The doctor shortage no one in Washington wants to talk about

OPINION:

Growing up in rural America, you learn early that we take care of our own. Neighbors show up. Families pitch in. When something needs fixing, folks roll up their sleeves and get to work. But when it comes to healthcare, rural America can’t simply “work harder” to fill the gaps. You can’t magically create a doctor who isn’t there, and you can’t patch together a healthcare system with duct tape.

And yet, for decades, that’s exactly what rural communities have been expected to do.

I spent more than 30 years as a community pharmacist in East Tennessee and now represent this same rural region in Congress. I served the families who drove across two counties for a routine appointment, or who delayed their care altogether because the closest doctor wasn’t close enough. And I saw the heartbreak when a beloved physician retired, and no one stepped in to replace them. These stories used to be exceptions. Now they’re becoming the norm in too many rural towns across America.

We often talk about hospital closures, workforce shortages, and long drive times. But those problems are symptoms of a deeper issue: That our healthcare system was never built with rural America in mind. It was built around volume, density, and scale — the very things rural communities, by definition, do not have.

And the consequences are showing up all over the country.

You can see it in the data: fewer medical residents training in rural regions, fewer specialists practicing outside major cities, and more hospitals operating on margins supposedly so thin that a single bad year can mean closure. But the lived reality is even more stark. When a rural hospital shuts down, the nearest emergency room can be an hour’s drive away. When a pregnant mother must travel across multiple counties for prenatal care, or when a young doctor chooses an urban placement — not out of disregard for the value of rural communities, but because the system never encouraged them to work there — you begin to understand the depth of this crisis.

This health care model is a system that disadvantages rural America, and that’s exactly what is happening across rural districts right now.

For far too long, Congress has tried to put a Band-Aid over the symptoms while ignoring the festering sore underneath. One of the clearest examples is the way Medicare funds physician training. Most people don’t know how Graduate Medical Education (GME) works, but the truth is simple: the rules we have today almost guarantee most physicians will never practice in rural communities. Hospitals in major cities receive the largest number of residency slots, while rural hospitals — those most in need of a pipeline — often have none. The result is predictable: doctors train in urban settings, build their professional networks there, and usually stay there.

That’s why as co-chair of the Congressional Bipartisan Rural Health Caucus, I’ve championed policies like the Rural Physician Workforce Production Act. It tackles the problem at its root by lifting outdated Medicare caps that make it nearly impossible for rural hospitals to host residents. It allows urban teaching hospitals to send trainees to rural rotations without being penalized, and it creates a sustainable funding pathway so rural hospitals can finally grow their own physician pipeline.

Rural healthcare doesn’t need more Band-Aids. It needs structural reform. It needs Congress to admit a one-size-fits-all model doesn’t work the same for a town of 5,000 as it does for a city of 5 million.

The same philosophy is behind the new Rural Health Transformation Fund, created through President Trump’s Working Families Tax Cuts. At $50 billion, it is the single largest investment in rural healthcare in American history. It gives rural hospitals the resources to stabilize, modernize, expand services, and design long-term, community-based care systems that actually fit their needs.

Rural America isn’t asking for the impossible. They’re asking for a healthcare system that is accessible, affordable, and recognizes their challenges instead of penalizing them for living too far from big cities. Every community, big or small, deserves the chance to thrive. And that starts with dependable, local care.

If we’re willing to take an honest look at what isn’t working and modernize the outdated policies holding rural communities back, we can finally build a system that serves everyone. We can train more doctors where they’re needed, strengthen rural hospitals, and give families confidence that care will be there when they need it.

And with the right reforms, that future is well within reach.

• Rep. Diana Harshbarger has been a pharmacist for over 30 years, serves as the Co-Chair of the Congressional Bipartisan Rural Health Caucus, and is Vice Chair of the Subcommittee on Health under House Energy and Commerce.