ACP: Invest in Rural Communities to Decrease Health Disparities, Improve Access to Care

ACP President Isaac O. Opole, MBChB, PHD, MACP

Photo courtesy of University of California, Irvine School of Medicine

The American College of Physicians (ACP) has issued a new position paper highlighting the urgent need for policy initiatives to improve health care access and outcomes in rural communities.1

The paper, Improving Health and Health Care in Rural Communities: A Position Paper from the American College of Physicians, was published online April 1, 2025, in the Annals of Internal Medicine.

“It is important to remember that rural communities are diverse and cannot be easily categorized,” first author Josh Serchen, MPP, and colleagues wrote.1 “They differ in demographics, culture, geography, isolation levels, and economic activity, making it challenging to proffer a one-size-fits-all policy approach to address the unique challenges of rural communities.”

Serchen and colleagues listed several factors that place rural US residents at disadvantages for health and health care access. Rural populations experience significantly higher mortality rates from cardiovascular disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke compared with urban populations. These communities are also disproportionately affected by mental health conditions and substance use disorders, commonly referred to as “diseases of despair.” In addition, rural areas have seen a sharp rise in maternal mortality rates and rural residents are older than in nonrural communities.1

“Poor health outcomes for rural populations coincide with poor access to health care services,” authors added. Between 2010 and 2025, 150 rural hospitals in the US closed, with a record 19 closures in 2020. Researchers argue rural health suffers from “structural urbanism,” by which public health efforts and health systems in a profit-driven economy prioritize large consumer bases in cities and ignore rural needs, according to ACP.1

“More needs to be done to help our patients who live in rural communities,” ACP President Isaac O. Opole, MBChB, PhD, MACP, said in a press release.2 “Policymakers must invest in the economies, social services, and infrastructure of these areas, especially those programs that provide health coverage and services to them.”

The position paper was collaboratively drafted by the ACP Health and Public Policy Committee and the Medical Practice and Quality Committee. The Committees reviewed available peer-reviewed studies, reports, and surveys on rural health in the US, focusing on access, disparities, workforce, and telehealth. Input from various ACP councils and members informed the drafting of recommendations, which were ultimately approved by the ACP’s Board of Regents on February 11, 2025.1

In the paper, the ACP outlined the following 8 position statements and recommendations for improvement1:

1. Public policy efforts must identify, research, and address rural health care challenges.
2. Policymakers must address underlying social drivers of health that disproportionately affect rural communities.
3. Adequate funding is vital for rural communities to have high-quality coverage and health care provided by physician-led teams.
4. The nation needs more rural residency slots to expose physicians to rural medicine, and undergraduate and graduate educational institutions should partner with medical societies to recruit students in rural communities.
5. Targeted programs are needed to recruit, retain, and increase the rural physician workforce.
6. International medical graduates should get expanded opportunities to serve in rural communities.
7. Policymakers should collaborate with public and commercial payers to pilot population-based reimbursement strategies, along with incentives for physician recruitment and retention.
8. Licensure flexibility should support access to telehealth services and interstate medical care.

Editor’s note: The American College of Physicians will host the 2025 Internal Medicine Meeting April 3-5 in New Orleans, Louisiana. Stay tuned for coverage from Patient Care and Medical Economics, a sister publication devoted to the business of medicine.

References:

1. Serchen J, Johnson D, Cline K, et al. Improving health and health care in rural communities: A position paper from the American College of Physicians. Ann Intern Med. Published online April 1, 2025. doi:10.7326/ANNALS-24-03577

2. ACP Says Rural Communities Need Support to Decrease Health Disparities and Improve Access to Care. News release. American College of Physicians. March 31, 2025. Accessed April 3, 2025. https://www.acponline.org/acp-newsroom/acp-says-rural-communities-need-support-to-decrease-health-disparities-and-improve-access-to-care