Most rural communities have significant shortages of health care professionals and are unable to adequately staff hospitals and clinics because of a ratio mismatch: approximately 20% of people in the Unites States live in rural areas, yet only 10% of physicians practice in those same areas.
13,14 In 2015, a hospital chief executive officer I interviewed in rural Oregon stated that the hospital was at 23% of the necessary manpower, and most of their practicing physicians were older than 60 years. In a follow-up conversation in May 2018, he stated that his workforce diminished further, making the situation more dire.
In another case, a community hospital in rural Nevada was able to recruit and hire a physician; however, the physician stayed for less than a year because he experienced burnout due to having no backup and was required to be on call 24 hours per day/7 days per week. After his departure, the hospital eventually closed because of the workforce shortage.
During the Rural Training Track Collaborative meeting in Spokane, Washington, in April 2018, a chief financial officer of a critical access hospital in Idaho stated that the hospital's mean census was only 3 even during the cold and flu season. There was no regional primary care infrastructure to staff the community clinic or the hospital. The hospital was still operating because of community needs and subsidies; however, the operating margin was typically less than 1%. Health care professional shortage was the key concern when attempting to sustain operations, and the hospital had to transfer patients to other hospitals for even routine inpatient illness management.