Publications

Inspiring Rural Youth to Consider Healthcare Careers Through an Interpersonal Healthcare Traveling Roadshow

There are well-documented shortages of healthcare providers in rural and remote communities worldwide, and these shortages correlate with inequitable health outcomes for rural peoples. This paper will share our experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.

Burnout, Depression, and Diminished Well-Being among Physicians

Diminished well-being among physicians is of growing concern. The authors review measures of burnout and depression, causal factors, and interventions to improve well-being.

Recruitment of Residents to Rural Programs: Early Outcomes From Cohort 1 of the Rural Residency Planning and Development Grants Program

This study highlights the early recruitment outcomes of the 25 Cohort 1 RRPD grantees establishing rural residency programs, offering insight into recruitment strategies, application trends, and initial grantee successes. Understanding these emerging programs’ experiences is crucial for educators and leaders striving to enhance equity and access to health care in rural communities.

Health professional retention in underserved areas: findings from the National Health Service Corps Loan Repayment Program participants in the United States, 2019–2021

Health care provider retention is important for mitigating workforce shortages in underserved areas. The National Health Service Corps (NHSC) provides loan repayment for a two or three-year service commitment from clinicians to work in underserved areas. We observed that technical assistance and job resources were more influential on clinicians’ intentions, compared to individual- or community-level characteristics. Organizations with efficient and supportive work environments may help retain clinicians in underserved areas.

CDC Rural Public Health Strategic Plan – FY 2024-2029

The Rural Public Health Strategic Plan outlines key priorities, objectives, and outcomes for the next five years for collaborating with both internal and external partners, including federal agencies. The document includes background on CDC's rural public health efforts, the science and practice of rural public health, the structure and role of ORH, and the strategic plan's development. This plan will guide CDC's programs and research to ensure rural needs are part of public health programs at the outset.

Characteristics of Communities Affected by Critical Access Hospital Mergers

This descriptive study provides comparative statistics on the demographic, socioeconomic, health status, and geographic characteristics of communities served by CAHs by their merger status. Findings from this study will help inform hospital leaders, State Flex Programs, and policymakers about community characteristics that may be associated with CAH mergers, and the rural populations that are affected by CAH mergers.

New Report Highlights Strategies for Building, Growing, and Retaining Rural Health Workforce ​

The report from the National Rural Health Resource Center was done in collaboration with FORHP and is a product of the May 2024 Rural Health Workforce Summit. Each of the report's four key strategies include specific and practical actions that can be adopted to address workforce shortages.  

An Updated Model of Rural Hospital Financial Distress

Given the ongoing challenges and consequences of rural hospital unprofitability, there is a clear need for accurate assessments of financial distress risk. The financial distress model can be used by researchers, policymakers, and rural health advocates as a screening tool to identify at-risk rural hospitals for closer monitoring.

The Maternal and Child Health Workforce: A Snapshot of Current and Future Needs From Public Health WINS 2021

The MCH module highlights a need to further prioritize workforce development efforts for governmental public health staff, especially in LHDs. There is an ongoing need to meet public health professionals where they are and to tailor training models and workforce development plans to account for new and ongoing stressors faced by the workforce.

Utilizing Federal Data Sources to Support Nursing Workforce Analysis

In this article, we introduce and review 18 federal data sources pertinent to nursing workforce analysis. We categorize the datasets by their associated federal agency, describe each source, discuss their applicability to nursing workforce studies, present examples of past studies that employed these datasets, and highlight their limitations. Our aim is to help researchers, policymakers, and healthcare administrators efficiently locate and leverage relevant data for their analysis.

Inspiring Rural Youth to Consider Healthcare Careers Through an Interpersonal Healthcare Traveling Roadshow

There are well-documented shortages of healthcare providers in rural and remote communities worldwide, and these shortages correlate with inequitable health outcomes for rural peoples. This paper will share our experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.

Burnout, Depression, and Diminished Well-Being among Physicians

Diminished well-being among physicians is of growing concern. The authors review measures of burnout and depression, causal factors, and interventions to improve well-being.

Recruitment of Residents to Rural Programs: Early Outcomes From Cohort 1 of the Rural Residency Planning and Development Grants Program

This study highlights the early recruitment outcomes of the 25 Cohort 1 RRPD grantees establishing rural residency programs, offering insight into recruitment strategies, application trends, and initial grantee successes. Understanding these emerging programs’ experiences is crucial for educators and leaders striving to enhance equity and access to health care in rural communities.

