Rural Pa. Faces a Widening Health Services Gap. State Officials Think Loan Forgiveness Could Help

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BELLEFONTE — Health care professionals in rural Pennsylvania would be eligible for student debt relief under a bipartisan proposal aimed at addressing workforce gaps in remote communities.

Physicians, nurses and midwives working full time at a rural hospital, health clinic or birth center would qualify for the Rural Health Care Grant Program introduced by state Rep. Kathy Rapp (R., Warren).

In late June, Rapp called the program a “win-win” for rural health facilities and practitioners looking to pay off their loans — which can total hundreds of thousands of dollars — after the state House Health Committee unanimously sent the proposal to the full chamber for a vote.

“Ultimately, the real winners will be our rural communities, which will hopefully have fully staffed teams ready to care for residents,” Rapp said at the time.

The idea for the loan forgiveness program came from discussions with state policymakers and health officials, Rapp told Spotlight PA. Supporters say it will boost recruitment efforts for rural facilities. Advocates hope practitioners ultimately decide to stay in these communities long-term.

Rural hospitals have average vacancy rates of 26% for registered nurses and 28% for nursing support staff, according to a survey by the Hospital and Healthsystem Association of Pennsylvania. In 2023, the statewide vacancy rates for those positions were 14% and 19%, respectively.

Rapp hopes a state House vote on the legislation takes place this fall.

Keeping workers has always been a key issue for rural health, Lisa Davis, director of the Pennsylvania Office of Rural Health, told Spotlight PA. But in recent years, policymakers have started to pay attention to staff shortages and closures of specialty units, she added. She noted the recent shuttering of the maternity unit in Penn Highlands Elk.

Health care providers say increased operating costs have exacerbated their financial struggles, especially in rural areas where residents are typically older and more reliant on Medicare and Medicaid. Government-funded insurance programs tend to reimburse health care facilities for services at a lower rate than private insurance.

These challenges have resulted in service cuts, consolidations and closures, making it hard to access care in these communities.

“When rural facilities cannot attract or retain health care professionals, they can’t keep their doors open, and patients have to travel increasing distances to get basic preventative or emergency care. That’s bad for outcomes, and it’s bad for this commonwealth,” state Rep. Dan Frankel (D., Allegheny), who heads the Health Committee, said after advancing Rapp’s bill. “The foundation of our health care system is its workers, so that’s where any effort to support rural health institutions must begin.”

Hospital administrators and other health officials favor loan repayment programs as a recruitment tool. The state currently offers relief through the Primary Care Loan Repayment Program , which is open to physicians, dentists, psychologists and other practitioners.

The targeted pool of eligible employees — physicians, nurses or midwives, and nurse-midwives — under the state House proposal reflects where stakeholders thought the program would “do the most good and where we saw the most need,” Rapp said.

Davis, who also sits on the Pennsylvania Rural Health Association Board of Directors, told Spotlight PA this proposed program is the first to focus on both rural and areas with limited medical services. However, she hopes policymakers clarify the language to say whether an eligible facility needs to be in a medically underserved area, a rural county or both

To qualify for debt relief under the state House bill, an employee must work full time at a participating facility and stay for at least three years. Eligible workers include those at birth clinics, rural health clinics, hospitals and federally qualified health centers, which offer primary care regardless of someone’s ability to pay.

The state Department of Health would administer the program and prioritize dollars for facilities not associated with a health system.

An agency spokesperson declined to comment on the proposed legislation but told Spotlight PA in an email that the department supports the bill’s intent to recruit and retain practitioners in rural counties and places with gaps in care.

Under the bill, an entity that applies for funds could receive no more than $250,000 a year for its employees.

Rapp's bill doesn’t put a dollar amount on how much relief would be available. It instead directs lawmakers to determine that amount after the bill's passage.

Loan repayment programs often succeed at recruiting and retaining workers, according to Nicole Stallings, president and CEO of the Hospital and Healthsystem Association of Pennsylvania.

She added that debt relief also benefits communities, noting that a business is more likely to operate in an area where employees have access to care. Plus, loan repayment frees up a recipient’s budget, which makes it easier for them to take big life steps like buying a home and starting a family, Davis said.

Economic development opportunities are sought after as Pennsylvania’s rural populations shrink .

Most health care workers who participate in loan repayment efforts with a rural focus come from these communities. Usually, they stay in the area after their contractual period ends, Stallings and Davis said.

That was the case for Kim Amsley-Camp, a certified nurse-midwife, who moved from northern Virginia to her hometown in rural Franklin County nearly two decades ago as part of a federal loan repayment program .

Initially attracted to the program because of a $50,000 loan repayment benefit, Amsley-Camp always planned to relocate to an urban environment. However, she felt her work made more of a difference in a rural area.

“These are my people. This is my community,” Amsley-Camp told Spotlight PA. “This is the practice where I was born, in the hospital where I was born.”

She currently works at Keystone Health, a federally funded facility. Amsley-Camp said her work is rewarding, despite challenges that come with living in a rural community.

“Rural America is a good place, but we’ve got to sell it,” she said.

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