Becker's Hospital Review

16 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING Forty-three million Americans live in rural areas with primary care shortages. For the hospitals and health systems serving them, workforce instability is one of the top strategic challenges. Physician and clinician shortfalls, burnout and thin talent pipelines limit access and stretch already-lean operations. The strain is especially acute in markets hit by closures and consolidations. While short-term interventions offer temporary relief, leaders increasingly recognize that lasting stability requires more than recruitment incentives. Chris Gallagher, MD, founder and chief strategy officer at Access TeleCare — an athenahealth customer — pointed to an aging workforce, employed-physician churn and the waning returns of fixes like locum tenens staffing. "The idea that you could pop in a locums cover for a few months and then bring in a full-timer — it's just very challenging," he told Becker's Healthcare. "These locum assignments are getting longer and longer, so rural systems and hospitals are starting to look for options." Instead, executives are investing in long-term solutions rooted in education, partnerships and structural alignment, alongside care- model redesign. This article, the third in a four-part series, "Rural healthcare excellence in 2026: 26 lessons in making less do more," explores seven ways rural healthcare leaders are strengthening the workforce through long-range planning and cross-sector collaboration. 1. Compete on culture, not compensation For rural healthcare organizations that often can't match urban pay, culture is the rare retention lever that costs nothing — built through small, everyday choices: mutual respect, front-line empowerment and protected well-being. Kevin Stansbury, CEO of Lincoln Health in Hugo, Colo., credits that approach for going nearly two decades without relying on agency nurses. "I can foster an environment where our medical staff is very respectful to other clinical staff, and that our service and support staff feel empowered to do the right thing," he told Becker's. "Those are the kinds of things we can do, and it doesn't cost me any money to do that." Sourcing matters too. Mr. Stansbury's team works with an immigration law firm to recruit international nurses, then screens thoroughly for clinicians who actually want to live in a remote community, which is a trait culture can't manufacture after the fact. His bottom line: "We can't compete financially, but we can whip the urban systems with our culture." Across rural systems, that culture is increasingly built on well-being. Soniya Fidler, president of UCHealth Yampa Valley Medical Center in Steamboat Springs, Colo., believes protecting staff is a core employer duty amid pressures that range from workplace violence and burnout to housing and childcare costs. "We must take care of our people with the same level of safety, quality and accountability that we give our patients," she said. 2. Grow your own — and keep talent local The longest-range workforce strategy begins well before a job application: grow-your-own pipelines that recruit students from local schools. Georgetown, S.C.-based Tidelands Health teamed with the county school district and a technical college to enroll high school juniors in health science courses, cover two years of college tuition and guarantee a job after graduation. Its first cohort drew 15 students, with a goal of 50 a year across nursing, medical assisting and EKG technician roles. "If we do this for five years, that's 250 people who are working for us and getting a chance at free education, which they may not have had covered otherwise," Jeremy Stephens, Tidelands' CHRO, told Becker's. Other systems start even earlier. Sky Lakes Medical Center in Klamath Falls, Ore., built a career and technical education center with its school district and community college, letting high schoolers work in its facilities. "We started that two years ago because students were saying, 'I want a healthcare career, but I don't know where to go,'" CHRO Bryan Fix told Becker's. "We wanted to support them while they were still in focused career and tech ed programs in high school." 3. Put every clinician at the top of their license With physicians scarce, the highest-leverage move is often structural: redesigning teams so every clinician works to the full extent of their training. Policy is pushing the same way. Signaling that shortages can't be solved by physician supply alone, CMS built scope-of-practice into its $50 billion Rural Health Transformation Program, rewarding states that grant nurse practitioners, physician assistants and pharmacists fuller practice authority, especially in primary care. Redesign also means reassessing who does what as virtual and in-person care blend. Dr. Gallagher of Access TeleCare said organizations are getting honest about where virtual care's "ceiling" lies — which capabilities translate to a screen and which don't. Some specialties, like infectious disease, can be handled almost entirely from afar; others, like behavioral health, still benefit from a clinician walking the halls to observe patients. Making those virtual care assessments helps organizations "define the role of the virtual team and the role of the in-person team," Dr. Gallagher said. "It's important to decide who does what, where the value is created for each." Strengthening the Backbone of Care 7 rural workforce transformation strategies changing the labor landscape Rural Healthcare Excellence in 2026

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