Health professional retention in underserved areas: findings from the National Health Service Corps Loan Repayment Program participants in the United States, 2019–2021

Health care provider retention is important for mitigating workforce shortages in underserved areas. The National Health Service Corps (NHSC) provides loan repayment for a two or three-year service commitment from clinicians to work in underserved areas. We observed that technical assistance and job resources were more influential on clinicians’ intentions, compared to individual- or community-level characteristics. Organizations with efficient and supportive work environments may help retain clinicians in underserved areas.

Nurse Corps’ impact on increasing registered nurse staffing in critical shortage areas and facilities, 2017 to 2022

This paper reports on Nurse Corps applications, awards, and distribution in 2 cohorts in the period 2017 to 2022 to assess the impact of receiving an additional $200 million appropriated in 2021. 

Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review

Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs’ impact on the U.S. behavioral health workforce. 

Rural hospitals at risk of closing

The report is based on the latest hospital financial information that was released by CMS earlier this month (in April 2024).  

The Availability of Midwifery Care in Rural United States Communities

Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. 

Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022 ​

In the US, access to maternity care in rural counties continues to decline. This infographic from the FORHP-funded University of Minnesota Rural Health Research Center updates their 2017 analysis on hospital-based obstetric services in rural counties, showing that rural counties with no hospital-based obstetric services increased from 54% of rural counties in 2014 to almost 59% in 2022.

Understanding the Rise of Ransomware Attacks on Rural Hospitals

Hospitals face a growing threat from ransomware attacks that are designed to disrupt care delivery and may consequently threaten patient outcomes and hospital finances. This policy brief presents findings from a novel database of hospital ransomware attacks, focusing on the frequency and characteristics of ransomware attacks on rural hospitals.

International Medical Graduates and the Physician Workforce

Physician shortages and the geographic maldistribution of general and specialist physicians impair health care delivery and worsen health inequity in the US. International medical graduates (IMGs) represent a potential solution given their ready supply.

Addressing the Nurse Retention Crisis—Leveraging Policies Supported by Evidence

Using survey data from registered nurses who participated in the Michigan Nurses’ Study, Friese and colleagues1 evaluated patterns in the employment plans of nurses in 2022 and 2023, providing good news for employers and nurses. Declines were documented in the number of nurses intending to leave their current position and reducing their clinical hours. Nurses reported faring better in 2023 relative to 2022, experiencing less burnout, less job dissatisfaction, fewer experiences of workplace violence, fewer instances of understaffing during a recent shift, and less frequent mandatory overtime.

Inspiring rural youth to consider healthcare careers through an interprofessional healthcare traveling roadshow

This paper will share their experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.

New Report Concludes that Achieving Value in Rural Areas May Require Increased Spending. ​

The Physician-Focused Payment Model Technical Advisory Committee (PTAC), an independent federal advisory committee, has transmitted a Report to the Secretary of Health and Human Services. This report compiles information from previous payment model proposals PTAC reviewed, literature addressing the topic, and input received during a rural-focused meeting last year.  They conclude that while value-based care often focuses on improving quality while reducing spending, achieving value in rural areas may require increasing spending.  ​

Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022 ​

In the US, access to maternity care in rural counties continues to decline. This infographic from the FORHP-funded University of Minnesota Rural Health Research Center updates their 2017 analysis on hospital-based obstetric services in rural counties, showing that rural counties with no hospital-based obstetric services increased from 54% of rural counties in 2014 to almost 59% in 2022.

The Rewards of Working as Rural Docs

While working in a rural area comes with many challenges, many health care professionals are convinced that the benefits of being part of a small community, living among those you serve, and being appreciated for making the choice to play a vital role in their lives outweigh the drawbacks. Additionally, Rural Health Information Hub looks at how rural community health worker programs are proving their value and finding sustainability.

Rural Community Health Worker Programs: Proving Value and Finding Sustainability

For decades, community health workers (CHWs) provided their services outside usual healthcare reimbursement models. In recent years, with research supporting CHWs as professionals effectively assisting patients with navigating health-related social determinants, federal and private payers are exploring reimbursement mechanisms. Four rural healthcare organizations share both the impact and the continued sustainability challenges and successes of their CHW programs.

Workplace factors related to health care leader well-being in rural settings

Working with two rurally focused organizations, we administered a Rural Leader Burnout survey to executive leaders to examine which workplace factors contribute to health care leader well-being in rural settings. 

