New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021

Evidence shows that those living in rural communities experience consistently worse health outcomes than their urban and suburban counterparts. One proven strategy to address this disparity is to increase the physician supply in rural areas through graduate medical education (GME) training. However, rural hospitals have faced challenges developing training programs in these underserved areas, largely due to inadequate federal funding for rural GME. The Consolidated Appropriations Act of 2021 (CAA) contains multiple provisions that seek to address disparities in Medicare funding for rural GME, including funding for an increase in rural GME positions or slots (Section 126), expansion of rural training opportunities (Section 127), and relief for hospitals that have very low resident payments and/or caps (Section 131). In this Invited Commentary, the authors describe historical factors that have impeded the growth of training programs in rural areas, summarize the implications of each CAA provision for rural GME, and provide guidance for institutions seeking to avail themselves of the opportunities presented by the CAA. These policy changes create new opportunities for rural hospitals and partnering urban medical centers to bolster rural GME training, and consequently the physician workforce in underserved communities.

Automated summary

Evidence shows that rural residents have consistently worse health outcomes compared to urban and suburban residents. Increasing the physician supply in rural areas through graduate medical education (GME) training is a proven strategy to address this disparity. However, inadequate federal funding for rural GME has hindered the development of training programs in rural hospitals. The Consolidated Appropriations Act of 2021 aims to address the disparities in Medicare funding for rural GME by providing funding for an increase in rural GME positions, expansion of rural training opportunities, and relief for hospitals with low resident payments and/or caps. These policy changes present new opportunities for rural hospitals and partnering urban medical centers to strengthen rural GME training and improve the physician workforce in underserved communities.