How Federal Policy Can Better Serve the Rural Health Care Workforce

Ivy Love

Rural communities across the country are facing a litany of challenges in accessing the health care they need. The incidence of some chronic conditions, including high blood pressure and obesity, is higher for rural residents. The share of residents over 65 is higher in rural than urban locales, and older adults often have more complex health care needs. Meanwhile, according to recent Health Resources and Services Administration (HRSA) data, there are fewer physicians, dentists, and registered nurses in rural areas than in urban areas, relative to the population. And there are ways federal policy can help education providers and local communities ensure more rural primary and allied health professionals enter the field.

These challenges are complex, and no one policy can solve everything. But there are ways we can build on past and current federal initiatives to do better for rural residents and their health care providers. With a new administration and Congress on the way soon, it's a good time to take stock of where we are and where we could go.

Here are three ideas policymakers should consider:

1. Include more occupations in financial aid programs for health professionals. One important federal initiative currently contributing to alleviating rural health provider access is the National Health Service Corps (NHSC), which offers scholarships and loan forgiveness to health care professionals who agree to work for a few years in a federally-designated Health Professional Shortage Area (HPSA), including underserved rural locations. As it stands, student loan forgiveness is available to some who completed only undergraduate training for a health-related field (e.g., registered nurse, substance use disorder counselor) as well as physicians and dentists. Meanwhile, NHSC scholarships are not available to allied health students, only for eligible students preparing to become doctors, dentists, and nurses. Recruiting and retaining respiratory therapists, radiology technicians, dental hygienists, and other allied health professionals can be challenging in many rural communities. Expanding access to NHSC scholarships and loans for students and newly-graduated professionals in these fields could be a game changer. While the National Health Service Corps has done much for rural care access, it's important to consider how to promote the recruitment and retention of both local allied health professionals and primary care providers-ideally, those who are rooted in and committed to the local community for the long haul.
2. Empower local colleges to meet needs. A huge barrier to expanding allied health programs in higher education is institutional capacity. Colleges must have the facilities, faculty, and clinical partnerships to ensure they can admit and support enough students to meet local needs. One past federal investment to learn from here is the Trade Adjustment Assistance Community College and Career Training (TAACCCT), which provided nearly $2 billion between 2011-18 to community colleges expanding their capacity to support workers impacted by the Great Recession. Unsurprisingly, many TAACCCTgrantees prioritized building, expanding, and enhancing health care programs. For example, community colleges participating in the Consortium for Healthcare Education Online (CHEO) used TAACCCT resources to redesign courses for hybrid and online delivery, including lab courses, making programs more accessible for rural students. And the great news is that this massive investment paid off. Our research found that TAACCCT had a positive, significant impact on both program completion and labor market outcomes. New federal initiatives should continue to provide rural colleges with support to expand their health care programs-a crucial step to tackle health care provider shortages in these communities.
3. Apprenticeship support is allied health workforce support. The US Department of Labor estimates that apprenticeships in health-related occupations grew by a staggering 169 percent between 2018-23. And this growth is no accident. Federal initiatives such as the 2015 American Apprenticeship Initiative (AAI) provided needed capacity-building resources to state agencies and their partners to create and enhance apprenticeship opportunities in high-need sectors, including health care. For example, the Vermont Department of Labor used part of their $3 million AAI grant to develop new apprenticeship programs for medical assistants and surgery technicians, among other health-related occupations. Apprentices earned $15 for on-the-job training, and 90 percent of apprentices in health-related programs were able to earn credits toward a college credential through their apprenticeship as well. Since then, the federal government has continued to invest in apprenticeship development. Several recipients in the second round of Apprenticeships Building America grants, just awarded this year, are developing new apprenticeship pathways for medical assistants, nurses, surgical technologists, and more. This strategy to create paid, mentored training for future health workers should continue to be front of mind for policymakers who want to ensure strong workforce pathways in health care for rural residents.

Rural communities aren't homogenous, and neither are their health care workforce needs. However, federal policy and resources that consider the rural workforce and include allied health roles will be crucial to increase the number of health care providers in rural communities. We can learn from what's worked before and make it even better for future rural health care workforce development and retention.

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