Stemming the Tide

When NCSBN published the results of the 2022 Nursing Workforce Study that found that more than 100,000 nurses had already left the profession and almost 900,000 additional nurses had indicated an intent to leave, it confirmed what most health care CEOs and nursing administrators already knew: the system was hemorrhaging nurses. 

HHS to report to Congress on Maternal Health

The Department of Health and Human Services (HHS) recently sent a report to Congress on agency-wide activities and outcomes of programs addressing the maternal health crisis. The report includes trends on maternal health outcomes, drivers contributing to the crisis, HHS actions to address drivers, and a measurement framework to assess progress. The report also addresses the lack of access to maternal health care in rural areas and highlights programs aimed at increasing the rural maternal health workforce 

RUPRI brief on rural pharmacy presence

The RUPRI Center for Rural Health Policy Analysis released a new data brief continuing its series of reports exploring the availability of retail pharmacy services in rural America. Researchers at RUPRI found that between 2018 and 2023 the number of retail pharmacies across the U.S. declined by 3.9%. During that same period retail pharmacies in rural areas declined by almost 6%. The overall number of rural communities with retail pharmacies changed little during that 5-year period, but there was a substantial number of community-level changes. 184 communities lost all local retail pharmacy service while 195 other rural communities gained retail pharmacy service. 

Behavioral Health Workforce Distribution in Socially Disadvantaged Communities

Amid a growing behavioral health crisis in the US, less than half of individuals who need services for mental health or substance use concerns receive care. Multiple factors impact access to behavioral health services, including payment, stigma, and the availability of a positioned behavioral health workforce in areas with the greatest need. This article explores the geographic distribution of 3 behavioral health clinician types in disadvantaged communities in the US across a standardized index of area disadvantage.  

IRHA President Whitney Zahnd on Rural-Urban Health Disparities

This week, IRHA President, Whitney Zahnd spoke with Iowa Public Radio about rural-urban disparities in mortality and challenges with access to care in rural areas.  

HHS launches Maternal Mental Health Task Force’s National Strategy to improve maternal mental health care.

The vision set forth by this national strategy is one in which maternal mental health (also known as perinatal mental health) and substance use care is seamless and integrated across medical, community, and social systems. The vision includes models of care and support that are innovative and sensitive to individuals’ experiences, culture, and community and does not distinguish between physical health care and mental health care. Building upon existing federal government efforts, the task force outlines a path to achieve the vision within a framework consisting of the following five pillars, each with supporting priorities and recommendations.

How Upfront, Predictable Payments Can Improve Primary Care

Experts increasingly agree that to strengthen primary care in the U.S., we should promote “prospective payment” in which providers are given upfront payments to care for each patient for a particular period of time.

​Rural Hospitals’ Perspectives On Health System Affiliation

This brief explores the current trend in hospital affiliation from a rural perspective and offers guidance to rural hospital leaders in navigating a potential affiliation.

​Physician and Advanced Practice Clinician Burnout in Rural and Urban Settings

Recruiting rural-practicing clinicians is a high priority. In this study, we explored burnout and contributing work conditions among rural, urban, and family practice physicians and advanced practice clinicians (APCs) in an Upper Midwestern health care system.

Preparing behavioral health clinicians for success and retention in rural safety net practices

This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention.

​HRSA’s National Sample Survey of Registered Nurses

​HRSA’s Bureau of Health Workforce provides demographic, training and education, employment, COVID-19 impact, and workforce projection data for registered nurses (RNs) in the U.S.

​Advancing Racial Equity in U.S. Health Care: The Commonwealth Fund 2024 State Health Disparities Report

​This report evaluates disparities in health and health care across racial and ethnic groups, both within states and between U.S. states.

​It Can’t Just Be About the Money: How to Assure an Adequate Public Health Workforce

Salary disparities emphasize the urgency of rectifying pay inequities in public health occupations. However, many public health positions are governed by state employee pay structures that cannot be changed for only one agency. Given the challenges of increasing governmental pay just for public health, additional approaches are needed for public health recruitment and retention that are within the public health sector’s control.

​Interventions for health workforce retention in rural and remote areas: a systematic review

Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention.

​Taking Action Against Clinician Burnout

​Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care.

​Support for Vulnerable Rural Hospitals: Lessons Learned

An overview of state and federal programs and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals describes challenges – including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities.

Additional Publications by Focus Area