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The State of Rural Hospitals in America

Nurse practitioners are helping to meet urgent staffing needs.

Rural hospital closings are weakening the healthcare safety net for millions of U.S. residents.

Since 2010, 138 rural hospitals have closed.1 Then came the COVID-19 pandemic, which has further strained the resources of rural facilities struggling to keep their doors open. Now, experts say, another 453 rural hospitals are vulnerable.1

“Even in places where hospitals remain open, services are disappearing rapidly,” the Chartis Group writes in its 2021 report, Rural Communities at Risk. “Our ‘Crises Collide’ study published earlier this year revealed that more than 160 rural communities have lost access to obstetrics and that 252 rural hospitals that offered chemotherapy in 2014 no longer offered the service by 2018.”1


What’s Ailing Rural Hospitals?

The American Hospital Association (AHA) has identified a number of critical, ongoing challenges to the viability of rural hospitals. These include:2

  • Low patient volume: “Due to low population density in rural areas, hospitals lack scale to cover the high fixed operating costs,” the AHA writes in its 2019 Rural Report.2
  • Challenging payer mix: “Rural hospitals are more likely to serve a population that relies on Medicare and Medicaid. However, these programs reimburse less than the cost of providing care, making rural hospitals especially vulnerable to policy changes in payment of services,” the AHA says.2
  • Geographic isolation: “Rural communities are often located away from population centers and other healthcare facilities. According to a recent Pew Research Center survey, among the quarter of rural Americans traveling the longest to reach an acute care facility, the average travel time is 34 minutes by car. … Geographic challenges such as these can cause patients to delay or forego healthcare services, which can increase the complexity and overall cost of care once services are delivered,” the AHA says.2
  • Workforce shortages: “Recruitment and retention of healthcare professionals is an ongoing challenge and expense for rural hospitals. While almost 20% of the U.S. population lives in rural areas, less than 10% of U.S. physicians practice in these communities.” The AHA says nurse practitioners are helping to extend coverage and now constitute 19% of the rural hospital primary care workforce.2

The Future of Rural Hospitals

To help stanch the loss of these lifesaving facilities, the Chartis report says healthcare advocates and policymakers must “reimagine strategies for addressing the rural hospital crisis and the widespread vulnerability of the communities they serve.”1

Funding is critical, and President Joe Biden’s Build Back Better Plan includes billions of dollars to “help rural hospitals stay open in the long run and improve the care provided to rural communities.”3

"The bill's $8.5 billion allocation for rural providers will protect and support care for many of the nation's most vulnerable patients, especially those who live in rural, underserved communities," Chip Kahn, president and CEO of the Federation of American Hospitals, told the Becker Hospital Review.4

The AHA’s report recommends numerous changes in federal policies, including those that would increase reimbursements from federal and private payers, ease regulatory requirements, expand coverage and federal funding for telehealth services, reduce prescription drug costs, and make recruitment and retention a top priority.2

Choose Your Nursing Career Path

A Master of Science in Nursing (MSN) degree can lead you to a rewarding job serving patients in much-needed rural hospitals, or to positions in many other career destinations.

If you’re getting ready to select an online MSN program, look for an accredited university that offers flexibility and choice. Walden University, No. 1 in Master of Science in Nursing graduates in the U.S.,5 lets you tailor your studies to your career interests.

If you want to provide direct patient care, Walden’s online MSN degree program offers five nurse practitioner specializations that can prepare you to pursue certification and credentialing. If leadership in nursing is your ambition, there’s a Nurse Executive specialization. Other indirect patient care options include Nursing Education, Nursing Informatics, and Public Health Nursing.

As a leader in distance education for more than 50 years, Walden understands that working professionals need flexibility to achieve their educational goals. Walden’s online MSN degree program lets you earn a degree while staying active in your nursing career and personal life.

Earning a master’s in nursing online can help prepare you to make a difference in the lives of patients and build healthier communities, anywhere you choose to live and work.

Walden University is an accredited institution offering a Master of Science in Nursing (MSN) online degree program. Expand your career options and earn your degree in a convenient, flexible format that fits your busy life.

5Source: National Center for Education Statistics (NCES) IPEDS database. Based on the most recent year of completions survey data available, using CIP code family 51.38 “Registered Nursing, Nursing Administration, Nursing Research, and Clinical Nursing” for Master’s degrees (Award level 7). Available at (Retrieved January 2021; may consist of or include provisional release data.)

Walden University is accredited by The Higher Learning Commission,