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Emily M Hawes, Mark Holmes, Erin P Fraher, Alyssa Zamierowski, Judith Pauwels, Louis A Sanner, Jacob Rains, Cristen P Page


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.


Hawes EM, Holmes M, Fraher EP, Zamierowski A, Pauwels J, Sanner LA, Rains J, Page CP. New Opportunities for Expanding Rural Graduate Medical Education to Improve Rural Health Outcomes: Implications of the Consolidated Appropriations Act of 2021. Acad Med. 2022 Sep 1;97(9):1259-1263. doi: 10.1097/ACM.0000000000004797. Epub 2022 Jun 8. PMID: 35767355.

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