Pennsylvania’s rural hospitals are dealing with a shortage of physicians and mental health providers that has become dire, leaving patients in rural communities with dwindling options for care.

That was the message members of the Center for Rural Pennsylvania heard on Thursday during a hearing with hospital and health care center executives, and public health experts.

The center, a bicameral, bipartisan legislative agency, heard from hospital and health center executives, as well as public health experts about the challenges facing rural health care providers at a public hearing in Bradford.

Dr. Jill Owens, president of Upper Allegheny Health System,  put it bluntly: “Rural hospitals are in crisis,” she told the panel.

Owens said that difficulty attracting and retaining health care providers, low Medicaid and Medicare reimbursement and other challenges have led to care deserts and declining health outcomes for rural Pennsylvanians. And without action to reform the struggling health care system and more funding and resources for local providers, the situation is unlikely to improve any time soon.

Attracting Providers

Jeannine McMillan, executive director of the Center for Population Health, a nonprofit focused on population and public health initiatives in rural Cambria and Somerset counties, said that both counties suffer from a lack of primary care physicians and mental health providers.

“Extreme challenges, including lack of adequate public transportation, availability of broadband, food deserts and difficulty recruiting clinicians are magnified in rural communities,” McMillan said.

While her organization has been fortunate to receive funding from philanthropic groups, McMillan said that “significant investments are needed” to improve health outcomes in rural communities.

A study conducted by the Hospital and Healthsystem Association of Pennsylvania (HAP) found that rural hospitals have struggled to fill 39% of vacant registered nurse positions. By comparison, HAP found the average vacancy rates for direct care RNs to be more than 30% statewide.

Kate Slatt, vice president of Innovative Payment and Care Delivery for the Hospital and Healthsystem Association of Pennsylvania, said that HAP supports efforts to strengthen the education and training pipeline for those pursuing health care careers and the creation of an office within Democratic Gov. Josh Shapiro’s administration to focus on “health care workforce innovation and reform,” it does not support legislative attempts to limit the staff-to-patient ratios at Pennsylvania hospitals.

In late June, the House passed HB 106, also known as the “Patient Safety Act.” The bill, co-sponsored by state Reps. Thomas Mehaffie, R-Dauphin, and Kathleen Tomlinson, R-Bucks, would outline the number of patients per-nurse required in different hospital settings.

Supporters of the legislation, including nurses who weathered unmanageable caseloads during the COVID-19 pandemic and the unions representing them, said the legislation protects patients and improves health care outcomes.

In July, the bill was referred to the Senate Health and Human Services Committee.

Maternal Health Deserts

Public health officials also warned lawmakers at the hearing about an “alarming” trend in rural health — a lack of labor and delivery services.

From January 2010 to April 2022, 30 Pennsylvania hospitals closed their doors. Many others were forced to cut specific services — such as OB/GYN — in order to remain financially viable, according to HAP.

Similarly, of Pennsylvania’s 42 rural hospitals, 60% do not have labor and delivery services,  an analysis from the Center for Healthcare Quality and Payment Reform found.

“Many pregnant persons in rural areas need to drive almost 40 minutes to reach a hospital that can assist them during birth, which exceeds the recommended 30-minute travel time once a person begins labor,” Lisa Davis, director of the Pennsylvania Office of Rural Health and Outreach explained. “These challenges also contribute to increases in births outside of hospitals versus in hospitals without OB units and in preterm birth, all of which carry greater risks for both mothers and newborns.”

A 2022 report from the March of Dimes found that six of Pennsylvania’s 67 counties — Cameron, Forest, Greene, Juniata, Sullivan, and Wyoming counties —  classified as “maternal health deserts” because they lacked hospitals providing obstetric care and birth centers, and had no OB/GYN or certified nurse midwives.

State Sen. Judy Schwank, D-Berks, said she was “very concerned” about the impact maternal health care deserts in rural Pennsylvania could have on the commonwealth’s maternal mortality rate.

“There are hospitals in the state that close maternity care that send persons in labor to another facility by either lifeflight helicopter or ambulance during the times when they can go but those are really expensive, or they may end up just having to deliver in the emergency department if they can’t travel,” Davis explained. “So this is something I think we really need to focus on.”

Davis offered that alternative services, such as birthing centers, may be an effective option for rural communities across the commonwealth.