HHS expanding medical residencies in rural areas


Photo: Knaupe/.

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), has awarded nearly $11 million to 15 entities to strengthen the healthcare workforce by establishing new residency programs in rural communities.

Nearly 70% of areas designated as primary medical Health Professional Shortage Areas are in rural areas, HHS said. Physician shortages, poverty, and geographic isolation contribute to lack of access to care and poorer health outcomes for rural Americans.

More than half of rural U.S. counties lack hospital obstetric services. In response to the declining access to rural maternal health care, three of the 15 awards will be used specifically to develop new family medicine residency programs with enhanced obstetrical training in rural communities.


The award recipients will each receive up to $750,000 to establish new rural residency programs, which can be used to support accreditation costs, curriculum development, faculty recruitment and retention, resident recruitment activities, and consultation services to support program development.

Throughout the duration of the grant, the recipients will have access to one-on-one advisor support, tools, and resources provided by the HRSA funded Rural Residency Planning and Development Technical Assistance Center to navigate the various stages of program development.

HHS framed the awards as part of a broader administration effort to advance health equity and access to care, highlighting the Centers for Medicare and Medicaid Services’ recent move to award the first 200 of 1,000 new Medicare-funded physician residency slots. CMS prioritized hospitals with training programs in geographic areas demonstrating the greatest need for additional providers, as determined by Health Professional Shortage Areas, HHS said.

For fiscal year 2024, CMS proposed that rural emergency hospitals (REHs) could be designated as graduate medical education training sites. The idea is that more medical residents would be able to train in rural settings, thus potentially addressing workforce shortages in those communities.

HRSA has doled out money through a number of programs throughout the year aimed at strengthening the rural health workforce, including $175 million through the Teaching Health Center Graduate Medical Education (THCGME) Program to support the training of residents in community-based residency programs; $23 million through the Teaching Health Center Planning and Development Program; and $9.4 million through the Primary Care Training and Enhancement: Residency Training in Primary Care program.


Last summer CMS implemented a new provider type, Rural Emergency Hospitals. Small rural hospitals can seek this provider designation through a Conditions of Participation for REHs. This allows them to provide continued access to emergency services, observation care and additional medical and outpatient services, and to provide maternal health, behavioral health and substance use disorder services.

The REH provider type was established by the Consolidated Appropriations Act of 2021 to address the growing concern over closures of rural hospitals. More than 140 have closed since 2010, with a record-breaking 19 hospitals closing in 2020 alone. Rural hospital closures deprive people living in rural areas of crucial services, including access to emergency care.

In April Senators Bob Casey (D-PA) and Chuck Grassley (R-IA) reintroduced the Rural Hospital Support Act, subsequently drawing support from the American Hospital Association. The AHA applauded the bill’s efforts to modify and extend some Medicare payments to rural hospitals.

The Alliance for Rural Hospital Access also applauded the legislation, saying it would permanently extend the Medicare Dependent Hospital (MDH) program and the Low-Volume Hospital Payment Adjustment, providing vulnerable hospitals with more predictable Medicare reimbursements and greater financial stability.

Twitter: @JELagasse
Email the writer: [email protected]

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