment and retention.
• Licensure flexibilities should support access to telehealth services and interstate medical care.

Editor’s note: The American College of Physicians will host the 2025 Internal Medicine Meeting April 3-5 in New Orleans, Louisiana. Stay tuned for coverage from Medical Economics and Patient Care, a sister publication devoted to clinical care in primary care.